2021-05-12T11:33:21-05:00 2020-06-30 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402411122 990 2019-07-01 020222140 Mary Hitchcock Memorial Hospital MARY 6036505000 One Medical Center Drive Lebanon NH 03756 Daniel P Jantzen CPA CFO 2021-05-12 true Kim Scifres P01316095 5023263996 2019 2022-09-23 18:48:47Z JOANNE M CONROY MD One Medical Center Drive Lebanon NH 03756 1455466797 false X WWW.DARTMOUTH-HITCHCOCK.ORG X 1889 NH ADVANCING HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, COMMUNITY PARTNERSHIPS; PROVIDING EACH PERSON THE BEST CARE IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. 21 14 6541 497 11938304 0 28349009 34484885 1295829353 1295443322 20877294 18523480 44780872 106532953 1389836528 1454984640 4155379 10933352 0 0 746284236 818348129 0 0 264966 575126652 650046324 1325566267 1479327805 64270261 -24343165 1550625147 2041764780 868932139 1392639404 681693008 649125376 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 1091368698 10933352 1324784331 MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IS AN ACUTE AND TERTIARY CARE TEACHING HOSPITAL LOCATED IN LEBANON, NEW HAMPSHIRE. MHMH PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A MAJOR TEACHING HOSPITAL, A TERTIARY CARE REFERRAL HOSPITAL, AND AS A PROSPECTIVE PAYMENT SYSTEM HOSPITAL (AS DEFINED BY CMS). MHMH PROVIDES A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, PSYCHIATRY AND REHABILITATION FOR INFANTS, CHILDREN AND ADULTS. DURING FY 2020, MHMH PROVIDED 126,638 ACUTE PATIENT DAYS OF INPATIENT SERVICE AND HAD 27,309 TOTAL ACUTE CARE DISCHARGES, WHILE MHMH'S EMERGENCY ROOM WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 28,774 DISCHARGES. DARTMOUTH-HITCHCOCK CLINIC (DHC) PROVIDES THE PHYSICIAN STAFF FOR THE HOSPITAL AND THE SOPHISTICATION ESSENTIAL FOR THE DEVELOPMENT 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 MHMH AND DHC 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 DHC, MHMH 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. THROUGH FORMAL AFFILIATIONS AND OTHER CLINICAL COLLABORATIONS, MHMH ALSO SEEKS TO PARTNER WITH OTHER AREA HEALTH CARE PROVIDERS TO IMPROVE THE HEALTH STATUS OF THE REGION. THE JACK BYRNE CENTER FOR PALLIATIVE & HOSPICE CARE COORDINATES MHMH'S CLINICAL, EDUCATIONAL, AND RESEARCH EFFORTS AND VISITING NURSE ALLIANCES AROUND THE REGION TO OFFER MUCH-NEEDED END-OF-LIFE CARE FOR PATIENTS IN A CLINICAL SETTING THAT MEETS THE NEEDS OF PATIENTS AND THEIR FAMILIES. MHMH ALSO CONTINUES TO BUILD ITS TELE-MEDICINE PROGRAM TO PROVIDE CARE ACROSS ITS RURAL REGION AND IN PARTICULAR TO MAKE SPECIALIST CONSULTATION AND CARE AVAILABLE TO CRITICAL ACCESS AND COMMUNITY HOSPITALS. THIS ALLOWS CAREGIVERS AT REMOTE LOCATIONS TO ACCESS SPECIALISTS AT MHMH AND DHC AND TO BRING THEM "VIRTUALLY" TO THE PATIENT'S BEDSIDE. MHMH'S CONNECTED CARE CENTER FOR TELE-HEALTH IN LEBANON OFFERS A 24/7 TEAM OF PHYSICIANS, PHARMACISTS, AND NURSES SUPPORTING THE FOLLOWING ACUTE CARE TELE-HEALTH SERVICE LINES: TELE-EMERGENCY, TELE-PHARMACY, TELE-NEUROLOGY, TELE-ICU, TELE-PSYCHIATRY, AND TELE-NEONATOLOGY; OUTPATIENT TELE-URGENT CARE 7 DAYS/WEEK; AND OUTPATIENT VIRTUAL VISITS IN PEDIATRICS AND MORE THAN 30 SPECIALTY SERVICES TO PATIENTS IN 17 CLINICAL LOCATIONS ALONG WITH PATIENT HOMES. IN AN EFFORT TO INTEGRATE BEHAVIORAL HEALTH AND PRIMARY CARE, MHMH CONTINUES TO BE THE LEAD CONVENER FOR THE STATE OF NEW HAMPSHIRE'S DELIVERY SYSTEM REFORM INCENTIVE PROGRAM ("DSRIP") FOR THE REGION 1 INTEGRATED DELIVERY NETWORK. THIS PROGRAM IS FUNDED THROUGH A SECTION 1115 WAIVER RESEARCH AND DEMONSTRATION TRANSFORMATION WAIVER THAT THE STATE OF NEW HAMPSHIRE RECEIVED FROM CMS. THE WAIVER ENABLES HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS WITHIN A REGION TO FORM RELATIONSHIPS FOCUSED ON TRANSFORMING CARE, TO COMBAT THE OPIOID CRISIS, AND STRENGTHEN THE STATE'S STRAINED MENTAL HEALTH SYSTEM. THIS WORK BEGAN IN JULY 2016 AND WILL CONTINUE THROUGH DECEMBER 31, 2020. IN ADDITION TO MHMH, DARTMOUTH-HITCHCOCK CLINIC (DHC) AND CHESHIRE MEDICAL CENTER (CHESHIRE) ARE PLAYING LEADERSHIP ROLES IN THIS INITIATIVE. MHMH has also partnered with Colby-Sawyer College to provide nursing education to both Colby-Sawyer students and to MHMH staff. MHMH also sponsors numerous training programs through the Workforce Readiness Institute, a department of MHMH focused on providing training pathways for entry-level staff to gain the necessary education and certifications to move into higher-paying roles. Along with providing flu clinics to bring vaccinations to area communities, MHMH also created a community COVID testing center during the latter part of FY '20. Additionally, MHMH and DHC have served both the State of New Hampshire and area communities as "subject matter experts" during the COVID pandemic. During FY '20, MHMH commenced construction of a new Patient Pavilion, expanding its current in-patient capacity at the Lebanon campus. (For the last three years, MHMH has turned away almost 2,500 patients per year because the hospital was at full capacity during the patients' time of need.) Expected to be completed early in FY '23, the project will cost in excess of $100 million and will expand in-patient capacity to more fully meet the acute-care needs of the region. MHMH FILES AN ANNUAL COMMUNITY BENEFITS REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS IT PROVIDES. THE MOST RECENT COMMUNITY BENEFITS REPORT IS AVAILABLE BY REQUEST. FINANCIAL ASSISTANCE (FORMERLY CALLED "CHARITY CARE") 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, 2020, MHMH PROVIDED FINANCIAL ASSISTANCE TO 17,000 PATIENTS IN THE AMOUNT OF $23,299,566 AS MEASURED BY GROSS CHARGES. THE ESTIMATED COST OF PROVIDING THIS CARE FOR THE YEAR ENDED JUNE 30, 2019 WAS $7,545,627. MHMH ALSO ROUTINELY PROVIDES SERVICES TO MEDICAID PATIENTS AT REIMBURSEMENT LEVELS THAT ARE BELOW THE COST OF THE CARE PROVIDED. THE COMMUNITY HEALTH ACTIVITIES NOTED 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 PARTNERING WITH THE HEALTHY EATING ACTIVE LIVING NH INITIATIVE, THE WOMEN'S HEALTH RESOURCE CENTER, AND SMOKING PREVENTION AND CESSATION. THIS CATEGORY OF SUPPORT ALSO INCLUDES FINANCIAL CONTRIBUTIONS AND THE CONTRIBUTION OF TIME AND SERVICES TO COMMUNITY PROGRAMS, HOSPITALS AND AGENCIES. MHMH ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO ITS PATIENTS THAT IS REPORTED AS PROVISION FOR BAD DEBT, WHICH IS NOT INCLUDED IN THE AMOUNTS REPORTED ABOVE. DURING THE YEAR ENDED JUNE 30, 2020, THE HOSPITAL REPORTED A PROVISION FOR BAD DEBT OF $43,174,978. 92037219 62081886 AS A COMPONENT OF NEW HAMPSHIRE'S ONLY INTEGRATED ACADEMIC MEDICAL CENTER, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) PROVIDES THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH (GSM) SUPPORT FOR PHYSICIANS' UNPAID TEACHING TIME AS PART OF ITS COMMUNITY BENEFIT INITIATIVES. THIS SUPPORT CONSISTS OF THE TIME PHYSICIANS SPEND PROVIDING CLINICAL SUPERVISION AND EDUCATION FOR RESIDENTS AND MEDICAL STUDENTS. IN ADDITION, THE HOSPITAL 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 DARTMOUTH-HITCHCOCK CLINIC (DHC) 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. IN FY20, MHMH CONTINUED THE TRANSITION OF RESEARCH ACTIVITIES AND MANAGEMENT FROM GSM TO MHMH UNDER THE LEADERSHIP OF THE VICE PRESIDENT FOR RESEARCH OPERATIONS. 