TY 2023 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) Dr Stephen Goldberg...................................................................... Trustee/Physician	40.00 .................	X		394,850	34,338
(2) Dr Jennifer Lucas...................................................................... Trustee/Medical Staff President	40.00 .................	X		478,605	27,189
(3) Dr Richard McKenzie...................................................................... Trustee/Physician	40.00 .................	X		325,369	29,203
(4) Dr Patrick Fitzpatrick...................................................................... Treas.(end 12/23);Trustee/Physician	40.00 .................	X	X	1,072,541	44,697
(5) Robert Nutter...................................................................... President & CEO	40.00 .................	X	X	887,247	42,436
(6) Audrey Goudie...................................................................... Trustee	1.00 .................	X		0	0
(7) Susan Ide...................................................................... Trustee (start 8/24)	1.00 .................	X		0	0
(8) Richard Jesseman...................................................................... Trustee	1.00 .................	X		0	0
(9) Elizabeth Kunz...................................................................... Trustee (end 12/23)	1.00 .................	X		0	0
(10) Robert MacLeod...................................................................... Trustee	1.00 .................	X		0	0
(11) Laurie Morgan...................................................................... Trustee/LRH Auxiliary Representative	1.00 .................	X		0	0
(12) Stephen Noyes...................................................................... Trustee	1.00 .................	X		0	0
(13) Charyl Reardon...................................................................... Trustee	1.00 .................	X		0	0
(14) Paul Smith...................................................................... Trustee	1.00 .................	X		0	0
(15) Jeff Woodward...................................................................... Chair	1.00 .................	X		0	0
(16) Fred Chisolm...................................................................... Trustee/Treasurer (start 12/23)	1.00 .................	X	X	0	0
(17) Ashley Garrison...................................................................... Secretary/Vice Chair (start 12/23)	1.00 .................	X	X	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Stenson Tamaddon LLC One North Central Avenue 1030 Phoenix,AZ85004	Tax services	935,549
C3 Revenue Cycle Solutions LLC 4011 West Vasconia Street Tampa,FL33629	Billing bervices	741,776
BE Smith Services LLC 8801 Renner Avenue Lenexa,KS66219	Contract labor	729,707
General Linen Services LLC 75 Centre Road Somersworth,NH03878	Cleaning services	578,618
Timberwolf Logging LLC PO Box 455 Littleton,NH03561	Logging services	272,224
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 14

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2023

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2022. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2023

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3 % support tests—2022. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2023

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2023

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2023

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization Littleton Hospital Association

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization Littleton Hospital Association		Employer identification number 02-0222152

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization Littleton Hospital Association			Employer identification number 02-0222152
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

right arrow

Complete if the organization is described below. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ right arrow

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... right arrow

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2022

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check right arrow

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check right arrow

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2022

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

16,100

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

16,100

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	The Hospital maintains memberships with health industry groups and collaborative networks, including the American Hospital Association ("AHA"). A portion of the dues remitted to the AHA may be made available for the AHA to use towards lobbying expenditures on behalf of causes of interest to its members and their programs and missions. During the period covered by this Form 990, the Hospital paid AHA total membership dues and fees of $64,376. The Hospital is unable to determine an exact amount of the dues paid during this period that may have been used by the AHA on lobbying purposes, though the Hospital estimates that 25%, or approximately $16,100, of the total dues paid to the AHA may have been available for such uses. Therefore, the Hospital has disclosed the $16,100 estimated figure on this Schedule C, Part II-B, Line 1f.

Return Reference

Explanation

Part II-B, Line 1:

The Hospital maintains memberships with health industry groups and collaborative networks, including the American Hospital Association ("AHA"). A portion of the dues remitted to the AHA may be made available for the AHA to use towards lobbying expenditures on behalf of causes of interest to its members and their programs and missions. During the period covered by this Form 990, the Hospital paid AHA total membership dues and fees of $64,376. The Hospital is unable to determine an exact amount of the dues paid during this period that may have been used by the AHA on lobbying purposes, though the Hospital estimates that 25%, or approximately $16,100, of the total dues paid to the AHA may have been available for such uses. Therefore, the Hospital has disclosed the $16,100 estimated figure on this Schedule C, Part II-B, Line 1f.

Schedule C (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow

Attach to Form 990.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after July 25, 2006, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow

Number of states where property subject to conservation easement is located right arrow

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2022

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	2,624,405	2,386,830	2,757,824	2,432,225	2,374,660
b	Contributions ...	44,966		116,439	29,896	1,058
c	Net investment earnings, gains, and losses	-119,893	277,727	-487,433	403,922	129,189
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	473,817	40,152		108,219	72,682
f	Administrative expenses ....
g	End of year balance ......	2,075,661	2,624,405	2,386,830	2,757,824	2,432,225

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment right arrow

0 %

Permanent endowment right arrow

100.000 %

Term endowment right arrow

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	1,981,468		1,981,468
b	Buildings ....	50,037,778	33,176,542	16,861,236
c	Leasehold improvements	1,355,697	555,833	799,864
d	Equipment ....	60,590,959	48,476,200	12,114,759
e	Other .....	688,970		688,970
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				32,446,297

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)Other receivables				1,041,658
(2)Employee benefit plan assets				5,572,876
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,614,534

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Estimated third-party payor settlements	5,457,621
Operating lease liabilities	2,832,390
Fair value of interest rate swap	495,257
Malpractice liabilities	2,041,658
Discount stock option plan	4,559,155
Deferred executive comp	1,013,721



