2018-05-15T15:23:34-05:00 2017-06-30 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2016-07-01 020354549 The Cheshire Medical Center % KATHRYN WILLBARGER CHES 6033545400 580-590 Court Street Keene NH 034315400 DON CARUSO CEO 6033545400 2018-05-15 Timothy R Hepburn P00182393 8002447444 2016 2022-09-23 18:48:47Z Don Caruso 580-590 Court Street Keene NH 034315400 205018210 false X www.cheshire-med.com X 1980 NH To lead Keene, NH to become the nation's healthiest community through clinical and service excellence, collaborations, and compassion for every patient, every time 18 10 1314 169 0 0 971455 1019827 162842712 200628728 115332 1442230 1696200 1927245 165625699 205018030 219946 1156399 0 0 75660041 121758429 0 0 0 94760044 84227294 170640031 207142122 -5014332 -2124092 134879963 126657747 74712747 63505786 60167216 63151961 X THE CHESHIRE MEDICAL CENTER IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE WITH A MISSION TO LEAD OUR COMMUNITY TO BECOME THE NATIONS HEALTHIEST COMMUNITY THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME. false false 176999289 1156399 202554537 The Cheshire Medical Center (CMC), is a community hospital located in Keene, New Hampshire. CMC is a not-for-profit organization, as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. On March 2, 2014, CMC affiliated with Dartmouth-Hitchcock Health ("D-HH") a non-profit tax-exempt corporation with a principal place of business at One Medical Center Drive, Lebanon, New Hampshire. Consistent with the D-HH vision and strategy to create a sustainable health system, CMC and D-HH share a common commitment to improving population health, value-based care, and creating new payment models for the benefit of the citizens of New Hampshire and Vermont. CMC provides a broad range of patient services and health related community services, consistent with its role as a community hospital. These include a full range of services in both acute and critical medicine, surgery, and rehabilitation. During FY17 CMC provided 19,147 days of inpatient care and had 4,154 hospital discharges, while the emergency department was open to the public 24 hours per day, 7 days per week and had 22,964 patient visits. Each year Cheshire Medical Center files an annual Community Benefit Report with the State of New Hampshire which outlines the community and charitable benefits they provide. The most recent Community Benefit Reports are available upon request or can be found on Cheshires website (http://www.cheshire-med.com/about_us/communityben_report.html). The Community health activities include the cost or value of several different types of programs including the cost of community based education programs, involving a variety of chronic disease and wellness topics such as: stress management and resiliency, nutrition, physical education and exercise, high blood pressure prevention and monitoring, diabetes prevention and monitoring, advanced directive planning, and others. In total, CMC provided over $8 million in Community Benefits including unreimbursed charity care, health services, health profession education, subsidized health services, and community-building activities. These contributions are in addition to the over $25 million dollars in unreimbursed Medicaid and Medicare costs absorbed by CMC. 176999289 true true false true false false false false false true true true false false true false false true false false true false false false false false true true true true true true false false false false false false false true true false false false false false false true true true false false true 178 0 true 1314 true false false false false false false false false false false X 18 10 true false false false true true true true true false false true true true true true true true false false NH X KATHRYN WILLBARGER 6033545454 580-590 COURT STREET Keene NH 034315400 Ed Bergeron Jr Trustee end 1/1/17 1.0 0.0 X 0 0 0 John Birkmeyer MD Trustee end 10/14/16 1.0 60.0 X 0 881467 39333 Judith Boule MD Trustee end 1/1/17 1.0 40.5 X 0 318698 285605 H Roger Hansen Trustee/Vice Chair 1.0 1.5 X X 0 0 0 Nathalie Houder Trustee/Treasurer 1.0 0.5 X X 0 0 0 Michael Kapiloff Trustee 1.0 0.0 X 0 0 0 Geof Molina Trustee 1.0 0.0 X 0 0 0 Steven Paris MD Trustee/At Large eff 1/1/17 1.0 41.01 X 0 419708 51805 Leslie Pitts MD Trustee 1.0 40.0 