2022-05-12T18:30:56-05:00 2021-06-30 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402413902 990 2020-07-01 222519596 Dartmouth-Hitchcock Clinic DART 6036531155 One Medical Center Drive Lebanon NH 03756 Wendy E Fielding CFO 2022-05-12 true Wendy E Fielding 999009999 Kim Scifres P01316095 5023263996 2020 2022-09-23 18:48:47Z Joanne M Conroy MD One Medical Center Drive Lebanon NH 03756 623398483 false X www.dartmouth-hitchcock.org X 1983 NH Advancing health through research, education, clinical practice, and community partnerships; providing each person the best care in the right place, at the right time, every time. 22 16 5599 193 645888 0 24093904 74843390 348577612 407746462 94898 995284 125967304 139794708 498733718 623379844 3969949 3877220 0 0 318246495 346742249 0 0 93290 207292227 241103374 529508671 591722843 -30774953 31657001 252063565 263269510 558937659 510349111 -306874094 -247079601 WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 467772508 3877220 544548952 Dartmouth-Hitchcock Clinic (DHC) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code (Code) and is exempt from federal income taxes on related income, pursuant to Section 501(a) of the Code. DHC and its subsidiaries form a multispecialty physician practice group which operates throughout New Hampshire and Vermont and provides both medical services to patients and medical education and research. Health care services provided during fiscal year 2021 resulted in 1,340,175 office visits recorded by DHC personnel, with 332,085 unique patients served . The promotion of health through the medical practice activities of DHC provides the basis for the organization's tax-exempt status. DHC operates as an integral component of (and is fully owned by) Dartmouth-Hitchcock Health (D-HH), a New Hampshire not-for-profit corporation organized to support medical organizations like DHC. DHC provides the physician staff to a related affiliate, Mary Hitchcock Memorial Hospital (MHMH, also a fully-owned member of D-HH) and the related sophistication essential for the development and operations of the Hospital as the largest and only teaching hospital in New Hampshire and the designation by the federal government as a rural referral center for northern New England. The shared mission of DHC and MHMH is to advance health through research, education, clinical practice, and community partnerships, providing each person the best care, in the right place, at the right time, every time. Consistent with this mission, and in partnership with MHMH, DHC provides high-quality, cost-effective, comprehensive, and integrated health care to individuals, families, and the communities it serves regardless of a patient's ability to pay. DHC actively supports community-based health care, and promotes the coordination of services among health care providers and social services organizations within the regions it serves. DHC also seeks to work collaboratively with other area health care providers to improve the health status of residents in the region. DHC, MHMH, and Cheshire Medical Center (Cheshire) played key roles in the state-wide federally-funded delivery system reform incentive program (DSRIP) from 2016 - 2021. This NH program was funded from 2016 - 2020, but grant funding was able to be carried over for an additional year of interventions and all work was completed by 31st of December, 2021. Dartmouth-Hitchcock Clinic and Cheshire Medical Center co-sponsored the development of an integrated delivery network which brought health systems, community mental health centers, and social service organizations together to collaborate on improving health for Medicaid beneficiaries with mental health diseases and/or substance use disorders. While DSRIP funding has now expired, this work laid the foundation for ongoing programming and in August 2021, MHMH was awarded a HRSA grant to develop the behavioral workforce in rural New Hampshire. In addition to the alternative payment models and integrated care delivery relationships noted above, DHC has several shared risk contracts with the largest commercial insurance carriers in its market. DHC was responsible for managing the cost of care and health of approximately 100,000 members across these patient populations during fiscal year 2021. The Jack Byrne Center for Palliative & Hospice Care coordinates the clinical, education, and research efforts of DHC and Visiting Nurse alliances around the region. This effort provides much-needed end-of-life care for patients in a clinical setting that meets the needs of patients and their families. Due to increased patient demand in the southern part of New Hampshire, DHC commenced a major construction project to expand the Manchester clinic site to increase patient capacity. The 94,000 square-foot addition includes a state-of-the-art, six-room extended-stay (23-hour) ambulatory surgery center, expanded medical office space to support primary and specialty care outpatient clinics, and a fixed