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	16,399,802
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2022

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	117,322,047
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	5,972,898
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d	19,286
e	Add lines 2a through 2d .....................			2e	5,992,184
3	Subtract line 2e from line 1..................			3	111,329,863
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	84,088
b	Other (Describe in Part XIII.) ...........	4b	5,442,103
c	Add lines 4a and 4b....................			4c	5,526,191
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	116,856,054

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	125,393,300
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ...........	2d	19,286
e	Add lines 2a through 2d....................			2e	19,286
3	Subtract line 2e from line 1...................			3	125,374,014
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	84,088
b	Other (Describe in Part XIII.) ...........	4b	5,300,868
c	Add lines 4a and 4b.....................			4c	5,384,956
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	130,758,970

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4:	The Hospital maintains a perpetually restricted endowment fund, intended to provide support for current and future operations of the Hospital. Specifically, the endowment funds are restricted to be used in furtherance of health care services and related activities. The endowment fund is composed of permanently restricted capital, though accumulated earnings may be expended for the provision of care services.
Part X, Line 2:	The Hospital is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. Management evaluated the Hospital's tax position and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying financial statements with the exception of the Employee Retention Credit ("ERC") reserve discussed below: The Employee Retention Credit (ERC) was established by the Coronavirus Aid, Relief and Economic Security Act (CARES Act) and was intended to help organizations retain their workforce during the pandemic. ERC provides a per employee credit to eligible businesses based on a percentage of qualified wages and health insurance benefits paid to employees. ERC is a refundable tax credit claimed quarterly as either a reduction in payroll taxes or cash refunds. While management believes the Hospital met the requirements of the ERC program, a reserve has been established totaling approximately $2,700,000 as of September 30, 2024, should the Internal Revenue Service determine the Hospital is not eligible to receive the credits and seeks reimbursement. This reserve is included in accounts payable, accrued expenses and other current liabilities in accompanying balance sheet.
Part XI, Line 2d - Other Adjustments:	Fundraising event expenses 19,286.
Part XI, Line 4b - Other Adjustments:	Provision for bad debts 5,165,782. Contribution expense 135,086. Change in value of interest rate swap 141,235.
Part XII, Line 2d - Other Adjustments:	Fundraising event expenses 19,286.
Part XII, Line 4b - Other Adjustments:	Provision for bad debts 5,165,782. Contribution expense 135,086.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right arrow

Attach to Form 990. Right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization
Littleton Hospital Association

Employer identification number

02-0222152

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	0	0	Investments	4,911,000
















3a	Sub-total ....	0	0		4,911,000
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	0	0		4,911,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2023

Schedule F (Form 990) 2023

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2023

Schedule F (Form 990) 2023Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2023

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2023

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
Form 990, Schedule F, Part IV:	The Organization holds an interest in Drake Capital Offshore Partners, L.P ("Drake"), a Cayman Island-based exempted partnership. For U.S. tax purposes, the Partnership has filed an election to be treated as a corporation. The Organization's interest in Drake is under the ownership thresholds requiring filing of the Form 5471. Accordingly, the Organization is not required to prepare or submit to the IRS a Form 5471 regarding this investment with this tax return. Additionally, the Organization did not make any transfers to Drake during the period covered by this Form 990. Accordingly, the Organization is not required to prepare or submit to the IRS any Forms 926 regarding this investment with this tax return.

Schedule F (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization
Littleton Hospital Association

Employer identification number

02-0222152

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990) 2023

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Golf Tournament (event type)	(b) Event #2 (event type)	(c) Other events (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	62,775			62,775
2	Less: Contributions . . . .	10,775			10,775
3	Gross income (line 1 minus line 2) . . . . . .	52,000			52,000

4	Cash prizes . . . . .	0
5	Noncash prizes . . . .	10,775	10,775
6	Rent/facility costs . . . .	7,957	7,957
7	Food and beverages . . .	9,325	9,325
8	Entertainment . . . .	778	778
9	Other direct expenses . . .	1,227	1,227
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		30,062
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		21,938

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990) 2023

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	468,785		468,785	0.370 %
b	Medicaid (from Worksheet 3, column a) . . . . .	4,869,353	1,787,180	3,082,173	2.450 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	5,338,138	1,787,180	3,550,958	2.820 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	13,995		13,995	0.010 %
f	Health professions education (from Worksheet 5) . . .	344,647		344,647	0.270 %
g	Subsidized health services (from Worksheet 6) . . . .	38,905,572	18,648,322	20,257,250	16.130 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	8,825		8,825	0.010 %
j	Total. Other Benefits . .	39,273,039	18,648,322	20,624,717	16.420 %
k	Total. Add lines 7d and 7j .	44,611,177	20,435,502	24,175,675	19.240 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development			680		680	0 %
3	Community support			135,086		135,086	0.110 %
4	Environmental improvements			41,136		41,136	0.030 %
5	Leadership development and training for community members			780		780	0 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total			177,682		177,682	0.140 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,419,664

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

16,960,820

Enter Medicare allowable costs of care relating to payments on line 5.....