X 0 311687 206097 Kary Shumway Trustee 1.0 0.0 X 0 0 0 Katherine Snow Trustee/Secretary eff 1/1/17 1.0 1.0 X X 0 0 0 Sylvia McBeth Trustee end 1/1/17 1.0 0.0 X 0 0 0 Gregg Tewksbury CPA Trustee/Board Chair 2.0 0.5 X X 0 0 0 Mary Louise Caffrey Trustee/Bd Scrtry end 1/1/17 1.0 0.5 X X 0 0 0 Don Caruso MD Trustee/CEO 1.0 42.0 X X 0 481452 245158 Cherie Holmes MD Trustee/Ex-Officio 1.0 40.0 X 0 420601 124316 Wendy Fielding Trustee 1.0 40.0 X 0 236246 39755 Timothy Fisher MD Trustee end 1/1/17 1.0 40.0 X 0 355429 42897 Maria Padin Trustee eff 1/1/17 1.0 61.0 X 0 409356 197804 Anne Huot Trustee eff 1/1/17 1.0 0.0 X 0 0 0 Martha Landry Trustee eff 1/1/17 1.0 0.0 X 0 0 0 John Round Trustee eff 1/1/17 1.0 0.0 X 0 0 0 Andrew Tremblay MD Trustee eff 1/1/17 1.0 40.0 X 0 289219 58272 Jennifer DiNubila DO Trustee eff 1/1/17 1.0 40.0 X 0 354876 34709 Robert Cochrane CFO End 2/28/2017 51.0 2.0 X 296476 0 21666 Cindi Coughlin CNO 40.0 0.0 X 220836 0 115253 Kathryn Willbarger VP Finance eff 3/1/17 40.0 0.0 X 120771 0 30759 Paul Pezone VP Facilities & Support Srvcs 40.0 0.0 X 202370 0 24839 Julie Green VP Human Resources 40.0 0.0 X 202458 0 29316 Erli Chen Physicist 40.0 0.0 X 227194 0 44742 Latasha Heape Chief CRNA 50.0 0.0 X 168596 0 23370 Jose Montero VP Pop Hlth/Sys End 11/13/16 40.0 0.0 X 219110 0 23408 Denis Fortier Director of Pharmacy 40.0 0.0 X 152722 0 32920 Peter Malloy CIO End 2/3/17 40.0 0.0 X 151485 0 17985 Arthur W Nichols Former President 0.0 0.0 X 506030 0 73485 2468048 4478739 1763494 45 true true false Fresenius Management Services 16343 Collections Center Drive CHICAGO IL 60693 Dialysis Service 235971 The MacMillin Company LLC 17 Elm Street KEENE NH 03431 Construction 280924 Experis US Inc 29973 Network Place CHICAGO IL 60673 Staffing Service 209781 Biofire Diagnostics LLC PO Box 581463 SALT LAKE CITY UT 84158 Diagnostic Testing 199205 KE Bergeron Mechanical PO Box 48 DUBLIN NH 03444 Construction 180503 17 338618 384392 296817 1019827 NET PATIENT SERVICE REVENUE 621300 198766540 198766540 PHARMACY AND DRUGS 446110 569535 569535 FOOD SERVICES 722210 1085559 1085559 MISCELLANEOUS HEALTH SERVICES 621300 81749 81749 GIFT SHOP INCOME 453220 113274 113274 12071 12071 200628728 1100697 1100697 0 0 1616 180 0 1436 1436 1436 336533 5000 336533 5000 341533 341533 0 0 0 0 0 0 0 0 0 MEANINGFUL USE 621300 168350 168350 CHILDCARE INCOME 624410 660714 660714 REBATES AND DISCOUNTS 621300 702179 702179 394566 394566 1925809 205018030 202554537 1443666 X 340119 340119 816280 816280 0 0 1912663 1564558 348105 437802 437802 86351819 70635788 15716031 2079523 1701050 378473 27207708 22255905 4951803 3768914 3082972 685942 0 103142 84370 18772 69690 57006 12684 17835 17835 0 45100 45100 16262852 13303013 2959839 777920 636339 141581 1578199 1290967 287232 0 0 8692825 7110731 1582094 254594 208258 46336 0 78400 78400 1019078 833606 185472 0 10345816 8462877 1882939 669779 547879 121900 MEDICAL SUPPLIES 33039596 33039596 MET AND PILOT TAXES 8140932 8140932 FOOD AND CAFETERIA EXPENSES 1011603 1011603 CHILD CARE EXPENSES 829286 678356 150930 1290647 1055749 234898 207142122 176999289 30142833 0 15651110 10644911 0 0 0 0 17351293 17222925 0 0 0 0 0 0 2895599 3135600 2111297 1953881 211371961 146438926 71445933 64933035 20406022 23868744 944847 0 2067141 1008141 286667 179167 1720054 3711343 134879963 126657747 8296967 6276717 0 0 0 101463 28037718 26964602 0 0 0 0 0 0 0 0 38378062 30163004 74712747 63505786 X 55694213 58249962 4473003 4901999 0 0 60167216 63151961 134879963 126657747 X -2124092 2138448 2970389 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 17835 17835 false Form 990 Schedule C, Part II B, Line 1I Cheshire Medical Center 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. 