magnetic resonance imaging (MRI) unit, among other uses. The addition opened in the spring of 2021. DHC and MHMH jointly file an annual community benefits report with the State of New Hampshire which outlines the community and charitable benefits DHC and MHMH provide. The complete and updated community benefits reports are available upon request; these reports can also be found on the organization's website. The broad categories used in the community benefit report to summarize the benefits mentioned here include: "financial assistance" (formerly called "charity care"), which represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended June 30, 2021, DHC provided financial assistance to 17,680 patients in the amount of $11,671,808 as measured by gross charges . The cost of providing this care for the year ended June 30, 2020, was $14,971,650. DHC also routinely provides services to Medicaid patients at reimbursement levels that are well below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the year ended June 30, 2021 was $45,943,615 . Community health activities include the cost or value of several different types of programs, including the cost of community-based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include Granite State Fit Kids Health Program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, and Smoking Prevention and Cessation programs. This category also includes financial contributions and the contribution of time and services to community programs, hospitals, and agencies. DHC also provides a significant amount of uncompensated care to its patients that is reported as "provision for bad debts," which is not included in the amounts reported above. For the fiscal year ended June 30, 2021, DHC reported a provision for bad debts of approximately $28,230,228 . 27071074 1117230 As a component of an integrated academic medical center, Dartmouth-Hitchcock Clinic (DHC) provides significant support for academic and research programs through its support of the Geisel School of Medicine at Dartmouth College (GSM). DHC provides support for physicians' unpaid teaching time as part of its community benefit initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, DHC provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to Mary Hitchcock Memorial Hospital (MHMH) and GSM. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across New Hampshire, Vermont, and beyond as well as uncompensated costs of academic and medical research activities. During fiscal year 2021, DHC continued the transition of research activities and management from GSM to DHC, under the leadership of the Vice President for Research. 494843582 true true false true false false false false true true true false true true false false true false true true true false false false false false true true true false false false true false false true false false false false false true true true true false false true 0 0 5599 true true true false false false false false false false false false true false X 22 16 false false false false true true true true true false false true true true true true true true true false NH X Wendy E Fielding 6036505634 One Medical Center Drive Lebanon NH 03756 Charles G Plimpton MBA Trustee/Secretary/Treasurer 1.5 2.5 X X 0 0 0 Edward H Stansfield III MA Trustee/ Chair 0.8 2.3 X X 0 0 0 Joanne M Conroy MD Trustee, Ex-Officio, CEO 16.2 39.9 X X 1481660 0 47969 Aaron J Mancuso MD Trustee (eff. 6/1/21) / Physician 28.0 12.0 X 461261 0 53200 Carl W Dobson MD Trustee (Eff. 1/1/21) / Medical Director 0.8 40.0 X 0 465308 55977 Cherie Holmes MD Trustee (thru 12/31/20)/Physician 12.0 29.0 X 526558 0 45791 David P Paul Trustee 0.8 0.8 X 0 0 0 Duane A Compton PHD Trustee / Ex-Officio 0.8 1.7 X 0 0 0 Elof Eriksson MD PhD Trustee 0.8 0.8 X 0 0 0 Gary L Freed MD Trustee (Effective 1/1/21) / Physician 28.0 12.0 X 764624 0 29585 Geraldine Bednash PHD RN FAAN Trustee (Effective 1/1/21) 0.8 0.8 X 0 0 0 Jennifer L Moyer MBA Trustee 0.8 0.8 X 0 0 0 Jocelyn Chertoff MD VP SRVC LN/DPT CHCR DGNSTC RAD 12.0 28.0 X 739732 0 46322 Jon Wahrenberger MDFAHAFAC Trustee (thru 12/31/20) / Physician 12.0 28.0 X 297749 0 61933 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (thru 5/31/21) / Academics CMO 40.0 0.5 X 473151 0 63118 KURT K RHYNHART MD TRUSTEE/Divisional Chief of Trauma 12.0 28.0 X 501615 0 49261 Laura K Landy MBA Trustee 0.8 1.3 X 0 0 0 Marc B Wolpow JDMBA Trustee 0.8 1.3 X 0 0 0 Mark W Begor MBA Trustee 0.8 0.8 X 0 0 0 Pamela Thompson MSRNCENP Trustee 0.8 1.3 X 0 0 0 Paul P Danos PHD Trustee 0.8 1.3 X 0 0 0 Robert A Oden Jr PHD Trustee (thru 12/31/20) 1.5 2.5 X 0 0 0 Robert SD Higgins MD Trustee (Effective 1/1/21) 0.8 0.8 X 0 0 0 ROBERTA L HINES MD TRUSTEE 1.5 1.5 X 0 0 0 Thomas Glynn PHD Trustee (Effective 1/1/21) 0.8 0.8 X 0 0 0 Thomas Raffio Trustee 0.8 0.8 X 0 0 0 William J Conaty Trustee (thru 12/31/20) 0.8 1.3 X 0 0 0 Aimee M Claiborne Chief HR Officer 12.0 28.0 X 0 469738 59886 DANIEL P JANTZEN CFO 15.0 42.0 X 0 