17,223,829

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-263,009

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2023

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Littleton Regional Hospital 600 St Johnsbury Road Littleton,NH02790 www.littletonhealthcare.org	X	X	X	X

Schedule H (Form 990) 2023

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Littleton Regional Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 22

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Section C

Other website (list url): See Part V, Section C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Littleton Regional Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Section C

The FAP application form was widely available on a website (list url):

See Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

	Littleton Regional Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Littleton Regional Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2023

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Littleton Regional Hospital	Part V, Section B, Line 5: In 2022, the Northern New Hampshire Region (composed of 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. Through the assessment process, a survey was issued to a select group of local experts to review the most recent prior CHNA, to provide feedback on those past assessments, and to ascertain whether the previously identified needs remained a priority. Additionally, the group of hospitals and care facilities reviewed the data gathered from the secondary sources to determine the overall significant health needs for the community.For complete details of how the NNHR CHNA gathered community input in determining the significant health needs of the region, please see the full assessment and reports, available online at:https://littletonhealthcare.org/about-lrh/
Littleton Regional Hospital	Part V, Section B, Line 6a: Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR, or, the "Facilities") Community Health Needs Assessment ("CHNA"). NNHR conducted this CHNA in partnership with QHR Health ("QHR") to determine the health needs of the applicable regional and local communities. NNHR and QHR also developed an accompanying implementation plan to address the health needs identified through the CHNA process. The Northern New Hampshire Region Facilities included the following hospital facilities: - 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: Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR, or, the "Facilities") Community Health Needs Assessment ("CHNA"). The 2022 NNHR CHNA also involved many different organizations other than hospital facilities, including the following:- QHR Health- Stratasan- Bureau of Labor Statistics- NAMI- New Hampshire Fiscal Policy Institute- CDC- Cetners for Medicare and Madicaid Services- National Cancer Institute- Vermont Department of Health- Mental Health America- Vermont Housing Finance Agency- Vermont Legislative Joint Fiscal Office
Littleton Regional Hospital	Part V, Section B, Line 11: Littleton Regional Hospital ("LRH") participated in and contributed to the shared 2022 Northern New Hampshire Region Community Health Needs Assessment for its most recent CHNA. This assessment identified ten primary, significant health needs impacting the region served by the Hospital. An implantation plan framework, which organized these needs by key groups, was developed. The framework has allowed LRH to prioritize and address the identified needs as efficiently and effectively as possible.The ten identified health needs, and a summary of how those needs fit within the Hospital's overall implementation plan, are as follows: 1. Mental Health: LRH's emergency department acts as a regional intake center for all patients with emergent behavioral health needs. LRH also contracts with Dartmouth Health's Connect Care to provide telepsychiatry in its emergency department. LRH is continuously enhancing its inpatient units to better accommodate the behavioral health needs of patients whose primary diagnosis is not itself behavioral, but who are nonetheless 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 public on an ongoing basis. 2. Affordability of Healthcare Services: LRH's onsite 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, providing over a million dollars each year in Charity Care to those unable to pay for services. LRH's established endowment funds also 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 substance use disorder ("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 in the community. The group is actively engaged with AHEAD (Affordable Housing Education and Development) to determine the feasibility 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 also owns a multi-unit property in Littleton which provides on-call housing and longer-term stays options for those providing care services within the community. 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 provides 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 also helps coordinate emergent treatment for substance use disorders for The Doorway. 7. Access to Senior Services: Senior health services was ranked as one of the top health needs in the most recent CHNA, in part due to mobility and accessibility concerns. In response to this identified need, LRH maintains a Mobile Integrated Health Program, which works closely with local EMS providers throughout the region, as well as a mobile health clinic, to address healthcare access issues throughout Grafton and Coos Counties. LRH also collaborates clinically with a regional FQHC to bring specialty care closer to home for residents of Central New Hampshire through a visiting specialist program. These mobile health services help bring care to senior citizens who cannot otherwise travel to health facilities. 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 onsite 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 nonpatients 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, and contracts with Dartmouth Health for supplemental tele-neurology support.The complete Implementation Plan can be found within the shared 2022 CHNA, which is available online at:https://littletonhealthcare.org/about-lrh/
Schedule H, Section B, Lines 7 and 10:	Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR or the "Facilities") Community Health Needs Assessment (CHNA).The NNHR CHNA and its associated CHNA Implementation Strategy is available online on the Hospital's website at:https://littletonhealthcare.org/about-lrh/A direct link to the 2022 CHNA and its Implementation Strategy is available at:https://littletonhealthcare.org/wp-content/uploads/2023/01/NNHR-2022-CHNA_Littleton.pdfAs a shared, regional CHNA, the 2022 NNHR CHNA can also be found on multiple other organizations' websites, including the following:https://www.cottagehospital.org/uploads/files/NNHR%202022%20CHNA_Cottage.pdfhttps://www.midstatehealth.org/wp-content/uploads/2023/02/NNHR-2022-CHNA_Mid-State.pdf
Schedule H, Part V, Section B, Line 16a & 16b:	Information regarding the Hospital's billing and financial assistance policies can be found online at:https://littletonhealthcare.org/patients-and-visitors/my-bill/The Hospital's Financial Assistance Policy is available on the Hospital's website at:https://littletonhealthcare.org/wp-content/uploads/2024/02/Financial-Assistance-Program-Policy-2.20.2024.pdfThe Hospital's Financial Assistance Application is available on the Hospital's website at:https://littletonhealthcare.org/wp-content/uploads/2025/02/FAP-APPLICATION.pdfThe Hospital's Financial Assistance Plain Language and Eligibility Summary is available online at:https://littletonhealthcare.org/wp-content/uploads/2025/02/FAP-PLAIN-LANGUAGE-SUMMARY-2025.pdf