4542620 209216 175241 66580 4860497 4646853 264489 60023 428745 4542620 4487520 968233 414873 1223773 4646853 3602059 272723 929038 316300 4487520 3055274 234785 688499 376499 3602059 1.00000 false false 231151 231151 90282038 51036067 39245971 3262455 2596095 666360 117593317 92806765 24786553 3000 3000 64933035 0 PENSION LIABILITY 14311503 DUE TO RELATED PARTY 11882096 RESERVES FOR INSURANCE RELATED 1279929 ESTIMATED THIRD PARTY SETTLEME -766406 ACCRUED EARNED TIME 3455882 30163004 Intended uses of Endowment Funds Form 990, Schedule D, Part V, Line 4 The intended use of the endowment funds is to promote and advance mission-related programs of The Cheshire Medical Center. Central America and the Caribbean Investments 2586365 North America Investments 1527162 4113527 4113527 false false true true false false Activities per region Form 990, Schedule F, Part I, Line 3 The legal owner of The Cheshire Medical Center's foreign investments is a related organization, The Cheshire Health Foundation. Since a portion of the total foreign investments are allocated to the Medical Center's assets on the financial statements, those allocated investments have been disclosed on Schedule F, Part I, line 3 of The Cheshire Medical Center's Form 990. However, any required IRS Forms 926 and other foreign tax reporting obligations are filed by the legal owner, The Cheshire Health Foundation. Ownership interest in a foreign corporation Form 990, Schedule F, Part IV, Line 3 The Cheshire Medical Center did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 are not required to be filed. Direct or Indirect shareholder of a PFIC or QEF during the tax year Form 990, Schedule F, Part IV, Line 4 The Cheshire Medical Center meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Medical Center. true true true X 225. true X true true false true true 1291391 638941 652450 0.00310 26593809 22980444 3613365 0.01740 27885200 23619385 4265815 0.02050 2567549 458110 2109439 0.01020 1422873 1422873 0.00690 1226562 452601 0.00220 210220 6233 203987 0.00100 432610 432610 0.00210 5859814 464343 4621510 0.02240 33745014 24083728 8887325 0.04290 1 2965 285522 174318 111204 0.00080 3 3242 131918 58666 73252 0.00030 1 139719 139719 5 6207 557159 232984 324175 0.00110 true 5212169 1303042 65188433 87491655 -22303222 X true true 1 1 Cheshire Medical Center 580 Court Street Keene NH 03431 www.cheshire-med.com 00014 X X X Cheshire Medical Center 1 false false true X X X X X X X X X 15 true true true true X See Part V, Section C X true 15 true See Part V, Section C false true X 225. 300. X X X X X true true X X X X true X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X true X false X X X X true X false false Input from persons representing broad community interests Form 990, Schedule H, Part V, Section B, Line 5 Needs were prioritized based on data collected from several current assessment processes. Prioritization was completed by CHNA Leadership team. Several hundred people participated in forums and surveys to identify needs. CHNA conducted with one or more organizations Form 990, Schedule H, Part V, Section B, Line 6A & 6B The Cheshire Medical Center collaborated with Dartmouth-Hitchcock Clinic and Mary Hitchchcock Memorial Hospital; New Hampshire Department of Health and Human Servces; Greater Monadnock Public Health Network; The New Hampshire Hospital Association; Foundation for Healthy Communities; Antioch University New England; Monadnock United Way; New Hampshire Center for Public Policy Studies; Southwestern Regional Planning Commission; and Home Healthcare, Hospice, and Community Services. Community health needs assessment public availability FORM 990, SCHEDULE H, PART V, SECTION B, LINE 7a The Cheshire Medical Center's 2015 CHNA is available on the Medical Center's website at: http://www.cheshire-med.com/about_us/communityben_report.html Community health needs implementation strategy FORM 990, SCHEDULE H, PART V, SECTION B, LINE 10a The Cheshire Medical Center's 2015 CHNA Implementation Strategy is available on the Medical Center's website at: http://www.cheshire-med.com/about_us/communityben_report.html Community health needs identified FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11 The Cheshire Medical Center has implemented strategies to address all but two of the needs identified in its most recent CHNA. Access to behavioral health outpatient services is addressed by Community Partners Monadnock Family Services, Phoenix House, and MAPS Counseling Services. Expansion of personal and public transportation options is addressed by Community Partners Monadnock Regional Transportation Management Association, Home Healthcare Hospice and Community Services, and Southwest Regional Planning Commission. Method for applying for financial assistance Form 990, Schedule H, Part V, Section B, Line 15e The contact information for hospital facility staff available on the website (www.cheshire-med.com/patients_visitors/financial_assistance.html), in the supplemental FAP Brochure, and at all registration stations within the Medical Center. Measures to publicize the Financial Assistance Policy Form 990, Schedule H, Part V, Lines 16a, b, c, and i The Cheshire Medical Center's Financial Assistance Policy is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html The Cheshire Medical Center's FAP application is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html The Cheshire Medical Center's Plain Language Summary was available at all registration desks and by request and is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html Maximum charges to financial assistance policy eligible individuals Form 990, Schedule H, Part V, Section B, Line 22d The state of New Hampshire mandates a discount for all uninsured patients. This discount is equal to the average discount negotiated by the largest (by dollar) three commercial insurers. The Cheshire Medical Center has always been in full compliance with the laws of the state New Hampshire, and a committee is in place to ensure the hospital is in full compliance with final 501(r) regulations in areas where federal regulations differ from or are more stringent than those issued by the state. For fiscal year 2017, the uninsured discount rate was 45%. 2 Cheshire Med Center Collecting Station 580-590 Court Street Keene NH 03431 Collecting Station Cheshire Health Services Inc 580-590 Court Street Keene NH 03431 Non-Emergency Walk In Clinic Community Building Activities Form 990, Schedule H, Part II The Medical Center has been actively engaged since the spring of 2006 in Healthy Monadnock (HM) 2020: to make Keene and the surrounding region the healthiest in the nation by the year 2020. Healthy Monadnock is a community engagement initiative designed to foster and sustain a positive culture of health through the Monadnock region. The initiative engages individuals, organizations, and partners to increase healthy eating and active living, increase income and jobs, improve mental wellbeing, increase emergency preparedness, reduce substance misuse including tobacco, increase educational attainment and increase access and quality of healthcare. The Healthy Monadnock website links the Community Health Improvement Plan, invites the public to get involved, and promotes partner strategies and successes. The Healthy Monadnock initiative supports the implementation of population level environmental strategies that promote wellness and prevent the leading causes of death in the community. The "Champions Program" engages individuals, schools, and organizations to take steps to improve health at a personal and institutional level. As of June 30, 2017 there are 3,582 individual champions, 182 organizational champions, and 25 school champions. Individuals are either improving their personal health or working in support of the Healthy Monadnock goals and strategies. Organizations and schools are working to implement evidence based environmental and policy chnages that supports the health of their employees/students. There are 10 community partners involved in forwarding 11 of the 21 HM action strategies to improve healthy eating and active living in the places where we live, learn, work, and play. Partner identification and engagement is on-going to implement the remaining action strategies to increase educational attainment, improve income and jobs, improve quality and access to health care, and improve mental wellbeing. The organization is a founding member of the Council for Health Communities which has been in existence for over 20 years and has developed a variety of prevention, transportation, referral, and health promotion programs and now serves as the Public Health Advisory Council for the Monadnock Region. The purpose of the CHC is to lead the Healthy Monadnock community driven process for providing strategic directions, setting priorities, facilitating implementation, aligning activities, and ensuring evaluation that will improve health outcomes in the Greater Monadnock region. Membership is diverse, open to representatives from all institutions and organizations. It includes unaffiliated individuals, to allow for independent voices and real grass roots engagement. Bad Debt expense Form 990, Schedule H, Part III, Section A, Line 2 At cost bad debt