1183405917 true true false true false false false false true true true false true true false false true false false true true false false false false true true true true true true false false false false false true true false false false true false false false true true false false false true 1406 0 true 6541 true true true false false false false true true false false false false false false X 21 14 false false false false true true true true true false false true true true true true true false true true true NH X DANIEL P JANTZEN CPA 6036505634 ONE MEDICAL CENTER DRIVE LEBANON NH 03756 Charles G Plimpton MBA Trustee/Secretary/Treasurer 1.5 2.5 X X 0 0 0 Joanne M Conroy MD Trustee, Ex-Officio, CEO 37.8 18.3 X X 0 1356521 53900 Vincent S Conti MHA Trustee/Board Chair (Through 12/31/19) 0.8 1.8 X X 0 0 0 Cherie Holmes MD Trustee 28.0 13.0 X 0 485345 55299 David P Paul Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Duane A Compton PHD Trustee / Ex-Officio 0.8 1.7 X 0 0 0 Edward H Stansfield III MA Trustee/ Chair (effective 1/1/20) 0.8 2.3 X 0 0 0 Elof Eriksson MD PhD Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Jennifer L Moyer MBA Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Jocelyn Chertoff MD VP Service Line / DPT CHR Diagnostic Radiology 28.0 12.0 X 0 702848 42604 Jon Wahrenberger MDFAHAFAC Trustee 28.0 12.0 X 0 355485 65268 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (EFFECTIVE 1/1/20) 0.5 40.0 X 0 417979 57113 Kari M Rosenkranz MD Trustee (through 12/2019) / Physician 28.0 12.0 X 0 522969 36344 KURT K RHYNHART MD TRUSTEE 28.0 12.0 X 0 491637 42285 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 (effective 1/1/20) 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 1.5 2.5 X 0 0 0 ROBERTA L HINES MD TRUSTEE 1.5 1.5 X 0 0 0 Senator Judd A Greg Trustee (through 6/2020) 0.8 0.8 X 0 0 0 Thomas Raffio Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 William J Conaty Trustee 0.8 1.3 X 0 0 0 Aimee M Claiborne Chief HR Officer 28.0 12.0 X 452838 0 48214 DANIEL P JANTZEN CPA Chief Financial Officer 39.0 18.0 X 821761 0 56733 EDWARD MERRENS Chief Clinical Officer 28.0 13.0 X 0 794781 43222 JOHN KACAVAS Chief Legal Officer 28.0 15.0 X 714988 0 57857 Maria Padin MD Chief Medical Officer 28.0 14.0 X 0 430924 64642 Martin Purcell MBA Chief Information Officer 28.0 12.0 X 411454 0 53030 Matthew Haag VP Development 28.0 12.0 X 371795 0 35780 Patrick F Jordan III MBA Chief Operating Officer 39.0 18.0 X 770233 0 64134 Stephen Leblanc Chief Strategy Officer 28.0 14.5 X 0 828259 52333 Susan A Reeves EDDRN Chief Nursing Executive 28.0 12.5 X 577922 0 56445 GEORGE T BLIKE MD Chief Quality & Value Officer 28.0 13.5 X 0 474747 64154 Jeffrey Obrien MHA VP Clinical Operations 28.0 12.0 X 370955 0 59933 Karen Clements RNBSNMSB Chief Nursing Officer 28.0 12.0 X 360969 0 33521 Peter D Solberg MD Chief Medical Information Officer 28.0 12.0 X 0 390772 60729 Simon Hillier Dept. Chair - Anesthesiology 28.0 12.0 X 0 565423 57356 Staci Hermann PHARMDMS Chief Pharmacy Officer 28.0 12.0 X 285277 0 27090 BRUCE KING PRES/CEO NEW LNDN HOSPITAL (Through 3/2020) 40.0 0.0 X 368277 1219 56614 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 28.0 0 X 334203 0 54963 Kimberly Troland JD Deputy Gen Counsel 28.0 12.0 X 397737 0 42204 Leigh Burgess VP RESEARCH OPS 28.0 0 X 346934 0 51981 Tina E Naimie CPA VP CORP FINANCE 28.0 14.0 X 284775 0 23176 Christine Schon MPA FMR KEY EMP/ ADM VP PRMRY CARE 0.0 40.5 X 0 294491 56219 Richard I Rothstein MD Former Dept. Chair / Service Line LDR - MED 28.0 12.0 X 0 681373 57240 Sandra Wong MD SVP SVC LN & Chair of Surgery 28.0 12.0 X 0 720339 33203 Wendy Fielding MBA FMR KEY EMP / VP FINANCE PLANNING 28.0 13.0 X 282795 0 54116 Wendy Wells MD FMR KEY EMP / DPT CHR PATHOLOGY 28.0 12.0 X 0 596868 50558 7152913 10111980 1668260 554 true true false Conifer Revenue Cycle Solutions LLC 1500 S Douglas Rd Ste 200 Ananheim CA 92806 Revenue Management Services 38837394 Harvey Construction 10 Harvey Rd Bedford NH 03110 Construction 21294910 Huron Consulting Services LLC 550 West Van Buren St Chicago IL 60607 Consulting Services 9626557 Triage LLC 7200 World Communication Dr Omaha NE 68122 Staffing Services 7599043 HP Cumming Construction Company 25 Crossroad Route 100 Waterford VT 05676 Construction 6195493 161 22604501 11880384 4327833 34484885 NET PATIENT SERVICE REVENUE 622110 1141938206 1141938206 RESEARCH RELATED ACTIVITIES 622110 7509476 7509476 PHARMACY INCOME 446110 144135762 138985717 5150045 NEAH & PROGRAM RELATED INVESTMENTS 541990 1859878 689023 1170855 0 0 0 0 1295443322 18523480 -153530 18677010 742422 482157 260265 0 260265 260265 0 0 STIMULUS PAYMENT 622110 53788038 53788038 MEANINGFUL USE REFUND 622110 554741 554741 CAFETERIA 722212 2757959 2757959 49171950 43401016 5770934 0 106272688 1454984640 1386866217 11938304 21695234 8961820 8961820 1825930 1825930 145602 145602 10931123 3019460 7713174 198489 2297215 745023 1500952 51240 647940760 564083012 83857748 42719581 37166035 5553546 74117932 46645491 27472441 40341518 21204548 19121733 15237 1783232 35761 1747471 725905 725905 39600 39600 101305796 83076758 18229038 0 2684131 66049 2618082 17656927 12677676 4979251 17148987 1543409 15605578 18019239 1304863 16714376 4137205 2081807 2055398 163398 163398 16845507 1516096 15329411 67108563 20150290 46958273 19713148 7167448 12545700 MEDICAL SUPPLIES 288838575 286685296 2153279 MEDICAID ENHANCEMENT TAX 59707877 59707877 EQUIPMENT RENTAL & MAINT 15923947 10806353 5117594 ACADEMIC, GME, TEACHING & EDUCATIONAL 7948408 6408855 1539553 10295879 6217060 4078819 0 1479327805 1183405917 295656922 264966 47978831 210295802 639155 639751 162813811 156019685 372244 196023 0 0 11722180 11563390 19562504 26883997 10655043 23928953 1302580327 854517613 411951103 448062714 554941393 573546581 157549243 160162539 6282288 7665894 166157352 422799451 1550625147 2041764780 180227192 208215387 4113693 171284403 0 37885000 0 0 581142070 42315447 103449184 932939167 868932139 1392639404 X 591992644 551126847 89700364 97998529 681693008 649125376 1550625147 2041764780 X -24343165 2559348 -10783815 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 238915 false true 105038 343953 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINES IB & 1G MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) EMPLOYS THREE FULL TIME STAFF WHOSE DUTIES INCLUDE LOBBYING. TYPICAL EXPENSES ASSOCIATED WITH THE LOBBYING ACTIVITIES INCLUDE STAFF SALARY, TRAVEL, MEMBERSHIP FEES AND DUES. FROM TIME TO TIME, MARY HITCHCOCK MEMORIAL HOSPITAL, THROUGH ITS EMPLOYEES AND THE USE OF CONSULTANTS, CONTACTS GOVERNMENT OFFICIALS AND LEGISLATORS. THIS CONTACT IS FOR THE PURPOSE OF PROPOSING LEGISLATION OR EXPRESSING AN OPINION ON CHANGES IN LEGISLATION THAT AFFECT MHMH AND ITS ABILITY TO CARRY OUT ITS MISSION. THE ACTIVITIES INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. FOR THE FISCAL YEAR ENDED JUNE 30, 2020, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $238,915 IN CONJUCTION WITH THESE ACTIVITIES. LINE 1I MHMH 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. 59733699 2989578 698013 1592623 61828667 58012839 1209274 1592942 1081356 59733699 56795299 338335 2065129 1185924 58012839 54754800 137888 2553792 651181 56795299 72720335 378941 -377000 17967476 54754800 0.2664 0.5735 0.1601 false false 50342245 50342245 586991081 376904695 210086386 4111615 3944444 167171 584868473 473668474 111199999 76266913 0 76266913 448062714 PRIVATE EQUITIES 71351212 F HEDGE FUNDS 30194747 F OTHER INVESTMENTS 58616580 F 160162539 INVESTMENT IN CAPTIVE 24827511 DUE FROM AFFILIATES 347750949 CAPITAL LEASE RECEIVABLE 41654847 OTHER MISC ASSETS 8054136 UNAMORTIZED BOND ISSUANCE COSTS 512008 422799451 THIRD PARTY RESERVES 27435440 ACCRUED POST RETMNT PENS & MED 90978646 Payable to Dartmouth Hitchcock Health 814525081 932939167 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 INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROMOTE AND ADVANCE THE FOLLOWING MISSION-RELATED PROGRAMS: HEALTHCARE SERVICES, RESEARCH, CHARITY CARE, COMMUNITY OUTREACH AND ADVOCACY, EQUIPMENT PURCHASES, AND HEALTH EDUCATION. true East Asia and the Pacific 0 1 Program Services Medical program 5900 Central America and the Caribbean 0 1 Program Services Medical Services 1252 Sub-Saharan Africa 0 6 Program Services Medical Services 34439 Europe (Including Iceland and Greenland) 0 0 Program Services Program Support 55861 Central America and the Caribbean 0 0 Program Services Program Support 89741 Central America and the Caribbean 0 0 Investments Investments in captive 24827511 0 8 0 0 0 8 25014704 0 25014704 Europe (Including Iceland and Greenland) Program Support 21600 Cash FMV Central America and the Caribbean Program Support 89741 Cash FMV Europe (Including Iceland and Greenland) Program Support 34261 Cash FMV 3 0 true false true true true false Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS 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 HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. true true true X 225 true X true true false true true 9650339 0 9650339 0.0065 252268589 127270423 124998166 0.0845 0 0.0 0 0 261918928 127270423 134648505 0.0910 24796926 16201521 8595405 0.0058 52192530 14450425 37742105 0.0255 24599001 19104017 5494984 0.0037 24879364 19797436 5081928 0.0034 2741749 500 2741249 0.0019 0 0 129209570 69553899 59655671 0.0403 0 0 391128498 196824322 194304176 0.1313 10800 10800 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 924078 924078 0.0006 102191 102191 0.0001 0 0.0 0 0.0 0 0 1037069 0 1037069 0.0007 true 0 0 337697070 341843717 -4146647 X true true 1 1 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 