Schedule H (Form 990) 2023

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2023

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 7:	Littleton Hospital has several hospital clinical services and hospital-owned physician practices. Per the Instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completion of Schedule H and its costing method calculations. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices: a. Rural Health Clinic b. LRH Franconia Ortho c. LRH Urology Associates d. LRH Littleton Orthopaedics e. LRH Lincoln Urgent Care f. LRH General Surgery g. LRH NC Otolaryngology h. LRH Neurology i. LRH Urgent Care j. LRH NC Women's Health k. LRH NC Orthopedics l. LRH NC Sleep m. LRH Gastroenterology n. NC Spine Center o. Emergency p. Alpine Plymouth q. LRH Alpine PhysiciansThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $20.26 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $20.26 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions and guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H to convert charges to cost figures. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part 1, Line 7, were the following: a. Schedule H, Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g): The Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit or loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in Line 1c, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost-to-charge percentage. b. Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c); and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, as listed in line 1c above (which is part of the line 7g costs): The Hospital did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the Medicaid worksheets on the filed cost report for these allowable costs. c. Schedule H, Worksheet 4, Community Health Improvement Services and Community Benefit Operations: The hospital provided the following community health improvement services. i. Seasonal Flu Vaccine Clinic ii. UpToDate Wellness Clinic iii. Littleton Wellness FairBecause Worksheet 4 was used for these services' community benefits, Worksheet 2 was not utilized.d. Schedule H, Worksheet 5, Health Professions Education: The hospital provides nursing and life support saving education to local high school students. Because Worksheet 5 was used for these services' community benefits, Worksheet 2 was not utilized. e. Schedule H, Worksheet 8, Cash and In-Kind Donations to Community Groups: The hospital donates to support the following community groups. i. Boys & Girls Club - North Country - ii. Coos County Family Health iii. Linwood Ambulance iv. Lin-Wood Booster Athletic Program Sponsor v. Littleton Lions Club vi. Littleton Youth Soccer vii. LWCCCC - T-Shirt Sponsor viii. North Country Public Safety Foundation ix. Adaptive Sports Partners of the North Country x. Town of Lincoln - National Night Out xi. Town of Littleton Because Worksheet 8 was used for these services' community benefits, Worksheet 2 was not utilized. e. Community Building Activities: The Hospital provides community building activities by supporting the following activities within the below-listed entities.- Economic Development: i. Franconia Notch Chamber of Commerce ii. Northeast Kingdom Chamber of Commerce iii. Littleton Area Chamber of Commerce iv. Western White Mountain Chamber of Commerce- Community Support: i. Alcohol and Drug Prevention Treatment Fund - Environmental Improvements: i. Bio-Chemical Waste Management- Leadership development and training for community members: i. Community Advisory Board Participation (LHS Gallen/Career Center)
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5,165,782.
Part II, Community Building Activities:	Littleton Regional Healthcare participates in several community building activities that promote the health and wellbeing of the communities it serves. For example, LRH collaborates with a number of local agencies including the North Country Health Consortium, Littleton Area Senior Center, Ammonoosuc Community Health Services, to name just a few. These agencies share common goals that address access to healthcare, health improvement, health education, and affordable healthcare services.Additionally, LRH encourages senior management and mid-level management to be actively involved in the communities served by the Hospital. For example, LRH works with area schools to address the health of our young students, and also collaborates with local safety providers to promote safety and help prevent injury. As a community asset and center, LRH hosts multiple public engagement and volunteer opportunities. The Hospital's active volunteers provide a sense of communal enterprise, advancing high-quality, compassionate service to the Hospital's visitors, patients, and other community members.The Hospital also promotes public education and personal wellness through its publications of magazines and online blogs. These resources improve the general community's and region's access to resources and overall health literacy.Through these programs and the Hospital's collaboration with these agencies, LRH continues to bolster the strength and health of its community beyond just the services offered through its care facilities.
Part III, Line 2:	The Hospital utilized Worksheet 2 from the IRS Schedule H instructions/guidance to determine the ratio of patient care cost to charge (47.06% for fiscal year 2024) and multiplied this ratio by the Hospital's total bad debt expense of $5,165,782 to determine the Part II, Line 2 bad debt expense of $2,419,664.
Part III, Line 4:	See Footnote 2 on page 10 of the attached audited financial statements.
Part III, Line 8:	Form 990, Schedule H instructions and guidance contains a template (Worksheet 2) that may be used to determine the overall cost-to-charge ratio that could be applied throughout Schedule H in order to convert charges to cost figures. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report estimated cost and payment for these services.The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and rural health center, as detailed in these Schedules supplemental narratives, should be considered a community benefit, as community members benefit by having easy access to these services, facilities, and programs which are both offered and subsidized. These facilities and programs are offered and thus subsidized through the Hospital.
Part VI, Line 2:	Littleton Regional Hospital ("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. The Hospital also provides its financial assistance policies, applications, descriptions of coverage, and billing and financial literacy tools online, through the Hospital's website.
Part VI, Line 4:	The Hospital defines its primary service area as Grafton County. Grafton County, New Hampshire is the 5th largest county in New Hampshire, with an estimated population of 91,118, and a growth rate of 0.03%, according to the most recent United States census data. Of this population, people under five years of age make up 3.9% of the population, and people under 18 years of age make up 20.4% of the population. This contrasts with persons 65 years of age and over, who make up 21.9% of the population. All females account for 50.2% of the overall population in the County. The most recent census data found median household income to be $82,045, with per capita income through 2018-2022 of $37,847 (adjusted for inflation for 2022 dollars). The income data also found that 11% of the County's population to be considered at poverty level. Individuals with a disability account for 15.5% of the population, and people without health insurance represent 5.3% of the population.
Part VI, Line 5:	Littleton Regional Hospital's ("LRH") care services and hospital facilities significantly contribute to the health of its community. The list below covers just a few ways that the Hospital engages with its community to promote its overall health and wellbeing:Education: LRH maintains an internal Department of Education, which seeks to provide evidence-based educational opportunities, through the use of simulated learning experiences, that supports clinical staff in meeting the unique needs of a rural community.The Alpine Clinic: the largest orthopaedic practice in Northern New Hampshire with offices in four convenient locations. Our highly skilled orthopaedic surgeons have been providing care to the communities it serves for more than 20 years. With more than 90 years of combined orthopaedic experience, you can be confident that our surgeons provide the best possible care.The Doorway Program: For many people, addiction is a daily reality. The Doorway is here to help - whether it helps you or a loved one - we can connect you to support, services, and care that is right for you. The Doorway at LRH is part of a statewide initiative to address the growing opioid crisis. Littleton Regional Healthcare (LRH) serves as a hub for Northern New Hampshire.Sauter Birthing Suite: Our mission is to provide a high-quality, positive birth experience not only for our mothers but also for the entire family. Our goal is to make families feel welcome while giving the very best medical care in a comfortable, home-like environment.In addition to these specific clinics, LRH provides medical and specialty care across a wide array of practice areas, including: allergy; anesthesiology; behavioral health; cardiopulmonary; cardiology; dermatology; diagnostic imaging; emergency and urgent care; plastics; gastroenterology; general surgery; gynecology/obstetrics; hospice care; infection control; intensive care; laboratory work; maternity care; neurology and neuro surgery; occupational health; oncology; ophthalmology; orthopedics; otolaryngology; pain management; pharmacy access; primary care and family medicine; pulmonology; radiology; sleep medicine; addiction and substance abuse treatment; perioperative; and urology.
Part VI, Line 6:	Littleton Regional Hospital is not itself part of a formal, affiliated health care system. However, the Hospital does coordinate with many community partners and other hospital entities to collaborate on health assessments and responses, with the purpose of improving the overall wellbeing of the community which the Hospital serves. Additional details regarding these collaborative efforts can be found in the Hospital's shared Northern New Hampshire Region's 2022 Community Health Needs Assessment.
Part VI, Line 7, Reports Filed With States	NH