expense of $5,212,169 is 37% of the bad debt reported on The Cheshire Medical Center's Audited Financial Statements, which totals $14,125,119. Estimated bad debt expense attributable to FAP eligible patients Form 990, Schedule H, Part III, Section A, Line 3 Cheshire Medical Center Management estimates that approximately 25% of bad debt expense (approximately 5 times the region's poverty rate) is an appropriate estimation of patients who would have been eligible for the organization's financial assistance program but did not apply. This estimation is based on the recognition that the financial assistance program is available to residents with incomes of up to three times the federally defined poverty income levels and the assumption that patients who choose not to pay their bills are more likely to fall within the lower income levels. For 2017, the estimated amount of bad debt expense (at cost) attributable to patients who would have been eligible for financial assistance is $1,303,042. Financial statement footnote describing bad debt expense Form 990, Schedule H, Part III, Section A, Line 4 Footnote 1: Charity Care and Provision for Bad Debts The Health System provides care to patients who meet certain criteria under their financial assistance policies without charge or at amounts less than their established rates. Because the Health System does not anticipate collection of amounts determined to qualify as charity care, they are not reported as revenue. The Health System grants credit without collateral to patients. Most are local residents and are insured under third-party arrangements. Additions to the allowance for uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for bad debts is based upon managements assessment of historical and expected net collections, business and economic conditions, trends in federal and state governmental healthcare coverage, and other collection indicators (Notes 1 and 4). Footnote 4: Accounts receivable are reduced by an allowance for estimated uncollectibles. In evaluating the collectability of accounts receivable, the Health System analyzes past collection history and identifies trends for several categories of self-pay accounts (uninsured, residual balances, precollection accounts and charity) to estimate the appropriate allowance percentages in establishing the allowance for bad debt expense. Management performs collection rate look-back analyses on a quarterly basis to evaluate the sufficiency of the allowance for estimated uncollectibles. Throughout the year, after all reasonable collection efforts have been exhausted, the difference between the standard rates and the amounts actually collected, including contractual adjustments and uninsured discounts, will be written off against the allowance for estimated uncollectibles. In addition to the review of the categories of revenue,management monitors the write offs against established allowances as of a point in time to determine the appropriateness of the underlying assumptions used in estimating the allowance for estimated uncollectibles. Medicare shortfalls Form 990, Schedule H, Part III, Section B, Line 8 The shortfall should be considered community benefit because The Cheshire Medical Center is the only hospital/medical center in Cheshire County, New Hampshire and is designated by CMS as a Medicare Dependent Hospital (MDH) due to greater than 60% of our average daily census being comprised of Medicare Patients. Our presence in the community allows the residents of Cheshire County, especially the elderly population, to receive comprehensive hospital and medical services close to home. Credit and Collection Policy Form 990, Schedule H, Part III, Section C, Line 9b Systems are in place to capture financial assistance accounts prior to a bill going to the patient. FAP eligible patients are not charged more than the amount generally billed. Needs Assessment Form 990, Schedule H, Part VI, Line 2 In 2016 (tax form year 2015), a Community Health Needs Assessment (CHNA) was completed with an implementation strategy identified for community benefit activities for the next three years. The Council for a Healthier Community (CHC) serves as the CHNA Leadership Team (see Attachment A: CHC Membership List). The CHC is the Public Health Advisory Council for the Greater Monadnock region. The primary