WWW.DARTMOUTH-HITCHCOCK.ORG 01799 X X X X X X PSYCH UNIT AND TRANSPLANT UNIT CANCER CENTER MARY HITCHCOCK MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 18 true true true true X https://www.dartmouth-hitchcock.org/about-dhh/community-health.html X X true 19 true https://www.dartmouth-hitchcock.org/about-dhh/community-health.html false true X 225.0 300.0 X X X X X X X true true X X X true X https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html X https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html X https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC, COLLECTIVELY KNOWN AS D-H) ARE ACTIVELY ENGAGED IN THE DEVELOPMENT OF THE UPPER VALLEY REGIONAL PUBLIC HEALTH ADVISORY COUNCIL AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL (WITH 60+ COMMUNITY REPRESENTATIVES). MEMBERS OF THESE TWO COMMUNITY HEALTH ADVISORY GROUPS HAVE HAD THE OPPORTUNITY TO REVIEW AND COMMENT ON DRAFTS OF DARTMOUTH-HITCHOCK'S COMMUNITY HEALTH IMPROVEMENT PLAN. THE PLAN DOCUMENT HAS ALSO BEEN CIRCULATED TO PUBLIC HEALTH OFFICIALS IN NEW HAMPSHIRE AND VERMONT FOR THEIR COMMENT. IN ADDITION, DARTMOUTH-HITCHCOCK REPRESENTATIVES SERVE ON NUMEROUS BOARDS, TASK FORCES, MUNICIPAL HEALTH LEADERSHIP AND PLANNING TEAMS, AND OTHER COMMUNITY HEALTH LEADERSHIP ENTITIES IN ORDER TO ENSURE THAT BOTH ORGANIZATIONS PARTICIPATE IN AND BETTER-UNDERSTAND THE NEEDS OF OUR COMMUNITY. MHMH CONTRACTED WITH JOHN SNOW RESEARCH AND TRAINING INSTITUTE/COMMUNITY HEALTH INSTITUTE TO PROVIDE CONSULTATION AND TECHNICAL EXPERTISE TO OUR ASSESSMENT PROCESS. JOHN SNOW RESEARCH AND TRAINING INSTITUTE IS A PUBLIC HEALTH MANAGEMENT CONSULTING AND RESEARCH ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES THROUGHOUT THE WORLD. DURING THE PERIOD MARCH THROUGH AUGUST 2018, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY DARTMOUTH-HITCHCOCK AND ALICE PECK DAY MEMORIAL HOSPITAL IN PARTNERSHIP WITH NEW LONDON HOSPITAL, VALLEY REGIONAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES, AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. WHILE DARTMOUTH-HITCHCOCK MEDICAL CENTER SERVES AS A TERTIARY REFERRAL MEDICAL CENTER FOR A LARGE, MULTI-STATE AREA, THE GEOGRAPHIC AREA OF INTEREST FOR THE PURPOSES OF THIS ASSESSMENT WAS THE PRIMARY SERVICE AREA OF MARY HITCHCOCK MEMORIAL HOSPITAL AND ALICE PECK DAY MEMORIAL HOSPITAL. THIS PRIMARY SERVICE AREA WAS DEFINED AS 19 MUNICIPALITIES COMPRISING THE UPPER VALLEY OF NEW HAMPSHIRE AND VERMONT WITH A TOTAL RESIDENT POPULATION OF APPROXIMATELY 70,000 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE PRIMARY SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), POPULATIONS EXPERIENCING HEALTH DISPARITIES OR VULNERABLE TO POOR HEALTH OUTCOMES ARE PRIMARILY DEFINED AS THOSE POPULATIONS FACING SIGNIFICANT INCOME AND SOCIAL DETERMINANTS CHALLENGES, WHICH IN THIS REGION ARE MORE STRONGLY ASSOCIATED WITH NEGATIVE IMPACTS ON HEALTH THAN RACE OR ETHNICITY. ENHANCED EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THESE POPULATIONS THROUGH TARGETED SURVEYS AND COMMUNITY CONVERSATIONS, INCLUDING FACILITATED SURVEYS AND DISCUSSIONS AT COMMUNITY SUPPERS, A REGIONAL FREE CLINIC, HOMELESS PROGRAMS, AND OTHER COMMUNITY SETTINGS SERVING ECONOMICALLY-VULNERABLE RESIDENTS. IN ADDITION, WE CONVENED A FOCUS GROUP OF BLACK AND AFRICAN-AMERICAN COMMUNITY MEMBERS. FINDINGS OF THIS ASSESSMENT HAVE BEEN SHARED WITH PUBLIC HEALTH OFFICIALS IN NH AND VT, AS WELL AS WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY. DURING THIS ASSESSMENT, MARY HITCHCOCK MEMORIAL HOSPITAL USED SURVEYS FROM MARCH 2018 THROUGH AUGUST 2018 TO GENERATE INPUT FROM 2,100 RESIDENTS. SURVEYS WERE MADE AVAILABLE THROUGH PRIMARY CARE CLINICS, FREE CARE CLINICS, A SHELTER FOR THE HOMELESS, A FREE COMMUNITY DINNER, ANNUAL TOWN MEETINGS/ELECTIONS, AND NUMEROUS OTHER COMMUNITY LOCATIONS. VISITING NURSES AND OTHERS PROVIDED PRE-PAID MAILERS AND SURVEYS TO HOMEBOUND RESIDENTS. RESIDENTS COMPLETING SURVEYS INCLUDED MEMBERS OF AFRICAN-AMERICAN, HISPANIC, NATIVE AMERICAN, AND ASIAN POPULATIONS. SURVEYS WERE DISTRIBUTED THROUGH REGIONAL HEALTH CLINICS, THE REGION'S SHELTER FOR HOMELESS POPULATIONS; THE REGION'S LOW-INCOME HOUSING TRUST; SENIOR CENTERS; SUBSTANCE USE DISORDER TREATMENT PROGRAMS, DELIVERED DIRECTLY TO RESIDENT HOMES, AND OTHER LOCATIONS WHERE POPULATIONS MOST AFFECTED BY HEALTH DISPARITIES CONGREGATE. MARY HITCHCOCK MEMORIAL HOSPITAL DISSEMINATED THE SURVEY TOGETHER WITH MULTIPLE COMMUNITY ORGANIZATIONS THAT SERVE LOW-INCOME, FRAIL, AND HEALTH DISPARITY POPULATIONS. COMMUNITY PARTNERS, PROVIDED ASSISTANCE DISSEMINATING THE SURVEY, INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHOSE MEMBERSHIP INCLUDES COMMUNITY MENTAL HEALTH SERVICES, SUBSTANCE USE SERVICES, MENTAL HEALTH PEER LEADERS, WIC PROVIDERS, SENIOR SERVICES ADVOCATES, SERVICES WORKING WITH PEOPLE WITH PHYSICAL AND DEVELOPMENTAL DISABILITIES, COMMUNITY NURSING, VISITING NURSES, AND OTHER CORE HUMAN SERVICES. IN ADDITION TO ASSISTING IN SURVEY DISSEMINATION, THESE PROVIDERS ADVOCATED FOR UNDERSERVED AND VULNERABLE POPULATIONS IN OUR REGION AS A PART OF THE CHNA PROCESS. DURING THIS CHNA PROCESS, OUR CHNA COLLABORATIVE TEAM CONVENED ONE REGIONAL DISCUSSION GROUP OF PERSONS IDENTIFYING AS BLACK/AFRICAN-AMERICAN (MAY 10, 2018); WE MADE RESIDENT SURVEYS WIDELY AVAILABLE TO COMMUNITY RESIDENTS THROUGH PUBLIC LIST SERVES, DIRECT E-MAIL INVITATIONS TO PATIENTS OF OUR PRIMARY CARE CLINICS, SURVEY LINKS ON TOWN WEB SITES AND E-NEWS, EMPLOYEE E-NEWS IN MAJOR EMPLOYERS, AND THROUGH OTHER SYSTEMS THAT PROVIDED WIDESPREAD ACCESS TO OUR SURVEYS. WE ALSO REVIEWED MEETING MINUTES FROM TWO REGIONAL COMMUNITIES (HARTFORD, VT, AND CLAREMONT, NH), WHERE ISSUES OF RACIAL EQUITY AND RACISM HAVE BEEN EXPLORED AT TOWN AND SCHOOL GOVERNANCE LEVELS. WE PARTNERED CLOSELY WITH ORGANIZATIONS SERVING POPULATIONS AFFECTED BY POVERTY, LACK OF INSURANCE, HOMELESSNESS, BEHAVIORAL HEALTH CONDITIONS, AND SERIOUS AND CHRONIC ILLNESSES IN ORDER TO SURVEY THESE MEMBERS OF POPULATIONS IN OUR COMMUNITY, AND HOSTED MULTIPLE DISCUSSION GROUPS WITH PEOPLE AFFECTED BY POVERTY AND CHRONIC ILLNESS. WE RECOGNIZE THE LIMITATIONS OF OUR ENGAGEMENT OF RACIAL AND ETHNIC MINORITY MEMBERS OF OUR COMMUNITY, AND ARE WORKING TO IMPROVE THIS PART OF OUR CHNA PROCESS. OUR MINORITY POPULATION IS QUITE SMALL: 0.9% OF THE POPULATION OF GRAFTON COUNTY, NH IDENTIFIES AS AFRICAN AMERICAN, 0.4% AS NATIVE AMERICAN, 1.8% AS HISPANIC/LATINO, 3.0% AS ASIAN. 92.1% OF THE MHMH HOSPITAL SERVICE AREA'S RESIDENTS IDENTIFY AS CAUCASIAN. WIDE DISPERSAL OF THIS POPULATION ACROSS A LARGE GEOGRAPHY FURTHER COMPLICATES ENGAGEMENT EFFORTS. OUR SUMMER 2018 DISCUSSION GROUP WITH COMMUNITY MEMBERS IDENTIFYING AS BLACK/AFRICAN AMERICAN WAS A POSITIVE, BUT LIMITED IMPROVEMENT OVER PRIOR YEARS. HOUSEHOLD MEDIAN INCOME, INSURANCE STATUS, AND OTHER INDICATORS OF POVERTY ARE SIGNIFICANT DRIVERS OF DISPARITY IN OUR REGION. POVERTY RATES RANGE WIDELY BY TOWN, WITH A RANGE BY TOWN OF 2.9% TO 31.7% OF HOUSEHOLDS LIVING ON INCOMES BELOW 200% OF FEDERAL POVERTY LEVEL. THESE POPULATIONS FACE NOTABLE HEALTH DISPARITY CONDITIONS ASSOCIATED WITH POVERTY AND OTHER SOCIAL DETERMINANTS OF HEALTH NEEDS. DURING OUR ASSESSMENT PROCESS, MHMH MADE SPECIFIC EFFORTS TO CONTACT AND RECEIVE INPUT FROM MEMBERS OF INCOME-VULNERABLE POPULATIONS, INCLUDING: * A DISCUSSION GROUP WITH PREGNANT AND PARENTING TEENS PARTICIPATING IN AN ALTERNATIVE HIGH SCHOOL ENVIRONMENT AT THE FAMILY PLACE PARENT CHILD CENTER (MAY 1, 2018). * A DISCUSSION GROUP WITH ADULTS LIVING WITH DEVELOPMENTAL DISABILITIES AND THEIR FAMILIES/CAREGIVERS (MAY 4TH, 2018). * A DISCUSSION GROUP WITH PREGNANT WOMEN IN TREATMENT FOR SUBSTANCE USE DISORDERS (APRIL 9, 2018). * A DISCUSSION GROUP WITH COMMUNITY NURSES SERVING CHRONICALLY ILL, HOMEBOUND, AND OTHERWISE VULNERABLE OLDER ADULTS IN REGIONAL TOWNS (MAY 8, 2018). * A DISCUSSION GROUP WITH THE BOARD AND LEADERSHIP OF THE MASCOMA COMMUNITY HEALTH CLINIC, A COMMUNITY HEALTH CLINIC SEEKING FQHC-LOOKALIKE STATUS AND SERVING A SET OF COMMUNITIES WITH HEALTH DISPARITIES (MAY 14, 2018) * WORKING WITH THE GOOD NEIGHBOR HEALTH CLINIC AND MASCOMA COMMUNITY HEALTH CENTER TO DISSEMINATE SURVEYS TO PATIENTS WHO ARE UNINSURED AND LOW-INCOME. DISSEMINATING SURVEYS AT THE HAVEN (SHELTER); LISTEN COMMUNITY SERVICES (BASIC NEED SUPPORT, FOOD SHELF, AND COMMUNITY DINNERS); TO PARENTS OF CHILDREN IN DARTMOUTH-HITCHCOCK AND ALICE PECK DAY'S PEDIATRICS CLINICS; VIA WOMEN, INFANTS, AND CHILDREN'S CLINICS; THROUGH GRAFTON COUNTY SENIOR CITIZENS COUNCIL (HOME-DELIVERED MEALS AND CONGREGATE MEALS); THROUGH VISITING NURSE AND HOSPICE OF VT AND NH (HOME-VISITING PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FOR SENIORS WITH COMPLEX HEALTH NEEDS); AND THROUGH OTHER COMMUNITY ORGANIZATIONS SERVING PEOPLE AFFECTED BY POVERTY AND POOR HEALTH. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING MARCH 2018 - JUNE 2019, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO PARTNERED WITH NEIGHBORING HOSPITALS AND ORGANIZATIONS INCLUDING VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL, MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH. USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING MARCH 2018- JUNE 2019, IN ADDITION TO WORKING WITH DARTMOUTH-HITCHCOCK CLINIC, MHMH WORKED CLOSELY WITH THE MEMBER ORGANIZATIONS OF THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY (60+ MEMBER ORGANIZATIONS) AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL TO DISSEMINATE SURVEYS, SERVE AS KEY INFORMANTS, AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE NEEDS ASSESSMENT WAS DISTRIBUTED TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE REGION INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHICH IS A MEMBERSHIP GROUP OF REIGONAL NON-PROFIT, MUNICIPAL, SAFETY, HUMAN SERVICE, AND PUBLIC HEALTH ORGANIZATIONS. IT IS ALSO AVAILABLE FROM THE ORGANIZATION UPON REQUEST AND IS POSTED ON THE MHMH WEB PAGE. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH IS INCREASING COMMUNITY BENEFITS SPENDING TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE MOST RECENT CHNA IN AREAS OF TRAUMA AND VIOLENCE, SOCIAL DETERMINANTS OF HEALTH, IMPROVING ACCESS TO HEALTH CARE, AND NEEDS OF OLDER ADULTS, AS WELL AS MAINTAINING ONGOING INVESTMENTS IN BEHAVIORAL HEALTH AND SUBSTANCE USE NEEDS, STRENGTHENING FAMILIES AND CHILDREN, AND CANCER CARE AND TREATMENT. IN FY 2020, MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN OUR FY2016 AND FY2019 COMMUNITY HEALTH IMPROVEMENT PLANS. AREAS WERE ANALYZED AND MHMH RESPONDED BY INCREASING INVESTMENTS, MAINTAINING SIMILAR LEVELS OF INVESTMENTS FOR SERVICES AND INITIATIVES, OR LIMITING INVESTMENT IN AREAS WHERE OTHER COMMUNITY ORGANIZATIONS ALREADY PROVIDE LEADERSHIP AND SERVICES TO ADDRESS THE NEED, AND/OR WHERE THE IDENTIFIED NEED IS SIGNIFICANTLY OUTSIDE THE MISSION/SERVICES/SCOPE OF MHMH. MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT PLAN IS A 3-YEAR DOCUMENT IDENTIFYING ANTICIPATED INVESTMENTS AND ACTIVITIES THAT IT WILL TAKE TO ADDRESS NEEDS IDENTIFIED IN THE MOST RECENT UPPER VALLEY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). WITH THE ONSET OF COVID-19 IN FEBRUARY-MARCH 2020, MHMH HAS ADDED AND PRIORITIZED COVID-19 DRIVEN COMMUNITY NEEDS TO OUR OTHER CHNA PRIORITIES. THIS HAS INCLUDED PROVIDING SIGNIFICANT FUNDING AND STAFF SUPPORT TO HELP COMMUNITY FOOD SUPPORT PROGRAMS, BEHAVIORAL HEALTH PROVIDERS, NURSING HOMES, AND OTHER COMMUNITY ORGANIZATIONS ADAPT TO AND MAINTAIN BASIC SOCIAL SERVICES SAFELY DURING THE PANDEMIC. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MARY HTCHCOCK MEMORIAL HOSPITAL. PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF MHMH. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON MHMH'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. MHMH PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. MHMH CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, MHMH POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. MHMH SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, MHMH CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME. 0 Schedule H, Part V, Section C MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY CAN BE FOUND AT HTTPS://WWW.DARTMOUTHHITCHCOCK.ORG/BILLINGCHARGES/FINANCIAL_ASSISTANCE.HTML. MHMH HAS PLAIN LANGUAGE SUMMARY BROCHURES AVAILABLE AT ALL ADMISSION SITES AS WELL AS PLAIN LANGUAGE SUMMARY POSTERS AT ALL PHYSICAL LOCATIONS. Schedule H, Part VI, Line 2 FACILITY INFORMATION THE HOSPITAL HAS A 2ND CANCER TREATMENT CENTER LOCATED IN SAINT JOHNSBURY, VERMONT. THIS LOCATION IS REGISTERED UNDER THE SAME LICENSE AS THE ORGANIZATION'S MAIN CAMPUS LOCATED IN LEBANON, NEW HAMPSHIRE. Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG MHMH USES THE FPG GUIDELINES IN DETERMINING THE INITIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED. IN ADDITION, MHMH ALLOWS FOR CATASTROPHIC ASSISTANCE CONSIDERATION BASED ON A CALCULATION OF 10% OF TWO YEARS INCOME PLUS 10% OF AMOUNT OVER SHELTERED ASSETS. IF THE PROJECTED OR CURRENT SELF-PAY BALANCE IS GREATER THAN THIS CALCULATION, THE SELF-PAY BALANCE IS REDUCED TO THE SUM OF 10% OF TWO YEARS INCOME PLUS 10% OF ASSETS. EACH HOUSEHOLD IS ALLOWED CERTAIN SHELTERED ASSETS WHICH ARE NOT USED WHEN CALCULATING HOUSEHOLD INCOME OR ASSETS SAVINGS IS SHELTERED UP TO 100% OF FPL BASED ON FAMILY SIZE, EQUITY IN PRIMARY RESIDENCE UP TO $200,000 UP TO 55 AND $250,000 FOR AGED 55 AND OLDER, AND A RETIREMENT SHELTER OF UP TO $100,000 IN RETIREMENT ASSETS AS LONG AS IT IS EMPLOYER BASED CONTRIBUTIONS IF WORKING OR IRA IF SELF-EMPLOYED. IF A PATIENT IS RETIRED, PRIOR RETIREMENT ACCOUNTS WOULD BE INCLUDED AS A SHELTERED ASSET. Schedule H, Part I, Line 6a COMMUNITY BENEFITS REPORT MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT WITH THE STATE OF NEW HAMPSHIRE. FOR PURPOSES OF IRS FORM 990, SCHEDULE H, ONLY MHMH HOSPITAL NUMBERS WERE USED. ALL AMOUNTS RELATING TO DHC WERE EXCLUDED. THE NEW HAMPSHIRE COMMUNITY BENEFITS REPORT FILED FOR FISCAL YEAR 2020, DHC AND MHMH COMBINED, TOTALED $250,399,871. Schedule H, Part I, Line 7g Subsidized Health Services The organization did not include any subsidized health service costs attributable to a physician clinic on part I, line 7G. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, ratio of patient care to cost-to-charges. Schedule H, Part II Community Building Activities Community building activities include expenses related to coalitions that address regional public health networks, improvement in systems of care for substance use and mental health disorders, prevention of substance abuse, falls reduction for older adults, and prescription drug misuse. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The hospital is unable to estimate accurately the amount of bad debt expense attributable to patients eligible for financial assistance. Although a portion of bad debt expense may be related to patients who would qualify for charity care, a reportable figure cannot be reasonably estimated. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote MHMH FILES A CONSOLIDATED AUDITED FINANCIAL STATEMENT WITH DARTMOUTH-HITCHCOCK CLINIC AND OTHER SUBSIDIARIES. MHMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR FINANCIAL ASSISTANCE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MHMH DOES NOT ANTICIPATE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. MHMH GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS. MOST ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY ARRANGEMENTS. FOR FINANCIAL STATEMENT PURPOSES, Dartmouth Hitchcock Health HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The costing methodology used to calculate the amounts reported as Medicare shortfalls was derived from the Internal Revenue Service's Worksheet B as provided for Part III calculations. MHMH had revenues of $64,886,809 and costs of $88,702,476 for services not included on the Medicare Cost Report (Ambulance Services, Laboratory and other fee screens, and Medicare Part C & D services) MHMH incurred a net loss of $23,815,667 on the provision of these services. Because of the central role of the organization in serving the healthcare needs of its community and the demographic characteristics of the community served, it is likely that a portion of the medicare shortfall should be considered community benefit expenditure. MHMH has not identified a specific amount of medicare shortfall that should be reported as such. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance MHMH HAS A CREDIT AND COLLECTION POLICY THAT ADDRESSES THE PROCEDURES FOR PATIENTS WHO QUALIFY FOR REDUCED-COST CARE. THE POLICY PROHIBITS USING EXTRAORDINARY COLLECTION PRACTICES OR PLACING AMOUNTS WITH COLLECTION AGENCIES. IF A FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENT HAS A BALANCE FOR WHICH THEY ARE RESPONSIBLE AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE STANDARD PRACTICES ARE FOLLOWED AS OUTLINED IN THE D-H CREDIT AND COLLECTIONS POLICY. Schedule H, Part V, Section B, Line 16a FAP website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16a URL: https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html; Schedule H, Part V, Section B, Line 16b FAP Application website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16b URL: https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16c URL: https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html; Schedule H, Part VI, Line 2 Needs assessment MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY NEEDS ASSESSMENT AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT. DARTMOUTH-HITCHCOCK PARTICIPATES WITH OTHER HEALTH CARE CHARITABLE TRUSTS AND COMMUNITY PARTNERS IN EACH OF OUR SERVICE AREAS TO COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENTS. DURING FY2019, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL, TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO WORKED TOGETHER WITH NEIGHBORING HOSPITALS, INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CARE, VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL , AND VISITING NURSE & HOSPICE OF VT & NH TO USE SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENTS TOOLS AND APPROACH, TO ALLOW COMPARABILITY OF HEALTH DATA ACROSS A WIDER GEOGRAPHIC REGION. COLLECTIVELY D-H AND PARTNERED HOSPITALS HIRED COMMUNITY HEALTH INSTITUTE/JOHN SNOW RESEARCH AND TRAINING INSTITUTE, A PUBLIC HEALTH CONSULTING FIRM, TO PROVIDE TECHNICAL ASSISTANCE AND ANALYSIS RELATED TO OUR COMMUNITY HEALTH NEEDS ASSESSMENTS. THE NEEDS ASSESSMENT INCLUDED REVIEWING SELECTED SERVICE AREA DEMOGRAPHICS; PUBLIC HEALTH DATA AVAILABLE THROUGH NH AND VT HEALTH DEPARTMENTS, HOSPITAL DISCHARGE DATA, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND YOUTH RISK BEHAVIOR SURVEYS; FOCUS GROUPS WITH EMPLOYERS AND WITH COMMUNITY MEMBERS RECEIVING SERVICES AT REGIONAL SAFETY NET SERVICE ORGANIZATIONS; ELECTRONIC SURVEYS OF PROFESSIONAL HEALTH AND SOCIAL SERVICE PROVIDERS; AS WELL AS PAPER AND ELECTRONIC CONVENIENCE SURVEYS OF COMMUNITY RESIDENTS. THE FY2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AT 3 LARGE COMMUNITY MEETING (100+ TOTAL STAKEHOLDERS) HOSTED IN CONCERT WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY AND OTHERS FOR FURTHER COMMENTS AND FEEDBACK. ADDITIONALLY, MHMH COMMUNITY HEALTH STAFF PARTICIPATE IN OR LEAD MULTIPLE COMMUNITY COALITIONS AND PROJECTS CONNECTING US TO A WIDE ARRAY OF COMMUNITY-BASED HEALTH, MUNICIPAL, SCHOOL, SERVICE ORGANIZATION, REGIONAL PLANNING AND STATE PUBLIC HEALTH STAKEHOLDERS. WE REGULARLY REVIEW EMERGING NH & VT STATE HEALTH DATA; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS), AND CONVERSATIONS WITH COMMUNITY PARTNERS TO IDENTIFY CONCERNS THAT ARE EMERGING, INTENSIFYING, OR ARE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST CHNA WAS CONDUCTED. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PRO-ACTIVELY SCREENED USING PAPER AND/OR AN AUTOMATED TOOL TO IDENTIFY POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. IN ADDITION, SPECIFIC OUTPATIENT ACTIVITIES DEEMED TO HAVE A HIGHER RATE OF NEED ARE SCREENED AS PART OF REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTION REGARDING HOW TO COMPLETE THE QUALIFICATION PROCESS. IN SOME CASES A FINANCIAL COUNSELOR WILL ACT ON BEHALF OF THE PATIENT, AT THEIR SIGNED CONSENT, IN ORDER TO COMPLETE THE APPLICATION PROCESS (FOR EXAMPLE, IN NEW HAMPSHIRE A PATIENT MUST BE PHYSICALLY PRESENT AT THE DISTRICT OFFICE). IF A PATIENT DOESN'T QUALIFY FOR SPECIFIC PROGRAMS, THEY ARE ALSO CONSIDERED FOR FINANCIAL ASSISTANCE AS PART OF THEIR SCREENING. FOR OUTPATIENT SERVICES THAT ARE NOT ROUTINELY SCREENED, STAFF INTERACTING WITH PATIENTS ARE INSTRUCTED TO PROVIDE EITHER A FINANCIAL ASSISTANCE APPLICATION OR CONTACT INFORMATION FOR A FINANCIAL COUNSELOR WHEN A PATIENT EXPRESSES THEIR INABILITY TO MAKE PAYMENT. EVERY APPLICATION IS SCREENED FOR COMPLETED INCOME AND ASSET DOCUMENTATION. APPLICATIONS ARE ALSO SCREENED TO ASSURE THERE ARE NO OTHER POTENTIAL OPTIONS OF FEDERAL, STATE, OR LOCAL PROGRAMS. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY. Schedule H, Part VI, Line 4 Community information THE ORGANIZATION DEFINES ITS SERVICE REGION AS NEW HAMPSHIRE AND EASTERN VERMONT, WITH THE LARGEST PRESENCE IN A 19-TOWN REGION ADJOINING LEBANON, NEW HAMPSHIRE, SITE OF DARTMOUTH-HITCHCOCK MEDICAL CENTER WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC'S MAIN NORTHERN CLINIC. THE REGION HAS A POPULATION OF 70,000 PEOPLE, WITH TOWNS RANGING IN POPULATION FROM 200-14,000 PEOPLE. THESE TOWNS ARE GENERALLY CONSIDERED RURAL, THOUGH THE HANOVER, AND LEBANON, NH AND HARTFORD, VT COMMUNITIES ARE CONSIDERED TO BE A MICROPOLITAN AREA. AMONG THE REGION'S 19 TOWNS, MEDIAN HOUSEHOLD INCOME VARIES WIDELY, FROM $50K-$120K ANNUALLY 17.5% OF THE POPULATION IS OVER THE AGE OF 65; 11% OF CHILDREN LIVE IN HOUSEHOLDS WHOSE MEDIAN HOUSEHOLD INCOME IS LESS THAN 100% OF FEDERAL POVERTY LEVEL, 26.8% OF CHILDREN LIVE IN HOUSEHOLDS WITH INCOME LESS THAN 200% OF FEDERAL POVERTY LEVEL; 1.5% OF THE REGION'S RESIDENTS HAVE LIMITED ENGLISH PROFICIENCY; AND 7.1% LACKED HEALTH INSURANCE. 11.8% OF NH RESIDENTS AND 24.9% OF VERMONT RESIDENTS ARE MEDICAID BENEFICIARIES. THE REGION IS SERVED BY MHMH AND BY ALICE PECK DAY MEMORIAL HOSPITALS. THERE ARE NO FEDERALLY QUALIFIED HEALTH CENTERS OPERATING WITHIN THE REGION. THE GOOD NEIGHBOR HEALTH CLINIC, IN HARTFORD, VT, OFFERS CARE TO UNINSURED COMMUNITY MEMBERS. TWO MINOR CIVIL DIVISIONS IN OUR REGION, DORCHESTER NH AND PIERMONT NH, ARE CONSIDERED MEDICALLY UNDERSERVED AREAS. MHMH SERVES THE GENERAL POPULATION WITH A WIDE RANGE OF SERVICES. IN ADDITION TO GENERAL HOSPITAL POPULATIONS, THE ORGANIZATION PROVIDES SERVICES TO PATIENTS WITH HIGHLY-SPECIALIZED NEEDS THAT ARE NOT AVAILABLE ELSEWHERE IN NEW HAMPSHIRE. MHMH IS THE STATE'S ONLY TERTIARY REFERRAL CENTER, PROVIDES THE STATE'S ONLY COMPREHENSIVE CANCER CENTER (NORRIS COTTON CANCER CENTER ~ NCCC), OPERATES THE ONLY LEVEL I TRAUMA CENTER IN NEW HAMPSHIRE, OPERATES THE ONLY COMPREHENSIVE CHILDREN'S HOSPITAL AND ACCREDITED PEDIATRIC TRAUMA CENTER IN NEW HAMPSHIRE (CHILDREN'S HOSPITAL AT DARTMOUTH - CHAD), HOSTS THE ONLY LEVEL IV NEONATAL INTENSIVE CARE NURSERY AND ONE OF TWO PEDIATRIC INTENSIVE CARE UNITS IN NEW HAMPSHIRE, AND OPERATES THE ONLY HELICOPTER TRANSPORT SERVICE IN THE STATE. AS SUCH, THE SERVICE POPULATION IS BOTH THE GENERAL PUBLIC SEEKING PRIMARY HEALTH CARE SERVICES AS WELL AS RESIDENTS WITH UNIQUE AND HIGHLY-SPECIALIZED HEALTH CARE NEEDS. Schedule H, Part VI, Line 5 Promotion of community health MHMH SUPPORTS ORGANIZATIONS AND INITIATIVES THAT FURTHER HEALTH BY STRENGTHENING AND DEVELOPING KEY COMMUNITY CAPACITIES TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. THIS INCLUDES HOSTING OR LEADING COMMUNITY PARTNERSHIPS TO ADDRESS SUBSTANCE MISUSE AND TREATMENT AND TO IMPROVE PUBLIC HEALTH; PROVIDING FUNDING FOR CHILD AND ADULT ORAL HEALTH INITIATIVES, AND PARTICIPATION OF OUR STAFF IN OTHER PARTNERSHIPS INCLUDING THE OUTPATIENT FALLS PREVENTION TASK FORCE, THE TRANSPORTATION MANAGEMENT ASSOCIATION, AND THE UPPER VALLEY HOUSING COALITION. IN ADDITION, MHMH OPERATES HEALTH EDUCATION AND SUPPORT SERVICES SUCH AS A WOMEN'S HEALTH RESOURCE CENTER, THE AGING RESOURCE CENTER, AND A HEALTH EDUCATION CENTER. MHMH USES CASH CONTRIBUTIONS, CONTRACTED SERVICES, AND IN KIND CONTRIBUTION OF STAFF TIME AND EXPERTISE, TO SUPPORT THESE STRATEGIES WHICH IMPROVE COMMUNITY HEALTH. AT MHMH'S LEBANON, NH CAMPUS, THE HOSPITAL EXTENDS PROFESSIONAL STAFF PRIVILEGES TO QUALIFIED AND APPROPRIATE PHYSICIANS WHO ARE EMPLOYEES OF DARTMOUTH HITCHCOCK CLINIC, MARY HITCHCOCK MEMORIAL HOSPITAL, AND DARTMOUTH COLLEGE, WHO ALSO HOLD A FACULTY APPOINTMENT AT GEISEL SCHOOL OF MEDICINE. MARY HITCHCOCK'S TRUSTEES ANNUALLY SET STRATEGIC PRIORITIES FOR THE INSTITUTION AND APPROVE OPERATING AND CAPITAL BUDGETS WHICH SUPPORT IMPROVEMENTS, PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. EXAMPLES OF THESE INVESTMENTS INCLUDE THE DEVELOPMENT OF MARY HITCHCOCK'S PATIENT SAFETY AND TRAINING CENTER; ONGOING QUALITY AND PATIENT SAFETY INITIATIVES; PURCHASES OF NEW AND EMERGING MEDICAL TECHNOLOGIES; SUPPORT TRANSLATIONAL RESEARCH, AND MEDICAL EDUCATION OF THE 21 VOTING MEMBERS OF THE MARY HITCHCOCK BOARD OF TRUSTEES AT FY20 END, 14 ARE NEITHER CONTRACTORS NOR EMPLOYEES OF MHMH . Schedule H, Part VI, Line 6 Affiliated health care system COMMUNITY BENEFITS ARE PROVIDED BY THE DARTMOUTH HITCHCOCK HEALTH CARE