Schedule H (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
Littleton Hospital Association

Employer identification number
02-0222152

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Foundation for Healthy Communities 125 Airport Road Concord,NH03301	02-0275078	501(c)(3)	135,086	0			Substance abuse prevention, treatment and recovery efforts.

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2023

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Part I, Line 2:

From time to time the Hospital may award grants to other charitable organizations whose mission and operations align with the goals and exempt purpose of the Hospital. During the period covered by this Form 990, the Hospital only paid grants that supported the State of New Hampshire's substance abuse prevention, treatment, and recovery efforts, as part of the New Hampshire Hospital Association's commitment to the New Hampshire Governor's Commission of Alcohol and Other Drugs. These grants were reviewed and approved by the Hospital in conjunction with the New Hampshire Hospital Association's Executive Committee and Board of Trustees. Accordingly, these grant payments directly advanced the Hospital's own charitable purpose, and led to the provision of care and resources within the community served by the Hospital more generally.

Schedule I (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

Littleton Hospital Association

Employer identification number

02-0222152

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2023

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Dr Patrick Fitzpatrick Treas.(end 12/23);Trustee/Physician	(i) (ii)	528,346 ------------- 0	523,295 ------------- 0	20,900 ------------- 0	0 ------------- 0	44,697 ------------- 0	1,117,238 ------------- 0	0 ------------- 0
2Robert Nutter President & CEO	(i) (ii)	587,047 ------------- 0	270,095 ------------- 0	30,105 ------------- 0	0 ------------- 0	42,436 ------------- 0	929,683 ------------- 0	0 ------------- 0
3Dr Eric Emig Physician	(i) (ii)	616,058 ------------- 0	206,112 ------------- 0	1,548 ------------- 0	0 ------------- 0	27,623 ------------- 0	851,341 ------------- 0	0 ------------- 0
4Dr Jeffrey Kauffman Physician	(i) (ii)	665,562 ------------- 0	0 ------------- 0	1,548 ------------- 0	0 ------------- 0	34,041 ------------- 0	701,151 ------------- 0	0 ------------- 0
5Dr Edward Duffy CMO	(i) (ii)	473,702 ------------- 0	99,880 ------------- 0	39,459 ------------- 0	20,808 ------------- 0	36,315 ------------- 0	670,164 ------------- 0	0 ------------- 0
6Dr Jean Langevin Physician	(i) (ii)	615,399 ------------- 0	0 ------------- 0	23,328 ------------- 0	0 ------------- 0	4,601 ------------- 0	643,328 ------------- 0	0 ------------- 0
7Dr Jonathan Lamphier Physician	(i) (ii)	545,061 ------------- 0	50,000 ------------- 0	4,572 ------------- 0	0 ------------- 0	40,059 ------------- 0	639,692 ------------- 0	0 ------------- 0
8Dr Anthony Salerni Physician	(i) (ii)	592,542 ------------- 0	0 ------------- 0	4,572 ------------- 0	0 ------------- 0	36,802 ------------- 0	633,916 ------------- 0	0 ------------- 0
9Dr Jennifer Lucas Trustee/Medical Staff President	(i) (ii)	455,277 ------------- 0	0 ------------- 0	23,328 ------------- 0	0 ------------- 0	27,189 ------------- 0	505,794 ------------- 0	0 ------------- 0
10Steven Shaffer CFO (end 5/24)	(i) (ii)	302,000 ------------- 0	72,900 ------------- 0	27,036 ------------- 0	13,500 ------------- 0	31,198 ------------- 0	446,634 ------------- 0	0 ------------- 0
11Dr Stephen Goldberg Trustee/Physician	(i) (ii)	355,822 ------------- 0	20,000 ------------- 0	19,028 ------------- 0	0 ------------- 0	34,338 ------------- 0	429,188 ------------- 0	0 ------------- 0
12Koren Superchi COO/CNO	(i) (ii)	278,331 ------------- 0	68,545 ------------- 0	24,221 ------------- 0	12,693 ------------- 0	3,522 ------------- 0	387,312 ------------- 0	0 ------------- 0
13Dr Richard McKenzie Trustee/Physician	(i) (ii)	320,797 ------------- 0	0 ------------- 0	4,572 ------------- 0	0 ------------- 0	29,203 ------------- 0	354,572 ------------- 0	0 ------------- 0
14Leslie Walker Former VP of Finance	(i) (ii)	103,683 ------------- 0	5,000 ------------- 0	464 ------------- 0	0 ------------- 0	27,260 ------------- 0	136,407 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Part I, Line 4b