795941 60997 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 12.0 28.0 X 0 380284 58544 EDWARD MERRENS Chief Clinical Officer 12.0 29.0 X 739353 0 47445 JOHN KACAVAS Chief Legal Officer 12.0 31.0 X 0 727649 66274 Maria Padin MD Chief Medical Officer 12.0 30.0 X 552590 0 70033 Martin Purcell MBA Chief Information Officer 12.0 28.0 X 0 470064 55569 Matthew Haag VP Development 12.0 28.0 X 0 443871 39136 Patrick F Jordan III MBA Chief Operating Officer 15.0 42.0 X 0 756581 59599 Stephen Leblanc Chief Strategy Officer 12.0 31.0 X 786125 0 60997 Susan A Reeves EDDRN Executive VP (medical center) 12.0 28.5 X 0 588672 39469 Jeffrey Obrien MHA KEY EMP/ VP CLINICAL OPS 12.0 28.0 X 0 394484 65285 Karen Clements RNBSNMSB Chief Nursing Officer 12.0 28.0 X 0 377597 37227 Simon Hillier Dept Chair ANESTHESIOLOGY 12.0 28.0 X 622587 0 61932 Staci Hermann PHARMDMS CHIEF PHARMACY OFFICER 12.0 28.0 X 0 300938 29643 Daniel Stewart MD Physician 12.0 28.0 X 1231971 0 63830 Jock Mccullough MD Staff Physician 12.0 28.0 X 944510 0 52449 John Nigriny Staff Physician 40.0 0 X 1047379 0 63333 Lixia Ellis MD Physician 12.0 28.0 X 925709 0 53301 Timothy Ryken Staff Physician 12.0 28.0 X 1165725 0 63671 Christine Schon MPA FMR KEY EMP/ VP Ambulatory Care 20.0 20.5 X 373374 0 53981 GEORGE T BLIKE MD Former/ Chief Quality & Value Officer 9.0 22.5 X 400007 0 50140 Kimberly Troland JD FMR INTRM GC/DEPUTY GEN CNSL 12.0 28.0 X 0 435801 43015 Peter D Solberg MD Former key/Chief Health Information Officer 12.0 28.0 X 448995 0 68292 Richard I Rothstein MD Former Dept Chair/Srvc LN LDR - MED 12.0 28.0 X 684402 0 62209 Sandra Wong MD Former/ SVP SVC LN & Chair of Surgery 12.0 28.0 X 738701 0 35913 15907778 6606928 1875326 1714 true true false 0 56973742 17869648 74843390 NET PATIENT SERVICE REVENUE 621300 407746462 407746462 0 0 0 0 407746462 6071 -779 6850 839516 62932 7919 5110 831597 57822 889419 889419 994823 5610 0 989213 989213 989213 CONTRACTED REVENUE 621300 108758132 108111465 646667 CAFETERIA INCOME 722514 338902 338902 OTHER REVENUE 621300 29808255 29808255 0 0 0 0 138905289 623379844 545666182 645888 2224384 3618856 3618856 241123 241123 17241 17241 3657597 886006 2708321 63270 1535183 567984 937179 30020 272329601 236274007 36055594 20414277 17760421 2653856 31122120 26994417 4127703 17683471 15338126 2345345 662542 662542 317723 317723 39889629 32287961 7601668 0 960550 19972 940578 7531094 5575571 1955523 7404075 740407 6663668 7852513 613251 7239262 629932 348675 281257 33759 33363 396 6995669 699567 6296102 3359495 1185655 2173840 11675661 3068121 8607540 MEDICAL SUPPLIES 139740050 138837876 902174 EQUIP REPAIR & MAINTENANCE 6996393 4785173 2211220 ACADEMIC, GME, TEACHING & SUPPORT 2661187 2096904 564283 RECRUITMENT COSTS 838918 49211 789707 3554184 2803694 750490 0 591722843 494843582 96785971 93290 6158147 0 45372368 57728406 161724 167353 0 0 2047228 1301911 679143 630609 126405153 108789966 18875363 17615187 1224488 470236 58812630 54894923 1435821 3396090 117296653 127064795 252063565 263269510 241810363 262741134 13401173 0 0 0 7047317 2516936 296678806 245091041 558937659 510349111 X -308302368 -248853383 1428274 1773782 -306874094 -247079601 252063565 263269510 X 31657001 937264 27200228 X false true X true true true X 0 0 8020230 24093904 74843390 106957524 437313420 454429030 501802116 472942824 545666182 2412153572 0 0 0 437313420 454429030 509822346 497036728 620509572 2519111096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2519111096 735442 770344 1008778 989972 909298 4413834 0 735442 770344 1008778 989972 909298 4413834 -172489 150042 3882 4453 0 -14112 424980 425353 485850 421974 338902 2097059 438301353 455774769 511320856 498453127 621757772 2525607877 0.9974 0.8292 0 0.0018 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - , COLUMN A - 424980.0, COLUMN B - 425353.0, COLUMN C - 485850.0, COLUMN D - 421974.0, COLUMN E - 338902.0, COLUMN F - 2097059.0; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 44114 44114 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINE 1I DHC PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1I REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS. 1360094 368174 22736 1705532 1345817 28397 14120 1360094 1340985 61035 56203 1345817 1284444 1105 55436 1340985 1214414 72236 2206 1284444 0.0 0.4146 0.5854 false false 2505032 7215859 9720891 72493046 64616851 7876195 27567760 27559687 8073 16623456 16613428 10028 17615187 Public Equities Funds Private Equities Funds Hedge Funds Other Secuities INVESTMENT IN CAPTIVE - HAMDEN 54894923 F 54894923 DHC 457(B) PLAN ASSETS 119186370 DUE FROM AFFILIATE 4794033 OTHER MISC ASSETS 384 ESTIMATED THIRD PARTY SETTLEMENT 3084008 127064795 ACCRUED POST RETIREMENT PENSION 159604861 RESERVES FOR INSURANCE RELATED LOSS 85486180 ESTIMATED THIRD PARTY SETTLEMENT 245091041 Schedule D, Part X, Line 2 ASC 740 (FIN 48) FOOTNOTE NO ASC 740 (FIN 48) FOOTNOTE WAS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS AS THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT OR SINCE ADOPTION. Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH HITCHCOCK CLINIC true Central America and the Caribbean 0 0 ,Grant to recipients located in the region 17241 Central America and the Caribbean 0 0 Investments 61037494 0 0 0 0 0 0 61054735 0 61054735 Central America and the Caribbean PROGRAM SUPPORT 17241 CASH 1 0 true false true false true false Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. Schedule F, Part I, Line 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. true Advance Transit PO BOX 6834 4 WASHINGTON AVENUE SCARBOROUGH MN 040706834 222558708 501(c)3 34377 FMV PROGRAM SUPPORT Alice Peck Day Memorial Hospital ATTN MATTHEW HARRIS 10 ALICE PECK DAY DRIVE LEBANON AZ 03766 020222791 501(c)3 7250 FMV PROGRAM SUPPORT American Cancer Society 2 COMMERCE DRIVE SUITE 110 BEDFORD NH 03110 131788491 501(c)3 11455 FMV PROGRAM SUPPORT Amoskeag Health 145 HOLLIS STREET MANCHESTER NH 03101 020458174 501(c)3 14500 FMV PROGRAM SUPPORT ATRIUM HEALTH CAROLINAS HEALTHCARE SYSTEM c/o THERAPEUTIC RESEARCH DEV CHARLOTTE NC 282601979 560529945 501(c)3 5074 FMV CHARITABLE RESEARCH BAYLOR COLLEGE OF MEDICINE PO BOX 301207 DALLAS TX 753031207 741613878 501(c)3 31783 FMV CHARITABLE EDUCATIONAL SERVICES BOSTON UNIVERSITY ROOM 2B02 NEW YORK NY 100878763 042103547 501(c)3 85075 FMV CHARITABLE RESEARCH BRIGHAM AND WOMEN'S HOSPITAL INC 75 FRANCIS ST BOSTON MA 02115 042312909 501(c)3 61271 FMV CHARITABLE RESEARCH CEDARS-SINAI MEDICAL CENTER 6500 WILSHIRE BLVD SUITE 1150 SPONSORED RESEARCH FUNDS ADMIN LOS ANGELES CA 90048 951644600 501(c)3 57456 FMV CHARITABLE RESEARCH CENTERSTONE RESEARCH INSTITUTE INC 44 VANTAGE WAY NASHVILLE TN 37228 262505456 501(c)3 74090 FMV CHARITABLE RESEARCH Cheshire Medical Center 580 COURT STREET KEENE WI 03431 020354549 501(c)3 123207 FMV PROGRAM SUPPORT CHILDREN'S HOSPITAL PO BOX D-3053 300 LONGWOOD AVENUE BOSTON MA 02115 042774441 501(c)3 9937 FMV CHARITABLE RESEARCH CHILDREN'S HOSPITAL LOS ANGELES 4650 SUNSET BOULEVARD 13123 EAST 16TH AVE BOX 010 LOS ANGELES CA 90027 195612191 501(c)3 7035 FMV CHARITABLE RESEARCH CLEVELAND CLINIC FOUNDATION PO BOX 931562 9500 EUCLID AVE CLEVELAND OH 44195 340714585 501(c)3 13725 FMV CHARITABLE RESEARCH COMMONWEALTH OF MASSACHUSETTS DEPT OF REVENUE CHILD SUPPORT ENF DIVISION BOSTON MA 022055140 046002284 STATE OF MA 46304 FMV EDUCATIONAL SERVICES CREARE LLC 16 GREAT HOLLOW RD HANOVER NH 03755 020259551 6386 FMV CHARITABLE RESEARCH DUKE UNIVERSITY ACCOUNTS RECEIVABLE LOCKBOX 2400 PRATT AVE STE 9100-RM9314 CHARLOTTE NC 27710 560532129 501(c)3 5828 FMV CHARITABLE EDUCATIONAL SERVICES Families Flourish Northeast PO BOX 20 ENFIELD CENTER NH 03801 844591232 501(c)3 13350 FMV CHARITABLE PROGRAM SUPPORT Families in Transition 199 MANCHESTER STREET MANCHESTER NH 03103 020475414 501(c)3 13231 FMV PROGRAM SUPPORT FAMILY PLACE INC 319 US ROUTE 5 SOUTH NORWICH VT 05055 030305264 501(c)4 15140 FMV CHARITABLE PROGRAM SUPPORT Foundation for Healthy Communities (NHHA) 125 AIRPORT ROAD CONCORD NH 03301 020275078 501(c)3 424885 FMV PROGRAM SUPPORT Good Neighbor Health Clinic 70 NORTH MAIN STREET WHITE RIVER JCT OH 05001 030346949 501(c)3 18850 FMV PROGRAM SUPPORT Grafton County Senior Citizens Council ATTN ROBERTA BERNER PO BOX 433 LEBANON AZ 03766 237248316 501(c)3 5220 FMV PROGRAM SUPPORT Granite United Way 22 CONCORD STREET FLOOR 2 MANCHESTER NH 03101 026006033 501(c)3 11600 FMV PROGRAM SUPPORT Greater Manchester Chamber of Commerce 54 HANOVER STREET MANCHESTER WI 03101 020161920 501(c)3 5000 FMV PROGRAM SUPPORT HARVARD UNIVERSITY HARVARD MED-CME PO BOX 825 BOSTON MA 021170825 042103580 501(c)3 5227 FMV CHARITABLE EDUCATIONAL SERVICES Headrest Inc PO BOX 74008204 CHICAGO MN 606748204 237256865 501(c)3 12035 FMV PROGRAM SUPPORT HIVHCV Resource Center 2 BLACKSMITH ST LEBANON NH 03766 223104237 501(c)3 7250 FMV PROGRAM SUPPORT Listen Community Services 60 HANOVER ST LEBANON WI 03766 237225952 501(c)3 5800 FMV PROGRAM SUPPORT MAPS COUNSELING SERVICES 19 FEDERAL STREET KEENE NH 03431 020312473 501(c)3 7655 FMV CHARITABLE PROGRAM SUPPORT MASSACHUSETTS GENERAL HOSPITAL 100 CHARLES RIVER PLAZA STE 600 DEVELOPMENT OFFICE BOSTON MA 021142792 042697983 501(c)3 129890 FMV CHARITABLE RESEARCH MAYO CLINIC 13400 EAST SHEA BOULEVARD PO BOX 603644 ROCHESTER MN 55903 416011702 501(c)3 5920 FMV CHARITABLE RESEARCH MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF NURSING AT P BONHAM CHARLESTON SC 29407 576000722 STATE OF SC 85368 FMV EDUCATIONAL SERVICES MEMORIAL SLOAN-KETTERING CANCER CENTER PO BOX 27084 NEW YORK NY 100876352 131924236 501(c)3 9710 FMV CHARITABLE RESEARCH MICHIGAN STATE UNIVERSITY GRANTS CONTRACT ADMINISTRATION ROOM 360 EAST LANSING MI 48824 386005984 STATE OF MI 7694 FMV EDUCATIONAL SERVICES Monadnock Family Services 17 93RD ST ACCOUNTS RECEIVABLE DEPT KEENE NJ 03431 026012230 501(c)3 85450 FMV PROGRAM SUPPORT Mt Ascutney Hospital and Health Center ATTN MARTHA COLBURN 289 COUNTY ROAD WINDSOR AZ 05089 030183721 501(c)3 7250 FMV