SYSTEM, WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, AND OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IN LEBANON IS NEW HAMPSHIRE'S LARGEST HOSPITAL. IN FISCAL YEAR 2020 MHMH HAD 396 LICENSED INPATIENT BEDS. THE DARTMOUTH-HITCHCOCK CLINIC (DHC) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE WITH A NETWORK OF PROVIDERS ACROSS NEW HAMPSHIRE AND VERMONT. WHILE DHC'S MAIN OFFICES ARE LOCATED IN LEBANON, THE CLINIC ALSO HAS MULTI-SPECIALTY PRACTICES IN MANCHESTER, NASHUA, CONCORD, AND KEENE, NH AREAS AS WELL AS BENNINGTON, VT. IN ADDITION, THE CLINIC PROVIDES PRIMARY CARE IN RURAL COMMUNITIES IN VERMONT AND NORTHERN NEW HAMPSHIRE. THE HOSPITAL AND CLINIC OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING AND MANAGEMENT AND SHARE IDENTICAL MISSIONS. THE MEDICAL SCHOOL, WHICH WORKS CLOSELY WITH THE HOSPITAL AND CLINIC, IS FOCUSED ON MEDICAL EDUCATION AND RESEARCH. Schedule H, Part VI, Line 7 State filing of community benefit report NH true Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 501(c)(3) 91445 FMV PROGRAM SUPPORT American Cancer Society 2 Commerce Drive Suite 110 Bedford NH 03110 131788491 501(c)(3) 28440 FMV PROGRAM SUPPORT American Heart Association PO Box 4002012 Des Moines IA 503402012 135613797 501(c)(3) 24840 FMV PROGRAM SUPPORT Amoskeag Health 145 Hollis Street Manchester NH 03101 020458174 501(c)(3) 39600 FMV PROGRAM SUPPORT ANDERSON ORTHOPEDIC RESEARCH INSTITUTE 2501 PARKERS LN ALEXANDRIA VA 22306 237162048 501(c)(3) 12114 FMV CHARITABLE RESEARCH APPLIED GEOSOLUTIONS LLC 15 NEWMARKET ROAD DURHAM NH 03824 020518753 22550 FMV PROGRAM SUPPORT ATRIUM HEALTH CAROLINAS HEALTHCARE SYSTEM CHARLOTTE NH 282601979 560529945 501(c)(3) 31140 FMV CHARITABLE RESEARCH Bipartisan Policy Center Inc 1225 I Street NW Washington DC 02005 731628382 501(c)(3) 18000 FMV PROGRAM SUPPORT BOSTON MEDICAL CENTER 52 RATTLESNAKE HILL RD ANDOVER MA 01810 043314093 501(c)(3) 20074 FMV CHARITABLE RESEARCH BOSTON UNIVERSITY PO BOX 28763 NEW YORK NY 100878763 042103547 501(c)(3) 173863 FMV CHARITABLE RESEARCH BRD OF REGENTS UNIV OF OK HLTH SCIENCE ROOM 2B02 TULSA OK 741352512 731563627 St. of OK 40875 FMV EDUCATIONAL SERVICES BRIGHAM AND WOMEN'S HOSPITAL INC NURSING PROF DEVELOPMENT BOSTON MA 02115 042312909 501(c)(3) 140909 FMV CHARITABLE RESEARCH Business and Industry Association 122 North Main Street Concord NH 03301 020172300 501(c)(3) 9720 FMV PROGRAM SUPPORT CASE WESTERN RESERVE UNIVERSITY DEPT OF GENETICS GENOME SCIENCES CLEVELAND OH 441064948 341018992 501(c)(3) 8805 FMV CHARITABLE EDUCATIONAL SERVICES CEDARS-SINAI MEDICAL CENTER 6500 WILSHIRE BLVD SUITE 1150 LOS ANGELES CA 90048 951644600 501(c)(3) 204162 FMV CHARITABLE RESEARCH CENTERSTONE OF KENTUCKY INC 10101 LINN STATION RD LOUISVILLE KY 40223 310939757 501(c)(3) 43313 FMV CHARITABLE RESEARCH CENTERSTONE RESEARCH INSTITUTE 44 VANTAGE WAY SUITE 280 NASHVILLE TN 37228 262505456 501(c)(3) 153906 FMV CHARITABLE RESEARCH Cheshire Medical Center 580 Court St 590 Keene NH 03431 020354549 501(c)(3) 383753 FMV PROGRAM SUPPORT CLEVELAND CLINIC FOUNDATION ATTN STACIE PALLOTTA CLEVELAND OH 44195 340714585 501(c)(3) 82940 FMV CHARITABLE RESEARCH Colby Sawyer College 541 Main Street New London NH 03257 020222120 501(c)(3) 750000 FMV PROGRAM SUPPORT COMMONWEALTH OF MASSACHUSETTS DEPT OF REVENUE BOSTON MA 022055140 046002284 St. of MA 222875 FMV EDUCATIONAL SERVICES COMMUNITY MENTAL HEALTH AFFILIATES INC 270 JOHN DOWNEY DR NEW BRITAIN CT 06051 060934544 501(c)(3) 28873 FMV CHARITABLE PROGRAM SUPPORT CONCORD HOSPITAL 250 PLEASANT ST CONCORD NH 03301 222594672 501(c)(3) 8509 FMV CHARITABLE PROGRAM SUPPORT COOS COUNTY FAMILY HEALTH SERVICES 133 PLEASANT STREET BERLIN NH 03570 020350051 501(c)(3) 12593 FMV CHARITABLE PROGRAM SUPPORT Counseling Assoc of New London LLC 35 Newport Road New London NH 03257 201917474 501(c)(3) 111874 FMV PROGRAM SUPPORT CREARE LLC 16 GREAT HOLLOW RD HANOVER NH 03755 020259551 7191 FMV PROGRAM SUPPORT Crotched Mountain 1 Verney Drive Greenfield NH 03047 222541478 501(c)(3) 14256 FMV PROGRAM SUPPORT Easter Seals of NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 37168 FMV PROGRAM SUPPORT Families Flourish Northeast 235 Whitford Street Manchester NH 03104 844591232 501(c)(3) 36000 FMV PROGRAM SUPPORT Families in Transition 122 Market St Manchester NH 03101 020475414 501(c)(3) 63810 FMV PROGRAM SUPPORT Family Place Inc 319 US Route 5 South Norwich VT 05055 030305264 501(c)(3) 42521 FMV PROGRAM SUPPORT FEINSTEIN INSTITUTES FOR MEDICAL RESEARC 350 COMMUNITY DRIVE MANHASSET NY 11030 112673595 501(c)(3) 23777 FMV CHARITABLE RESEARCH Foundation for Healthy Communities (NHHA) 125 Airport Road Concord NH 03301 020275078 501(c)(3) 1004346 FMV PROGRAM SUPPORT Good Neighbor Health Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 46800 FMV PROGRAM SUPPORT Grafton County Senior Citizens Council 10 Campbell St Lebanon NH 03766 237248316 501(c)(3) 12960 FMV PROGRAM SUPPORT Grafton Regional Development Corporation 131 Main Street Plymouth NH 03264 043373604 501(c)(3) 10440 FMV PROGRAM SUPPORT Granite United Way 22 Concord Street Floor 2 Manchester NH 03101 026006033 501(c)(3) 14400 FMV PROGRAM SUPPORT GREATER NASHUA MENTAL HEALTH CENTER 100 WEST PEARL STREET NASHUA NH 03060 020222121 501(c)(3) 37747 FMV CHARITABLE PROGRAM SUPPORT GREATER SEACOAST COMMUNITY HEALTH 311 ROUTE 108 SOMERSWORTH NH 03878 020304203 501(c)(3) 5868 FMV CHARITABLE PROGRAM SUPPORT HARVARD UNIVERSITY HARVARD MED-CME BOSTON MA 021170825 042103580 501(c)(3) 5405 FMV CHARITABLE EDUCATIONAL SERVICES Headrest Inc 141 Mascoma St Lebanon NH 03766 237256865 501(c)(3) 33722 FMV PROGRAM SUPPORT HIVHCV Resource Center 2 Blacksmith Street Lebanon NH 03766 223104237 501(c)(3) 7200 FMV PROGRAM SUPPORT John Hopkins University Rubenstein Building Baltimore MD 21287 520595110 501(c)(3) 44885 FMV PROGRAM SUPPORT Keene Serenity Center 34 Mechanic Street Keene NH 03431 463123664 501(c)(3) 24473 FMV PROGRAM SUPPORT MAINE MEDICAL CENTER 22 BRAMHALL STREET PORTLAND ME 04102 010238552 501(c)(3) 87348 FMV CHARITABLE RESEARCH MAPS COUNSELING SERVICES 19 FEDERAL STREET KEENE NH 03431 020312473 501(c)(3) 8957 FMV CHARITABLE PROGRAM SUPPORT Mascoma Community Healthcare Inc 18 Roberts Road PO Box 550 Canaan NH 03741 465672753 501(c)(3) 10800 FMV PROGRAM SUPPORT MASSACHUSETTS GENERAL HOSPITAL 100 CHARLES RIVER PLAZA STE 600 BOSTON MA 021142792 042697983 501(c)(3) 84872 FMV CHARITABLE RESEARCH MAYFLOWER MEDICAL OUTREACH INC PO BOX 75449 OKLAHOMA CITY OK 73147 271245528 501(c)(3) 19803 FMV CHARITABLE RESEARCH MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 501(c)(3) 107521 FMV CHARITABLE RESEARCH MEDICAL UNIVERSITY OF SO CAROLINA 1 SOUTH PARK CIRCLE CHARLESTON SC 29407 576000722 St. of SC 136796 FMV EDUCATIONAL SERVICES MENTAL HLTH CTR OF GRTR MANCHESTER ATTN JOANN BATTY STAFF DEV MANCHESTER NH 03101 020258994 501(c)(3) 14767 FMV CHARITABLE PROGRAM SUPPORT MICHIGAN STATE UNIVERSITY 426 AUDITORIUM ROAD EAST LANSING MI 48824 386005984 St. of MI 25606 FMV EDUCATIONAL SERVICES Monadnock Area Peer Support Agency 64 Beaver Street Keene NH 03431 020484723 501(c)(3) 26705 FMV PROGRAM SUPPORT Monadnock Community Hospital 452 Old Street Rd Peterborough NH 03458 020222157 501(c)(3) 118968 FMV PROGRAM SUPPORT Monadnock Family Services 17 93rd Street Keene NH 03431 026012230 501(c)(3) 198847 FMV PROGRAM SUPPORT Monadnock United Way 23 Center Street Keene NH 03431 020236885 501(c)(3) 14400 FMV PROGRAM SUPPORT Mt Ascutney Hospital and Health Center 289 County Rd Windsor VT 05089 030183721 501(c)(3) 16200 FMV PROGRAM SUPPORT National Alliance on Mental Illness NH (NAMI) 85 No State Street Concord NH 03301 222760743 501(c)(3) 81931 FMV PROGRAM SUPPORT NEUROLOGY ASSOCIATES PA 331 N MAITLAND AVE MAITLAND FL 32751 591931548 24684 FMV CHARITABLE RESEARCH New Hampshire Catholic Charities 215 Myrtle Street Manchester NH 03104 020222163 501(c)(3) 10800 FMV PROGRAM SUPPORT New Hampshire Charitable Foundation 37 Pleasant Street Concord NH 03301 026005625 501(c)(3) 43200 FMV PROGRAM SUPPORT New Hampshire Coalition Against Domestic Violence PO Box 353 Concord NH 03302 020360151 501(c)(3) 18000 FMV PROGRAM SUPPORT New Hampshire Public Broadcast 268 Mast Road Durham NH 03824 943443883 501(c)(3) 14400 FMV PROGRAM SUPPORT New Hampshire Women's Foundation 18 Low Avenue Suite 205 Concord NH 03301 020495092 501(c)(3) 5616 FMV PROGRAM SUPPORT New London Hospital 273 Country Rd New London NH 03257 020222171 501(c)(3) 133209 FMV PROGRAM SUPPORT NORTHWESTERN UNIVERSITY DEPT OF MEDICAL SOCIAL SERVICES