Littleton Hospital Association maintains a 457(f) non-qualified deferred compensation plan. During the 2023 calendar year, certain directors, trustees, officers, key employees, and/or highest compensated employees received non-taxable employer-paid contributions into the plan. For these individuals, as these deferred compensation plan contributions were not deemed taxable, the payments have been included within the amounts reported on this Form 990, Schedule J, Part II, Column C. Such deferrals were as follows: - Steven Shaffer, $13,500. - Koren Superchi, $12,693. - Edward Duffy, $20,808. Additionally, Robert Nutter, the Organization's CEO, also participated in the Plan during this fiscal year. However, Mr. Nutter did not receive any contributions to his 457(f) plan, nor take any distributions out of his plan, during the 2023 calendar year. Accordingly, no amounts have been reported on this Schedule J, Part II, related to Mr. Nutter's involvement with this non-qualified deferred compensation plan.

Part I, Line 7

From time to time the Hospital may pay bonuses, incentive compensation, performance awards, or other non-fixed payments to selected employees or officers, based upon the accomplishment of defined goals and metrics. For example, certain bonuses are based on productivity measures using Medical Group Management Association's standards by relative value units ("RVUs"), and by each applicable individual's specialties as outlined in their respective contracts. Such performance measurement tools allow the Hospital to align alternative or non-fixed compensation with patient care outcomes and overall Hospital performance. Other bonuses are paid based on and subject to achieving organizational quality and financial metrics. The goals and measurements for these latter non-fixed payments and achievement awards were developed with input from the Board Executive Committee, and were approved by the Board of Directors.

Schedule J (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
Littleton Hospital Association

Employer identification number
02-0222152

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	New Hampshire Health and Education Facilities Authority	02-0279866		10-01-2015	5,331,100	Refunded series 2007 Bond		X		X		X
B	New Hampshire Health and Education Facilities Authority	02-0279866		10-01-2015	20,753,200	Refunded series 2007 Bond		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	1,736,092		6,003,483
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	5,331,100		20,753,200
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	41,800		162,500
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	5,289,300		20,590,700
12 Other unspent proceeds .............
13 Year of substantial completion .............	2015		2015
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2023

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X
b Exception to rebate? ........		X		X
c No rebate due? .........	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X

Schedule K (Form 990) 2023

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider ..........			Deutsche Bank AG
c Term of hedge .........			200000.0000000000 %
d Was the hedge superintegrated? ......				X
e Was the hedge terminated? ........				X
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

Schedule K, Part III, Line 2, Lease arrangements:

The Hospital holds lease arrangements which may result in private business use of the bond-financed property. This private business use would be due to agreements wherein the Hospital rents excess medical practice space to physician practices, including the following: Dartmouth Hitchcock's Cardiovascular Medicine satellite offices; Shippee Family Eye Care Littleton; Littleton Internal Medicine; and White Mountain Family Health. Accordingly, of the leased space offered by the Hospital, the majority is provided to other organizations directly tax exempt under Section 501(c)(3) or otherwise affiliated with charitable entities. Additionally, the private practices operate primarily for purposes related to or in direct furtherance of the Hospital's own activities and charitable purpose, including the provision of patient care and health services to the general region in which the Hospital operates. The Hospital actively monitors these lease arrangements to ensure that the tenants' activities conducted directly further the Hospital's mission to provide care to its patients. As a result, it is the Hospital's position that the presence of these practices on or near the Hospital's own campus enhances the Hospital's patients and community's access to care and health resources. Lastly, any space occupied by lease tenants working within or around the Hospital's campus constitutes only a nominal and immaterial footprint of the entire facility. Therefore, while these private practices may operate within or around bond-financed property, the Hospital does not believe that such activities would constitute an inappropriate private benefit or unauthorized use of the bond funds. The Hospital actively monitors any such entities leasing space in the bond-financed property to make sure their activities are substantially related to the Hospital's exempt purpose and would not constitute an unauthorized private benefit or unrelated business activity.