PROGRAM SUPPORT New Hampshire Business Committee for the Arts 155 DOW STREET SUITE 402 MANCHESTER NJ 03101 020397596 501(c)3 7500 FMV PROGRAM SUPPORT New Hampshire Charitable Foundation 215 MYRTLE STREET MANCHESTER NH 031044354 026005625 501(c)3 17400 FMV PROGRAM SUPPORT New Hampshire Coalition Against Domestic Violence 215 MYRTLE STREET MANCHESTER NH 031044354 020360151 501(c)3 5800 FMV PROGRAM SUPPORT New Hampshire Women's Foundation 18 LOW AVENUE SUITE 205 CONCORD GA 03301 020495092 501(c)3 5075 FMV PROGRAM SUPPORT New London Hospital PFS- POSTING CLERKS 273 COUNTY RD NEW LONDON CA 03257 020222171 501(c)3 31598 FMV PROGRAM SUPPORT OHIO STATE UNIVERSITY OFFICE OF SPONSORED PROGRAMS 1960 KENNY ROAD COLUMBUS OH 43210 316025986 STATE OF OH 5227 FMV EDUCATIONAL SERVICES OPEN SKY COMMUNITY SERVICES 4 MANN STREET WORCESTER MA 01602 042587863 501(c)3 7732 FMV CHARITABLE PROGRAM SUPPORT OREGON CLINIC PC 847 NE 19TH AVENUE SUITE 300 PORTLAND OR 97232 931127856 11931 FMV CHARITABLE RESEARCH OREGON HEALTH & SCIENCE UNIVERSITY PO BOX 575 PORTLAND OR 97207 931176109 501(c)3 22275 FMV CHARITABLE EDUCATIONAL SERVICES PROVIDENCE CENTER 528 NORTH N MAIN STREET PROVIDENCE RI 02860 050316969 501(c)3 44716 FMV CHARITABLE RESEARCH PUBLIC HEALTH COUNC OF THE UPPER VALLEY ONE COURT STREET SUITE 378 LEBANON NH 03766 752991608 501(c)3 32926 FMV CHARITABLE PROGRAM SUPPORT RECTOR & VISITORS OF UNIV OF VIRGINIA JOHN W STEINKE PO BOX 801355 CHARLOTTESVILLE VA 229081355 546001796 STATE OF VA 8269 FMV EDUCATIONAL SERVICES REGENTS OF THE UNIVERSITY OF CALIFORNIA UCSD CAMPUS MAIN DEPOSITORY 9500 GILMAN DRIVE MC 0009 LOS ANGELES CA 920930009 943067788 STATE OF CA 10528 FMV EDUCATIONAL SERVICES REGENTS OF UNIV OF MICHIGAN DEPT OF PATHOLOGY BILLING 2800 PLYMOUTH ROAD ANN ARBOR MI 48109 386006309 STATE OF MI 42070 FMV EDUCATIONAL SERVICES RESEARCH INSTITUTE AT NATIONWIDE CHILDRE PO BOX 781653 140 OLD ORANGEBURG ROAD BLDG 35 DETROIT MI 48278 316056230 501(c)3 10147 FMV CHARITABLE RESEARCH RHODE ISLAND HOSPITAL PO BOX 373 PROVIDENCE RI 02901 050258954 501(c)3 20768 FMV CHARITABLE RESEARCH SEATTLE CHILDREN'S HOSPITAL PO BOX 24728 SEATTLE WA 981240728 910564748 501(c)3 29504 FMV CHARITABLE RESEARCH SEVEN COUNTIES SERVICES INC 10101 LINN STATION ROAD 2491 WEHRLE DRIVE LOUISVILLE KY 40223 310939757 501(c)3 63832 FMV CHARITABLE RESEARCH SINAI HOSPITAL OF BALTIMORE INC 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 520486540 501(c)3 14463 FMV CHARITABLE RESEARCH Southeast Vermont Transit Inc 5830 NW 163RD STREET MIAMI LAKES WI 33014 030353976 501(c)3 8700 FMV PROGRAM SUPPORT SOUTHWESTERN COMMUNITY SERVICES INC 63 COMMUNITY WAY 63 COMMUNITY WAY KEENE NH 03431 026013808 501(c)3 11564 FMV CHARITABLE PROGRAM SUPPORT STANFORD UNIVERSITY 3145 PORTER DRIVE PALO ALTO CA 94305 941156365 501(c)3 15924 FMV CHARITABLE EDUCATIONAL SERVICES Sullivan County 14 MAIN STREET NEWPORT NH 03773 026000870 Sullivan County 18850 FMV PROGRAM SUPPORT TLC FAMILY RESOURCE CENTER PO BOX 1098 CLAREMONT NH 03743 522439830 501(c)3 8590 FMV CHARITABLE PROGRAM SUPPORT Tri-Valley Transit DEPT 106091 PO BOX 150502 HARTFORD VT 061150502 030335768 501(c)3 8193 FMV PROGRAM SUPPORT TRUSTEES OF DARTMOUTH COLLEGE CASHIERS OFFICE / AR DARTMOUTH COLLEGE HANOVER NH 03755 020222111 501(c)3 563925 FMV CHARITABLE EDUCATIONAL SERVICES TRUSTEES OF THE UNIV OF PENNSYLVANIA THE WHARTON SCHOOL LOCKBOX 9726 PHILADELPHIA PA 191789726 231352685 STATE OF PA 15652 FMV EDUCATIONAL SERVICES Twin Pines Housing Trust 226 HOLIDAY DRIVE SUITE 20 WHITE RIVER JCT NH 05001 222809527 501(c)3 11600 FMV PROGRAM SUPPORT United Way of Greater Nashua 20 BROAD STREET NASHUA NH 03064 026015642 501(c)3 5800 FMV PROGRAM SUPPORT UNIVERSITY OF ALABAMA AT BIRMINGHAM GRANTS CONTRACTS ACCOUNTING ATTN CYNTHIA HELMS BIRMINGHAM AL 352941210 636005396 STATE OF AL 174788 FMV EDUCATIONAL SERVICES UNIVERSITY OF ARIZONA 1303 E UNIVERSITY BLVD TUCSON AZ 857190521 742652689 STATE OF AZ 5346 FMV EDUCATIONAL SERVICES UNIVERSITY OF COLORADO UCHSC DNA DIAGNOSTIC LAB MAIL STOP 8313 PO BOX 6511 AURORA CO 80045 846000555 STATE OF CO 20747 FMV EDUCATIONAL SERVICES UNIVERSITY OF MARYLAND ACCOUNTING AND COMPLIANCE 220 ARCH STREET OFFICE LEVEL 2 BALTIMORE MD 212011531 526002033 STATE OF MD 56489 FMV EDUCATIONAL SERVICES UNIVERSITY OF NEBRASKA MEDICAL CTR 985100 NEBRASKA MED CTR OMAHA NE 681985045 470491233 STATE OF NE 9744 FMV EDUCATIONAL SERVICES UNIVERSITY OF PITTSBURGH FORBES ALLIES BUILDING STE 300 3109 FORBES AVENUE PITTSBURGH PA 15213 250965591 STATE OF PA 25676 FMV EDUCATIONAL SERVICES UNIVERSITY OF ROCHESTER SCHOOL OF NURSING EDVANTAGE ATTN REGISTRATION ROCHESTER NY 14642 160743209 501(c)3 56532 FMV CHARITABLE EDUCATIONAL SERVICES UNIVERSITY OF WASHINGTON GRANT CONTRACT ACCOUNTING 12455 COLLECTIONS DRIVE CHICAGO IL 60693 916001537 STATE OF WA 32102 FMV EDUCATIONAL SERVICES Upper Valley Community Nursing Project PO BOX 1302 LEBANON MN 03766 831224873 501(c)3 5800 FMV PROGRAM SUPPORT Upper Valley Haven 713 HARTFORD AVE WHITE RIVER JCT OH 05001 