TO OUR PATIENTS, NEIGHBORS, AND FRIENDS: Littleton Regional Healthcare (LRH) has a long tradition of delivering comprehensive award-winning care close to home, but a recent proposal to locate a for-profit urgent care center in our community could jeopardize the future of the hospital. LRH was founded more than a century ago by a pioneering local physician, business leaders and ordinary citizens to provide access to quality healthcare in our rural community. Since the beginning, the hospital has operated as a not-for-profit charitable 501(c)3 organization whose sole purpose is to provide vital healthcare services to patients in the community. We are proud to offer a wide range of specialty services, including surgery, intensive care, obstetrics, pediat rics, cancer treatment, sports medicine and more. LRH also serves as the region's largest em- ployer and contributes more than $57 million a year to the local economy in salaries, charity care, community education and purchase of local goods and services Recently an out-of-state, venture-capital-backed company has proposed opening a new facil- ty just three miles from the hospital, duplicating affordable urgent care services that will soon be available at LRH. If the new facility is approved, LRH would experience a significant decline in revenue and a higher percentage of patients who are uninsured or unable to pay. Under federal law, hospitals are required to care for all patients, regardless of their ability to pay The for-profit urgent care facility faces no such requirements. ts presence in our community would create an unlevel playing field and put other essential health services at risk If the proposed facility is approved, LRH estimates it would lose several million dollars in revenue and could no longer subsidize services that currently operate at a significant loss. As a result, the hospital could be forced to shut down critical services like obstetrics, intensive care or behavioral health-or risk closing the hospital's doors entirely. Similar challenges are playing out in rural communities across our nation. Between 2004 and 2014, more than 200 rural U.S. hospitals have closed their obstetrics programs due to financial pressures and provider shortages Access to quality health care services is essential in attracting and retaining professionals and new businesses to our community. Littleton Regional Healthcare has been fortunate to have outstanding doctors and staff and effective management over the years. Because of this, we are one of the few rural New Hampshire hospitals still able to maintain such a full array of services 24 hours a day, seven days a week We have every intention of continuing our mission to deliver these critical services, but challenges from operators who offer only profitable services-during profitable hours-will effectively siphon off program-sustaining revenue and put our current mission in serious jeopardy. Ultimately, our community must decide which services are most important. If you agree that services like obstetrics, intensive care or behavioral health are important for the future of our community, we urge you to stand with LRH and help keep vital services here in Littleton, Rural Councles Lose Birthing Units Health Resources and Services Administration, May 2017 of our patients and our community. REGIONAL HEALTHCARE