Schedule K (Form 990) 2023

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,297,380	1,429,132
9	Program service revenue (Part VIII, line 2g) .........	107,348,233	112,525,590
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,968,423	2,604,691
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	209,411	296,641
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	119,823,447	116,856,054
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	243,905	135,086
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	55,761,732	60,799,031
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	61,928,967	69,824,853
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	117,934,604	130,758,970
19	Revenue less expenses. Subtract line 18 from line 12.......	1,888,843	-13,902,916
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	123,327,936	102,964,897
21	Total liabilities (Part X, line 26).............	61,740,548	69,020,654
22	Net assets or fund balances. Subtract line 21 from line 20.....	61,587,388	33,944,243

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 87,991,233 including grants of $ 135,086 ) (Revenue $ 112,525,590 )
	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.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses87,991,233

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Thomas Tremblay........................................................................ Trustee/Secretary (start 12/23)	1.00 .......................	X	X			0	0	0
(19) Steven Shaffer........................................................................ CFO (end 5/24)	40.00 .......................		X			401,936	0	44,698
(20) Koren Superchi........................................................................ COO/CNO	40.00 .......................		X			371,097	0	16,215
(21) Dr Edward Duffy........................................................................ CMO	40.00 .......................		X			613,041	0	57,123
(22) Chris Frauenhofer........................................................................ Interim VP of Finance (start 5/24)	40.00 .......................		X			0	0	0
(23) Dr Eric Emig........................................................................ Physician	40.00 .......................			X		823,718	0	27,623
(24) Dr Jeffrey Kauffman........................................................................ Physician	40.00 .......................			X		667,110	0	34,041
(25) Dr Jean Langevin........................................................................ Physician	40.00 .......................			X		638,727	0	4,601
(26) Dr Jonathan Lamphier........................................................................ Physician	40.00 .......................			X		599,633	0	40,059
(27) Dr Anthony Salerni........................................................................ Physician	40.00 .......................			X		597,114	0	36,802
(28) Leslie Walker........................................................................ Former VP of Finance	0.00 .......................				X	109,147	0	27,260

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	7,980,135	0	466,285

1	Briefly describe the organization’s mission or most significant activities: To provide health care services in Northern New Hampshire.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	688
6	Total number of volunteers (estimate if necessary) .............	6	58
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	10,775
d	Related organizations		1d
e	Government grants (contributions)		1e	210,376

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,207,981

g	Noncash contributions included in lines 1a - 1f:$		1g	10,775

h Total. Add lines 1a-1f.......		1,429,132

		Business Code
2a	Patient services	621110	101,946,251	101,946,251
b	Disproportionate share revenue	621110	5,373,154	5,373,154
c	Pharmacies	456110	2,979,399	2,979,399
d	Auxiliary health services	621110	1,459,577	1,459,577
e	Cafeteria/dining services	722514	767,209	767,209
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		112,525,590

3 Investment income (including dividends, interest, and othersimilar amounts) ......			990,251			990,251
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	185,275
b	Less: rental expenses	6b	0
c	Rental income or (loss)	6c	185,275
d	Net rental income or (loss).......			185,275			185,275
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	21,468,838	72,885
b	Less: cost or other basis and sales expenses	7b	19,863,140	64,143
c	Gain or (loss)	7c	1,605,698	8,742
d	Net gain or (loss).........			1,614,440			1,614,440
8a	Gross income from fundraising events (not including $ 10,775of contributions reported on line 1c). See Part IV, line 18 ....
			8a	52,000
b	Less: direct expenses ...		8b	30,062
c	Net income or (loss) from fundraising events..			21,938			21,938
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	5,460
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			5,460			5,460
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a	Settlement proceeds		900099	178,968			178,968
b	Acquisition losses		900099	-95,000			-95,000
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			83,968
12	Total revenue. See instructions.....			116,856,054	112,525,590	0	2,901,332

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	135,086	135,086
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	4,840,587	3,348,336	1,492,251
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	45,572,289	31,523,313	14,048,976
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	812,261	561,858	250,403
9	Other employee benefits .......	6,512,404	4,504,767	2,007,637
10	Payroll taxes ...........	3,061,490	2,117,697	943,793
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	651,544		651,544
c	Accounting ...........	366,524		366,524
d	Lobbying ...........	16,094		16,094
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	84,088		84,088
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	19,577,156	10,494,317	9,082,839
12	Advertising and promotion ....	400,514	7,511	393,003
13	Office expenses .......	2,260,695	1,010,230	1,250,465
14	Information technology ......	2,874,622	380,906	2,493,716
15	Royalties ..
16	Occupancy ...........	4,977,425	1,920,371	3,057,054
17	Travel ............	263,105	193,484	69,621
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	249,747	191,894	57,853
20	Interest ...........	1,418,944	708,394	710,550
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,426,434	1,344,563	3,081,871
23	Insurance ...	1,785,181	123,612	1,661,569
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Pharmaceuticals	9,576,282	9,563,560	12,722
b	Medical/lab supplies	9,561,948	9,213,010	348,938
c	Provision for bad debts	5,165,782	5,165,782
d	NH Medicaid tax	4,753,634	4,753,634
e	All other expenses	1,415,134	728,908	686,226
25	Total functional expenses. Add lines 1 through 24e	130,758,970	87,991,233	42,767,737	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			168,744	1	246,342
2	Savings and temporary cash investments .........			3,027,732	2	917,107
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			30,833,742	4	16,193,141
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			2,110,578	8	2,301,887
9	Prepaid expenses and deferred charges ......			921,359	9	1,603,224
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	114,654,872
b	Less: accumulated depreciation	10b	82,208,575	33,226,072	10c	32,446,297
11	Investments—publicly traded securities .			42,639,799	11	34,409,829
12	Investments—other securities. See Part IV, line 11 .....				12	4,911,382
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			525,945	14	3,321,154
15	Other assets. See Part IV, line 11 ...........			9,873,965	15	6,614,534
16	Total assets. Add lines 1 through 15 (must equal line 33)...			123,327,936	16	102,964,897