030277908 501(c)3 24831 FMV PROGRAM SUPPORT VINFEN CORPORATION 950 CAMBRIDGE ST CAMBRIDGE MA 02141 042632219 501(c)3 11037 FMV CHARITABLE PROGRAM SUPPORT VIRGINIA COMMONWEALTH UNIVERSITY BOX 843035 RICHMOND VA 23219 546001758 STATE OF VA 11441 FMV EDUCATIONAL SERVICES Vital Communities 195 NORTH MAIN STREET WHITE RIVER JCT NH 05001 030355283 501(c)3 7250 FMV PROGRAM SUPPORT Waypoint PO BOX 448 MANCHESTER MN 031050448 020222164 501(c)3 8700 FMV PROGRAM SUPPORT WEILL MEDICAL COLLEGE OF CORNELL UNIV ATTN CORNELL ECHO 2001 NEW YORK NY 10021 131623978 501(c)3 36332 FMV CHARITABLE EDUCATIONAL SERVICES West Central Behavioral Health ATTN SUELLEN GRIFFIN 9 HANOVER STREET LEBANON AZ 03766 222645978 501(c)3 36339 FMV PROGRAM SUPPORT WEST VIRGINIA UNIVERSITY RESEARCH CORPOR ONE WATERFRONT PLACE 4TH-FLOOR - PO BOX 6001 MORGANTOWN WV 265066001 550665758 STATE OF WV 9553 FMV EDUCATIONAL SERVICES Willing Hands Enterprises 198 CHURCH STREET NORWICH NH 05055 202204811 501(c)3 8990 FMV PROGRAM SUPPORT Women's Information Service of the Upper Valley PO BOX 685 CONCORD NH 03301 020346512 501(c)3 5800 FMV PROGRAM SUPPORT YALE UNIVERSITY ATTN HILMEL AYUSO EMERG MED 464 CONGRESS AVE SUITE 260 NEW HAVEN CT 06519 060646973 501(c)3 9505 FMV CHARITABLE EDUCATIONAL SERVICES YMCA of Greater Nashua 33 WEST STREET LEBANON VT 03766 020222250 501(c)3 9375 FMV PROGRAM SUPPORT HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 501(c)3 204960 FMV Program support 68 20 Awards and Educational Assistance 32 211071 FMV Patient Assistance 1305 30052 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY DARTMOUTH-HITCHCOCK CLINIC (DHC) HAS WRITTEN GUIDELINES AND PROCEDURES. AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE DARTMOUTH INSTITUTE SCHOLARSHIPS (TDI) ARE PAID DIRECTLY TO DARTMOUTH COLLEGE ON BEHALF OF THE INDIVIDUALS RECEIVING THE AWARD. THE COORDINATORS OF THE PROGRAMS ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. X true true X X X X false true false false false false false false false Joanne M Conroy MD Trustee, Ex-Officio, CEO 1325265 0 0 0 156395 0 27315 0 20654 0 1529629 0 0 0 Jocelyn Chertoff MD VP SRVC LN/DPT CHCR DGNSTC RAD 669871 0 0 0 69861 0 27315 0 19007 0 786054 0 0 0 Cherie Holmes MD Trustee (thru 12/31/20)/Physician 482870 0 0 0 43688 0 27315 0 18476 0 572349 0 0 0 Jon Wahrenberger MDFAHAFAC Trustee (thru 12/31/20) / Physician 272759 0 0 0 24990 0 27315 0 34618 0 359682 0 0 0 KURT K RHYNHART MD TRUSTEE/Divisional Chief of Trauma 461521 0 0 0 40094 0 25140 0 24121 0 550876 0 0 0 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (thru 5/31/21) / Academics CMO 439781 0 0 0 33370 0 21615 0 41503 0 536269 0 0 0 Carl W Dobson MD Trustee (Eff. 1/1/21) / Medical Director 0 406538 0 39000 0 19770 0 14250 0 41727 0 521285 0 0 Gary L Freed MD Trustee (Effective 1/1/21) / Physician 700698 0 0 0 63926 0 21615 0 7970 0 794209 0 0 0 Aaron J Mancuso MD Trustee (eff. 6/1/21) / Physician 451814 0 0 0 9447 0 12969 0 40231 0 514461 0 0 0 Richard I Rothstein MD Former Dept Chair/Srvc LN LDR - MED 636624 0 0 0 47778 0 27315 0 34894 0 746611 0 0 0 Kimberly Troland JD FMR INTRM GC/DEPUTY GEN CNSL 0 389097 0 0 0 46704 0 21615 0 21400 0 478816 0 0 Aimee M Claiborne Chief HR Officer 0 420621 0 0 0 49117 0 21615 0 38271 0 529624 0 0 DANIEL P JANTZEN CFO 0 694897 0 0 0 101044 0 27315 0 33682 0 856938 0 0 Patrick F Jordan III MBA Chief Operating Officer 0 707368 0 0 0 49213 0 21615 0 37984 0 816180 0 0 JOHN KACAVAS Chief Legal Officer 0 609953 0 0 0 117696 0 27315 0 38959 0 793923 0 0 Stephen Leblanc Chief Strategy Officer 683250 0 0 0 102875 0 27315 0 33682 0 847122 0 0 0 EDWARD MERRENS Chief Clinical Officer 662631 0 0 0 76722 0 27315 0 20130 0 786798 0 0 0 Maria Padin MD Chief Medical Officer 467964 0 45000 0 39626 0 27315 0 42718 0 622623 0 0 0 Susan A Reeves EDDRN Executive VP (medical center) 0 553593 0 250 0 34829 0 0 0 39469 0 628141 0 0 Martin Purcell MBA Chief Information Officer 0 420780 0 0 0 49284 0 27315 0 28254 0 525633 0 0 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 0 326374 0 0 0 53910 0 27315 0 31229 0 438828 0 0 Matthew Haag VP Development 0 375989 0 38660 0 29222 0 21615 0 17521 0 483007 0 0 GEORGE T BLIKE MD Former/ Chief Quality & Value Officer 344982 0 0 0 55025 0 27315 0 22825 0 450147 0 0 0 Christine Schon MPA FMR KEY EMP/ VP Ambulatory Care 341947 0 0 0 31427 0 27315 0 26666 0 427355 0 0 0 Peter D Solberg MD Former key/Chief Health Information Officer 423124 0 0 0 25871 0 27315 0 40977 0 517287 0 0 0 Sandra Wong MD Former/ SVP SVC LN & Chair of Surgery 679177 0 0 0 59524 0 21615 0 14298 0 774614 0 0 0 Karen Clements RNBSNMSB Chief Nursing Officer 0 349699 0 250 0 27648 0 21615 0 15612 0 414824 0 0 Staci Hermann PHARMDMS CHIEF PHARMACY OFFICER 0 277779 0 0 0 23159 0 12959 0 16684 0 330581 0 0 Simon Hillier Dept Chair ANESTHESIOLOGY 569192 0 0 0 53395 0 27315 0 34617 0 684519 0 0 0 Jeffrey Obrien MHA KEY EMP/ VP CLINICAL OPS 0 366117 0 0 0 28367 0 27315 0 37970 0 459769 0 0 Lixia Ellis MD Physician 906029 0 0 