CHICAGO IL 60611 362167817 501(c)(3) 11876 FMV CHARITABLE EDUCATIONAL SERVICES OREGON CLINIC PC 847 NE 19TH AVENUE PORTLAND OR 97232 931127856 59242 FMV PROGRAM SUPPORT OREGON HEALTH & SCIENCE UNIVERSITY PO BOX 575 PORTLAND OR 97207 931176109 St. of OR 26466 FMV EDUCATIONAL SERVICES PENNSYLVANIA STATE UNIVERSITY 500 UNIVERSITY DRIVE HERSHEY PA 170330850 246000376 St. of PA 25746 FMV EDUCATIONAL SERVICES Planned Parenthood of Northern NE 784 Hercules Drive Colchester VT 05446 030222941 501(c)(3) 7370 FMV PROGRAM SUPPORT PROVIDENCE CENTER 528 NORTH MAIN STREET PROVIDENCE RI 02860 050316969 501(c)(3) 61962 FMV CHARITABLE RESEARCH PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY ONE COURT STREET LEBANON NH 03766 752991608 501(c)(3) 28862 FMV CHARITABLE PROGRAM SUPPORT Reality Check Inc 17 Turnpike Road Jaffrey NH 03452 263344553 501(c)(3) 30977 FMV PROGRAM SUPPORT RECTOR & VISITORS OF UNIV OF VIRGINIA JOHN W STEINKE CHARLOTTESVILLE VA 229081355 546001796 St. of VA 36154 FMV EDUCATIONAL SERVICES REGENTS OF THE UNIVERSITY OF CALIFORNIA UNIVERSITY OF CALIFORNIA SAN DIEGO LA JOLLA CA 920930009 943067788 St. of CA 35829 FMV EDUCATIONAL SERVICES REGENTS OF UNIV OF MICHIGAN DEPT OF PATHOLOGY BILLING ANN ARBOR MI 48109 386006309 St. of MI 117406 FMV EDUCATIONAL SERVICES RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL PO BOX 781653 DETROIT MI 48278 316056230 501(c)(3) 53484 FMV CHARITABLE RESEARCH Rock On Foundation 175 Canal Street Manchester NH 03101 461600795 501(c)(3) 7200 FMV PROGRAM SUPPORT Schwartz Center for Compassionate Health 205 Portland St 6th Floor Boston MA 02114 041564655 501(c)(3) 5040 FMV PROGRAM SUPPORT SEATTLE CHILDREN'S HOSPITAL PO BOX 24728 SEATTLE WA 981240728 910564748 501(c)(3) 45978 FMV CHARITABLE RESEARCH SECOND GROWTH INC PO BOX 206 HANOVER NH 03755 020519093 501(c)(3) 20714 FMV CHARITABLE PROGRAM SUPPORT SINAI HOSPITAL OF BALTIMORE INC 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 520486540 501(c)(3) 23031 FMV CHARITABLE RESEARCH Southwestern Community Services PO Box 603 / 63 Community Way Keene NH 03431 026013808 501(c)(3) 42338 FMV PROGRAM SUPPORT STANFORD UNIVERSITY 3145 PORTER DRIVE PALO ALTO CA 94305 941156365 501(c)(3) 30000 FMV CHARITABLE EDUCATIONAL SERVICES StayWorkPlay NH 235 Hanover Street Suite 1 Manchester NH 03101 270327032 501(c)(3) 10800 FMV PROGRAM SUPPORT Sullivan County 14 Main Street Newport NH 03773 026000870 501(c)(3) 86400 FMV PROGRAM SUPPORT The ALS Association 10 Ferry Street Concord NH 03301 133271855 501(c)(3) 5400 FMV PROGRAM SUPPORT THOMAS JEFFERSON UNIVERSITY 901 WALNUT ST PHILADELPHIA PA 19107 231352651 501(c)(3) 54921 FMV CHARITABLE EDUCATIONAL SERVICES TLC Family Resource Center PO Box 1098 Claremont NH 03743 522439830 501(c)(3) 53896 FMV PROGRAM SUPPORT Tri-Valley Transit 279 Creek Road Middlebury VT 05753 030335768 501(c)(3) 30600 FMV PROGRAM SUPPORT TRUSTEES OF DARTMOUTH COLLEGE 7 LEBANON STREET HANOVER NH 03755 020222111 501(c)(3) 1137577 FMV CHARITABLE EDUCATIONAL SERVICES TRUSTEES OF THE UNIV OF PENNSYLVANIA THE WHARTON SCHOOL PHILADELPHIA PA 191789726 231352685 St. of PA 24268 FMV EDUCATIONAL SERVICES Turning Points Network 11 School Street Claremont NH 03743 020350899 501(c)(3) 70181 FMV PROGRAM SUPPORT Twin Pines Housing Trust 226 Holiday Drive Suite 20 White River Junction VT 05001 222809527 501(c)(3) 28800 FMV PROGRAM SUPPORT UNIVERSITY OF ALABAMA AT BIRMINGHAM UAB SCHOOL OF NURSING BIRMINGHAM AL 352941210 636005396 St. of AL 58574 FMV EDUCATIONAL SERVICES UNIVERSITY OF ARIZONA PROJECTS CONTRACTING SERVICES TUCSON AZ 857190521 742652689 St. of AZ 13899 FMV EDUCATIONAL SERVICES UNIVERSITY OF COLORADO UCHSC DNA DIAGNOSTIC LAB AURORA CO 80045 846000555 St. of CO 29475 FMV EDUCATIONAL SERVICES UNIVERSITY OF MARYLAND BALTIMORE 220 ARCH STREET BALTIMORE MD 212011531 526002033 St. of MA 59139 FMV EDUCATIONAL SERVICES UNIVERSITY OF MIAMI DEPARTMENT OF PATHOLOGY ATLANTA GA 303845776 592695890 St. of FL 22035 FMV EDUCATIONAL SERVICES UNIVERSITY OF NEBRASKA MEDICAL CTR 985045 NEBRASKA MED CTR OMAHA NE 681985045 470491233 St. of NE 21020 FMV EDUCATIONAL SERVICES UNIVERSITY OF NEW HAMPSHIRE 51 COLLEGE ROAD DURHAM NH 03824 026000937 St. of NH 27113 FMV EDUCATIONAL SERVICES UNIVERSITY OF TEXAS AT AUSTIN VALUE INSTITUTE ATTN ROBERT CROSS AUSTIN TX 78712 746002003 St. of TX 50864 FMV EDUCATIONAL SERVICES UNIVERSITY OF VERMONT DEPT OF PEDIATRICS BURLINGTON VT 054050068 030179440 St. of VT 172897 FMV EDUCATIONAL SERVICES UNIVERSITY OF WASHINGTON GRANT CONTRACT ACCOUNTING CHICAGO IL 60693 916001537 St. of WA 53041 FMV EDUCATIONAL SERVICES Upper Valley Community Nursing Project PO Box 1302 Lebanon NH 03766 831224873 501(c)(3) 10800 FMV PROGRAM SUPPORT Upper Valley Habitat for Humanity PO Box 1038 White River Junction VT 05001 030306081 501(c)(3) 15404 FMV PROGRAM SUPPORT Upper Valley Haven 713 Hartford Ave White River Junction VT 05001 030277908 501(c)(3) 58050 FMV PROGRAM SUPPORT Valley Regional Hospital 243 Elm Street Claremont NH 03743 020222118 501(c)(3) 239538 FMV PROGRAM SUPPORT Vermont Medical Society 134 Main Street Montpelier VT 05601 030164911 501(c)(6) 5040 FMV PROGRAM SUPPORT VETERANS EDUCATION & RESEARCH ASSN OF NORTHERN NEW ENGLAND WHITE RIVER JUNCTION VT 05001 223091219 501(c)(3) 11470 FMV CHARITABLE RESEARCH VINFEN CORPORATION 950 CAMBRIDGE ST CAMBRIDGE MA 02141 042632219 501(c)(3) 61225 FMV CHARITABLE PROGRAM SUPPORT VIRGINIA COMMONWEALTH UNIVERSITY 800 E LEIGH STREET RICHMOND VA 23219 546001758 St. of VA 24577 FMV EDUCATIONAL SERVICES Vital Communities 195 North Main Street White River Junction VT 05001 030355283 501(c)(3) 24840 FMV PROGRAM SUPPORT West Central Behavioral Health 9 Hanover Street Lebanon NH 03766 222645978 501(c)(3) 231755 FMV PROGRAM SUPPORT WEST VIRGINIA UNIVERSITY RESEARCH CORPOR ONE WATERFRONT PLACE MORGANTOWN WV 265066001 550665758 St. of WV 16434 FMV EDUCATIONAL SERVICES Willing Hands Enterprises PO Box 172 Lebanon NH 03766 202204811 501(c)(3) 43560 FMV PROGRAM SUPPORT Women's Information Service of the Upper Valley 38 Bank Street Lebanon NH 03766 020346512 501(c)(3) 50400 FMV PROGRAM SUPPORT Woodstock Area Council on Aging 99 Senior Lane Woodstock VT 05091 030295419 501(c)(3) 14400 FMV PROGRAM SUPPORT Visiting Nurse Association and Hospice of Vermont and New Hampshire Inc 88 Prospect St White River Junction VT 05001 036006494 501(c)3 132200 FMV PROGRAM SUPPORT 116 4 Awards and Educational Assistance 78 896752 FMV D-H tuition Reimbursement Programs 400 833859 FMV Patient Assistance 792 42727 FMV CHARITABLE RESEARCH 1 52592 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) 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 AWARDS. THE COORDINATORS OF THE PROGRAM ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. X true true false true false false false false false false false Joanne M Conroy MD Trustee, Ex-Officio, CEO 0 1030023 0 184500 0 141998 0 26955 0 26945 0 1410421 0 0 Jocelyn Chertoff MD VP Service Line / DPT CHR Diagnostic Radiology 0 644951 0 0 0 57897 0 26955 0 15649 0 745452 0 0 Cherie Holmes MD Trustee 0 446943 0 1000 0 37402 0 26955 0 28344 0 540644 0 0 Kari M Rosenkranz MD Trustee (through 12/2019) / Physician 0 500097 0 0 0 22872 0 21355 0 14989 0 559313 0 0 Jon Wahrenberger MDFAHAFAC Trustee 0 336765 0 0 0 18720 0 26955 0 38313 0 420753 0 0 KURT K RHYNHART MD TRUSTEE 0 453257 0 0 0 38380 0 21355 0 20930 0 533922 0 0 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (EFFECTIVE 1/1/20) 0 384586 0 0 0 33393 0 21355 0 35758 0 475092 0 0 Richard I Rothstein MD Former Dept. Chair / Service Line LDR - MED 0 593894 0 0 0 87479 0 26955 0 30285 0 738613 0 0 Aimee M Claiborne Chief HR Officer 371431 0 45600 0 35807 0 12813 0 35401 0 501052 0 0 0 DANIEL P JANTZEN CPA Chief Financial Officer 643403 0 80400 0 97958 0 26955 0 29778 0 878494 0 0 0 Patrick F Jordan III MBA Chief Operating Officer 654825 0 80400 0 35008 0 21355 0 42779 0 834367 0 0 0 JOHN KACAVAS Chief Legal Officer 586982 0 74400 0 53606 0 23617 0 34240 0 772845 0 0 0 Stephen Leblanc Chief Strategy Officer 0 662188 0 80400 0 85671 0 26955 0 25378 0 880592 0 0 EDWARD MERRENS Chief Clinical Officer 0 648460 0 80400 0 65921 0 26955 0 16267 0 838003 0 0 Maria Padin MD Chief Medical Officer 0 394016 0 0 0 36908 0 26955 0 37687 0 495566 0 0 Susan A Reeves EDDRN Chief Nursing Executive 493481 0 60350 0 24091 0 26955 0 29490 0 634367 0 0 0 Martin Purcell MBA Chief Information Officer 385271 0 0 0 26183 0 26955 0 26075 0 464484 0 0 0 Matthew Haag VP Development 352781 0 0 