17	Accounts payable and accrued expenses .....	19,525,864	17	32,192,442
18	Grants payable ...		18
19	Deferred revenue .........	8,561,937	19
20	Tax-exempt bond liabilities .........	19,115,537	20	18,344,725
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	6,110,915	23	2,083,685
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	8,426,295	25	16,399,802
26	Total liabilities. Add lines 17 through 25..	61,740,548	26	69,020,654

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	58,441,127	27	29,912,854
28	Net assets with donor restrictions ...........	3,146,261	28	4,031,389
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	61,587,388	32	33,944,243
33	Total liabilities and net assets/fund balances ........	123,327,936	33	102,964,897

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No

Return Reference	Explanation
Form 990, Part VI, Section B, line 11b	The Form 990 is prepared with the assistance of an independent CPA firm, who coordinates with the Organization's finance personnel and officers to ensure the tax return is complete and accurate prior to its finalization. A complete copy of the Form 990 is circulated among the entire Board prior to the tax return's filing with the IRS.
Form 990, Part VI, Section B, line 12c	The Hospital's Board of Trustees has adopted a policy for identifying conflicts of interest, in compliance with applicable law. Through this policy, the Board commits to conduct itself at all times in an ethical manner. The Board will identify all "pecuniary benefit transactions and comply with the requirements of New Hampshire RSA 7:19-a, as it may be amended from time to time, and any successor statute. No Trustee who also is an employee of the Association may participate in Board determinations regarding his or her compensation, and no Trustee who also is a physician employed by the Association may vote with respect to the establishment of compensation and/or benefits to be paid to the Association's employed physicians generally. To monitor and enforce this policy, 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 authoritative bodies 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	The Board of Trustees will select, oversee and annually evaluate the Hospital's President/CEO, who will be a full-time salaried employee of the Hospital. Accordingly, compensation and benefits paid to the Hospital's President and CEO is subject to the review and approval of the Board of Trustees. The Board utilizes its Executive Committee and other resources, such as surveys, market research, and data from comparable organizations, to determine a compensation and benefits package that is reasonable and appropriate for the level of services and skills provided and employed by the President and CEO. Similarly, the Hospital's HR Director prepares compensation reports and packages using similar datapoints for other key employees and officers who are not the President and CEO. The President specifically reviews and approves the compensation and benefits of the CFO. Trustees will serve solely for the purpose of furthering the Hospital's charitable purposes and without compensation, except that reasonable expenses may be reimbursed as approved by the Board. However, Trustees may be employed by the Hospital, and in turn be compensated for their non-Trustee services as the Board may authorize.
Form 990, Part VI, Section C, line 19	The Hospital's governing documents and financial statements are made available upon request.
Form 990, Part VI, Section A, Line 16b:	Littleton Hospital Association may occasionally partner or collaborate with for-profit businesses or care practices to improve the Hospital's ability to provide services and care to its patients and the broader community. For example, certain private facilities, physician practices, or dental and eye care centers may also operate on the Hospital's campus or lease real estate from the Hospital where it has excess capacity. In the nature of transparency, the Hospital has deemed such arrangements as "joint ventures, and has therefore answered "Yes" on this Form 990, Part VI, Section A, Line 16a. The Hospital does not have a separate, formal joint venture policy. However, all joint venture arrangements and similar business agreements are subject to the review, approval, and oversight of the Hospital's top management and operational officials. The Hospital also reviews all joint venture agreements or similar contracts to ensure the arrangements are in compliance with applicable law, and the Hospital reviews any joint venture or similar activities closely and regularly. Accordingly, while there is no separate joint venture policy, any business arrangements that are similar in nature to a joint venture are thoroughly monitored and regularly reviewed to ensure that such activities are compliant with requisite laws and regulations, and that any such activities also contribute meaningfully to the Hospital's ability to fulfill its charitable purpose.
Form 990, Part XI, line 9:	Change in value of interest rate swap -141,235.
Form 990, Part XII, Line 2c:	For its year ending September 2024, the Hospital engaged Baker Newman Noyes, an independent public accounting firm, to perform an audit of its financial statements. The audit of the Hospital's financial statements was subject to the oversight of chief management employees, the Hospital's finance committee, and the Chief Financial Officer. The Hospital's Chief Financial Officer and other applicable staff and board members met with the auditors prior to the start, during, and at the end of the audit to review results and to coordinate timely and accurate testing of the Hospital's financial statements. These same review and oversight procedures are consistent with previous years.