0 19680 0 11400 0 41901 0 979010 0 0 0 Jock Mccullough MD Staff Physician 858543 0 0 0 85967 0 27315 0 25134 0 996959 0 0 0 Daniel Stewart MD Physician 1126597 0 0 0 105374 0 21615 0 42215 0 1295801 0 0 0 John Nigriny Staff Physician 962629 0 0 0 84750 0 21615 0 41718 0 1110712 0 0 0 Timothy Ryken Staff Physician 1072353 0 0 0 93372 0 21615 0 42056 0 1229396 0 0 0 Schedule J, Part II NOTE REGARDING COMPENSATION SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY DHC AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY D-H ON BEHALF OF ITS EMPLOYEES. Schedule J, Part I, Line 3 ESTABLISHING COMPENSATION CEO The process for determining compensation of the CEO is the responsibility of the Compensation Committee of Dartmouth Hitchcock Health (DHH). The compensation committee consists of the Chairperson of the Board and three or more members of the board who are elected by the board, acting upon the recommendation of the chairperson and are not employees of DHH, a related organization or a subsidiary organization of a related organization. The compensation committee determines the compensation of the CEO of DHC within ranges established by the board. Schedule J, Part I, Line 1a Health or social club dues or initiation fees THE ORGANIZATION HAS IN PLACE A MANAGEMENT SELF DEVELOPMENT PLAN (MSDP) DESIGNED TO PROMOTE PROFESSIONAL AND PERSONAL DEVELOPMENT. THE MSDP IS CAPPED AT 2% OF GROSS PAY AND MAY BE UTILIZED FOR EXPENSES SUCH AS PROFESSIONAL DUES, MEETINGS AND SEMINARS, TUITION REIMBURSEMENT, AND OTHER MISCELLANEOUS ITEMS THAT PROMOTE PROFESSIONAL KNOWLEDGE. THE MONIES MAY ALSO BE USED FOR UP TO A 50% REIMBURSEMENT OF THE COST OF A FITNESS/WELLNESS PROGRAM DESIGNED TO MAINTAIN THE HEALTH OF MANAGEMENT PERSONNEL. ALL EXPENSES ARE SUBMITTED FOR APPROVAL BEFORE REIMBURSEMENT. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Dartmouth Hitchcock Clinic (DHC) and Mary Hitchcock Memorial Hospital (MHMH) sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC and MHMH to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen to new participants in 1998. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization. THE FOLLOWING INDIVIDUALS HAVE A SPLIT DOLLAR LIFE PLAN ARRANGEMENT AND RESPECTIVE EMPLOYER PREMIUMS: DANIEL JANTZEN $135,240 STEPHEN LEBLANC $61,630 RICHARD ROTHSTEIN $105,722 Stephen Leblanc Officer Split Dollar Life X 0 61630 false true true Richard Rothstein Former Officer Split Dollar Life X 0 105723 false true true 167353 Amy Stansfield Family member of Trustee Ed Stansfield 189213 Employment Compensation false Patrick J O'Brien Family member of Trustee Jeff O'Brien 51301 Employment compensation false James Ebert Family member of an officer Maria Padin 58000 Employment compensation false Form 990, Part VI, Line 1a Delegate broad authority to a committee The DARTMOUTH-HITCHCOCK CLINIC (DHC) board has a Governance Committee who has the authority/responsibility of the DHC Board to ensure that DHC continues to fulfill its central mission and vision. This committee has authority to act on behalf of the full Board when the need arises. Members include the following who are all members of the governing board: Edward H. Stansfield, III, MA (Board Chair and Chair of Governance Committee) Jennifer L. Moyer, MBA (Chair - Talent Development and Compensation Committee) Roberta L. Hines, MD (Chair - Research and Education Committee) Charles G. Plimpton, MBA (Chair- Finance Committee) Pamela A. Thompson, MS, RN, CENP, FAAN (Chair - Value Committee) Ex Officio member: Dr. Joanne Conroy (CEO) Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D- HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders IN ADDITION TO RESERVED POWERS, DARTMOUTH-HITCHCOCK HEALTH (D-HH) SHALL HAVE THE AUTHORITY TO TAKE ACTIONS TO ESTABLISH, MANAGE, AND GOVERN THE SYSTEM AS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF DHC'S MISSION. THESE POWERS INCLUDE BUT ARE NOT LIMITED TO ITEMS SUCH AS THE ABILITY TO APPROVE, DISAPPROVE, OR MODIFY ALL MATERIAL GOVERNANCE, PROGRAMMATIC, AND FINANCIAL DECISIONS OF DHC'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF DHC'S BOARD OF TRUSTEES, ASSESS DHC A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE DHC'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY DHC, APPROVE KEY STRATEGIC RELATIONSHIPS, APPROVE THE ELIMINATION OR ADDITION OF ANY MATERIAL HEALTH CARE SERVICE OR PROGRAM, AND OTHER AUTHORITY TO TAKE ACTION ON BEHALF OF DHC. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORMS 990 AND 990-T ARE REVIEWED BY THE DIRECTOR OF FINANCIAL COMPLIANCE, VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 AND 990-T IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING OF THE FORMS. Form 990, Part VI, Line 12c Conflict of interest policy THE DARTMOUTH-HITCHCOCK CLINIC (DHC) BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. DARTMOUTH-HITCHCOCK HEALTH'S COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL INVOLVED MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION FOR THE CEO IS EVALUATED BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSULTATION WITH THE INDEPENDENT THIRD PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2021. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES ARE EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA, ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS, WITH THE LAST FORMAL PROCESS IN 2021. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. THE PROCESS DESCRIBED ABOVE TO ESTABLISH COMPENSATION WAS USED FOR THE FOLLOWING POSITIONS: Chief Financial Officer, Chief Strategy Officer, Chief Clinical Officer, Chief Legal Officer, Chief Human Resources Officer, Chief Operating Officer, Chief Nursing - Executive, Chief Nursing Officer, Chief Pharmacy Officer, Chief Quality & Value Officer, Department Chair - Anesthesia, Department Chair - Pathology, and similar positions. Form 990, Part VI, Line 19 Required documents available to the public DHC'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. CERTAIN FINANCIAL INFORMATION IS DISCLOSED THROUGH THE COMMUNITY BENEFITS ANNUAL REPORT. THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST EITHER IN ELECTRONIC OR HARD COPY FORM. Form 990, Part VII, Section A, Line 1a, Column (B) AVERAGE HOURS PER WEEK AS PART OF DARTMOUTH-HITCHCOCK CLINIC'S (DHC) AND MARY HITCHCOCK MEMORIAL HOSPITAL'S (MHMH) AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS ON THEIR FORM 990'S EVEN THOUGH COMPENSATION REPORTED IN PART VII IS BASED ON THE ENTITY ISSUING THE W-2. IN ADDITION, CERTAIN OFFICERS SPEND TIME ON DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC, ALONG WITH TWO SUPPORTING ORGANIZATIONS: DARTMOUTH-HITCHCOCK MEDICAL CENTER (DHMC) AND HAMDEN RISK RETENTION GROUP (HAMDEN). CERTAIN OFFICERS ALSO SPEND TIME ON RELATED ENTITIES, INCLUDING ALICE PECK DAY MEMORIAL HOSPITAL (APD), WINDSOR HOSPITAL CORPORATION (DBA MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER) (MAHHC), MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER (CHESHIRE), CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION (NLH), VISITING NURSE ASSOCIATION & HOSPICE OF VT AND NH (VNA), AND THE HITCHCOCK FOUNDATION (THC). Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS DARTMOUTH-HITCHCOCK CLINIC (DHC) IS PART OF THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) SYSTEM, WHICH INCLUDES DHC, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH), AND ITS SUBSIDIARIES. MHMH RECEIVED AUTHORITY FROM THE INTERNAL REVENUE SERVICE TO ACT AS DHC'S PAY AGENT AND IMPLEMENTED THIS PROCESS AT THE BEGINNING OF FISCAL YEAR 2010. ALL EXPENSES ARE PAID DIRECTLY BY MHMH AND REIMBURSED BY DHC. MHMH MANAGES ALL REQUIRED IRS REPORTING RELATED TO THESE DISBURSEMENTS. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Column (A) STATEMENT OF FUNCTIONAL EXPENSES MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC) OPERATE UNDER AN AFFILIATION AGREEMENT AS DIRECTED BY DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH ENTITIES. DUE TO THE INTEGRATED OPERATING STRUCTURE, RELATED MISSION, AND CLOSE RELATIONSHIP OF DHC AND MHMH, EXPENSES ARE SHARED BETWEEN THE TWO ENTITIES. ALL EXPENSES REPORTED WITHIN THIS FORM 990 ARE DHC'S SHARE OF EXPENSES AS DESIGNATED BY THE AFFILIATION AGREEMENT. Form 990, Part XI, Line 9 Other changes in net assets or fund balances PENSION RELATED AND OTHER CHARGES - 27222964; NET ASSET RELEASED FROM RESTRICTED - -22736; RENAISSANCE PSYCHIATRY OF NEW ENGLAND ONE MEDICAL CENTER DRIVE LEBANON NH 03756 813076466 PSYCHIATRY SERVICES NH 180074 392820 D-HC MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(c)(3) 3 D-HH false HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 HeaLTH CaRE ReSeaRCH NH 501(c)(3) 7 DHC true HAMDEN ASSURANCE RISK RETENTION GROUP INC 30 MAIN STREET STE 330 BURLINGTON VT 05401 208530788 SELF INSURANCE VT 501(c)(3) Type I DHC true DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORGANIZATION NH 501(c)(3) 7 NA false THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(c)(3) 3 D-HH false WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(c)(3) 3 D-HH false CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 501(c)(3) 3 D-HH false ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(c)(3) 3 D-HH false Visiting Nurse Association AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC 88 Prospect Street White River Junction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false POMPANOOSUC INVESTMENT CORPORATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020352330 REAL ESTATE HOLDING NH DHC C Corporation -124 75632 1 true HAMDEN ASSURANCE CO LTD 980121409 LIABILITY INSURANCE BD DHC C Corporation 0 50383987 0.702 true false true true false true false false false false true true true true true true true true true true Hitchcock Foundation O 302215 FMV Hitchcock Foundation Q 52724 FMV HAMDEN ASSURANCE RISK RETENTION GROUP INC M 5542222 FMV Hitchcock Foundation S 114397 FMV Hitchcock Foundation B 204960 FMV Hitchcock Foundation C 13027 FMV