0 19014 0 21355 0 14425 0 407575 0 0 0 Wendy Fielding MBA FMR KEY EMP / VP FINANCE PLANNING 263381 0 0 0 19414 0 21355 0 32761 0 336911 0 0 0 Christine Schon MPA FMR KEY EMP/ ADM VP PRMRY CARE 0 262978 0 2000 0 29513 0 26955 0 29264 0 350710 0 0 Wendy Wells MD FMR KEY EMP / DPT CHR PATHOLOGY 0 548491 0 0 0 48377 0 26955 0 23603 0 647426 0 0 Sandra Wong MD SVP SVC LN & Chair of Surgery 0 653814 0 0 0 66525 0 21355 0 11848 0 753542 0 0 GEORGE T BLIKE MD Chief Quality & Value Officer 0 433049 0 0 0 41698 0 26955 0 37199 0 538901 0 0 Karen Clements RNBSNMSB Chief Nursing Officer 333940 0 250 0 26779 0 21355 0 12166 0 394490 0 0 0 Staci Hermann PHARMDMS Chief Pharmacy Officer 260616 0 0 0 24661 0 12813 0 14277 0 312367 0 0 0 Simon Hillier Dept. Chair - Anesthesiology 0 516806 0 0 0 48617 0 26955 0 30401 0 622779 0 0 Jeffrey Obrien MHA VP Clinical Operations 343917 0 0 0 27038 0 26955 0 32978 0 430888 0 0 0 Peter D Solberg MD Chief Medical Information Officer 0 369462 0 0 0 21310 0 25455 0 35274 0 451501 0 0 Tina E Naimie CPA VP CORP FINANCE 273632 0 0 0 11143 0 21355 0 1821 0 307951 0 0 0 Kimberly Troland JD Deputy Gen Counsel 365343 0 0 0 32394 0 21355 0 20849 0 439941 0 0 0 BRUCE KING PRES/CEO NEW LNDN HOSPITAL (Through 3/2020) 319769 0 0 0 48508 1219 26955 0 29659 0 424891 1219 0 0 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 308219 0 0 0 25984 0 26955 0 28008 0 389166 0 0 0 Leigh Burgess VP RESEARCH OPS 332384 0 0 0 14550 0 21355 0 30626 0 398915 0 0 0 Schedule J, Part II NOTE REGARDING COMPENSATION FORM 990, SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY MHMH 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 III SPLIT DOLLAR LIFE PLAN MHMH SPONSORS A SPLIT DOLLAR LIFE PLAN FOR CERTAIN LONG-TERM EMPLOYEES. THE ORIGINAL OBJECTIVES FOR OFFERING THESE PLANS WERE TO BETTER ENABLE 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 IN 1998 AND THEREFORE NO FURTHER COSTS OF THE INDIVIDUAL EMPLOYEE INSURANCE PREMIUMS HAVE BEEN FUNDED BY THE ORGANIZATION. 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: DANIEL JANTZEN $130,828 STEPHEN LEBLANC $59,434 RICHARD ROTHSTEIN $102,290 Schedule J, Part I, Line 3 Compensation of the CEO The CEO is paid by Dartmouth Hitchcock Clinic, a related organization, which uses a compensation committee, an independent compensation consultant, a compensation survey or study, and approval by the board or compensation committee to establish the CEO's compensation. 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 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC (DHC), A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION. 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: DANIEL JANTZEN $130,828 STEPHEN LEBLANC $59,434 RICHARD ROTHSTEIN $102,290 A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 6646142B4 2014-08-13 41242990 REFUND ISSUE DATED 08/19/2009 false false false B NH HEALTH AND ED FACILITIES AUTHORITY 020279866 000000000 2016-07-01 35575000 SEE PART VI false false false A 7195000 41242990 352990 40890000 2014 true false true true B 24605000 35575000 408058 15936616 19230326 2017 true false true true A false false false false 0.0 0.0 0.0 false false true B false true false false 0.0 0.0 0.0 false false true A false true false false false false false false true B false true false false false false false false true A true B true Schedule K, Part I, Column (f) Bond B THE PURPOSE OF THE ISSUE WAS TO REFUND AN ISSUE DATED 10/24/2013 AND FINANCE CAPITAL PROJECTS. DANIEL JANTZEN OFFICER SPLIT DOLLAR LIFE X 0 130828 false true true DEBORAH JANTZEN FAMILY MEMBER SPLIT DOLLAR LIFE X 0 65195 false true true 196023 Aimee Claiborne Officer of MHMH 12500 Tuition Assistance Education X 12 4327833 Market value 0 false true true Schedule M, Part I, Line 32b Third parties used to solicit, process, or sell noncash contributions THE ORGANIZATION USES DARTMOUTH-HITCHCOCK HEALTH, MHMH'S PARENT ORGANIZATION, FOR SOLICITATION OF CONTRIBUTIONS AND ANNUAL FUND ACTIVITIES. Schedule M, Part I Explanations of reporting method for number of contributions Securities - Publicly traded - MHMH is reporting the number of contributors of stock. Form 990, Part VI, Line 15a OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR UNDERTAKEN ALTHOUGH PAID BY A RELATED ORGANIZATION, DARTMOUTH-HITCHCOCK CLINIC, 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 CONSIDERATION WITH THE INDEPENDENT THIRD PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2020. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Mary Hitchcock Memorial Hospital (MHMH) board has a Governance Committee who has the authority/responsibility of the MHMH Board to ensure that MHMH 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) William J. Conaty (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 MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF MHMH'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL, AND OPERATIONAL DECISIONS OF MHMH'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 MHMH TO CREATE AND MAINTAIN AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF THE MISSION OF MHMH AND OTHER ORGANIZATIONS WITHIN THE SYSTEM. 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 MHMH'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF MHMH'S BOARD OF TRUSTEES, ASSESS MHMH A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE MHMH'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY MHMH, 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 MHMH. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS, THE DIRECTOR OF CORPORATE FINANCE, THE 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 FORM 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING. Form 990, Part VI, Line 12c Conflict of interest policy THE MARY HITCHCOCK MEMORIAL HOSPITAL BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) 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 TRUSTEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL 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 IN 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 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA (ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS). THE LAST FORMAL PROCESS WAS COMPLETED IN 2020. 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 - Radiology, Department Chair - Pathology and similar positions. Form 990, Part VI, Line 19 Required documents available to the public MHMH'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. 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 AND MARY HITCHCOCK MEMORIAL HOSPITAL'S AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS' FORMS 990 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 (THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC), AND/OR DARTMOUTH-HITCHCOCK CLINIC ALONG WITH OTHER AFFILIATED ORGANIZATIONS: DARTMOUTH-HITCHCOCK MEDICAL CENTER, HAMDEN RISK RETENTION GROUP (AND RELATED ENTITIES), ALICE PECK DAY MEMORIAL HOSPITAL, WINDSOR HOSPITAL CORPORATION (DBA MT ASCUTNEY HOSPITAL AND HEALTH CENTER), MT. ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER, CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION, VNA & HOSPICE OF VT AND NH, AND THE HITCHCOCK FOUNDATION. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue All Other - Total Revenue: 49171950, Related or Exempt Function Revenue: 43401016, Unrelated Business Revenue: 5770934, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSET TRANSFER FROM AFFILIATES - 6410826; PENSION-RELATED AND OTHER CHANGES - -17194641; NEW ENGLAND ALLIANCE FOR HEALTH LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264232401 HLTH IMPROVMT NH 122629 968403 MHMH D-H SPECIALTY SERVICES LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 460876427 SHD SVGS PRGM NH 0 0 MHMH DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYS SVCS NH 501(c)(3) 10 D-HH false DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORG 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 AND HOSPICE FOR VERMONT AND NEW HAMPSHIRE 88 Prospect Street White River Juction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false DARTMOUTH -HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTING ORG. NH 501(c)(3) Type I NA false DARTMOUTH-HITCHCOCK MASTER INVESTMENT PROGRAM OF POOLED INVESTMENT ACCOUNTS 1 MED CTR DR LEBANON NH 03756 020205863 POOLED INVEST NH MHMH Excluded 16299826 675012810 false -210862 true 0.7575 false true true false true false true false false true true true true true true true true true true