purpose of the CHC is to provide a community framework that supports open communication and sets priorities for community collaboration and funding that encourages the health and wellness of the Greater Monadnock region. As such, their responsibilities include: Identifying and encouraging action planning to ensure community public health needs are met without unnecessary duplication - Supporting the needs assessments and data collection activities for the region - Advising and making recommendations, as appropriate, on funding opportunities. - Making recommendations within the Greater Monadnock region and to the state regarding priorities for service delivery based on needs assessments and data collection. The members of the CHNA Leadership Team represent the 33 towns in the Monadnock region. In addition, they represent, and are able to speak to the issues of our most vulnerable populations including the medically underserved and persons with low income. The 2016 CHNA report summarizes the work of the Council for a Healthier Community (CHC) and the collaborative efforts of other local groups to assess the needs of our region. This report is the compilation of work that occurred over the last three years, beginning in September of 2014 when the CHC reviewed the State Health Improvement Plan and identified regional assets and needs. The first Greater Monadnock Community Health Improvement Plan was finalized in September 2015, which serves as the foundation of this Community Health Needs Assessment. In addition, to ensure a comprehensive assessment and avoid duplication of efforts, the results of other community partners needs assessments were used to strengthen and support our process. The CHNA Leadership Team reviewed health and social well-being information from existing sources, recent assessments and neighboring service area CHNAs. They identified secondary data to review and then prioritized needs using a nominal group voting process. The results revealed five priority areas: - Behavioral Health: covering the full range of mental and emotional well-being; from daily stress and satisfaction to the treatment of mental illness - Substance & Alcohol Misuse: pose some of the greatest risks to individuals and community health and safety - Tobacco use: the most preventable cause of death - Obesity: increases the risk for many chronic diseases and impacts 25% of the regions adult population - Emergency Preparedness: Natural, accidental, or even intentional public health threats are all around us. The more prepared we are as a community; the more resilient we will be to recover from a disaster or emergency. Though not articulated as a stand-alone priority area, the need to address the social determinants of health is a focus in the Implementation Strategy that is embedded within each of these priority areas. We know that education, jobs, income, family stability, safety and transportation will contribute to health and wellbeing and require special attention given our rural location and socioeconomic pressures. In addition to these priorities, the implementation strategy also provides an overview of other CMC/DH community benefit activities that are aligned with our mission or considered necessary to support ongoing efforts from previously identified community needs. The community health needs identified in the 2016 CHNA provide the basis for the development of the Implementation Strategy. The 2016 CHNA, Implementation Strategy and Community Benefit report is available to the public on the Cheshire Medical Center website: www.cheshire-med.org. Patient education of eligibility for assistance Form 990, Schedule H, Part VI, Line 3 The Cheshire Medical Center is committed to providing medically necessary care to patients regardless of their ability to pay for services. Non-emergent patients sign a financial responsibility statement upon admission to certify recognition of their responsibility for payment of their bills. However, there will be instances where the patient, due to lack of funds or third party coverage, will not be able to meet this obligation. The Cheshire Medical Center notifies patients of their potential to obtain assistance through the registration and billing processes. Upon registration, patients without insurance are offered the opportunity to apply for financial assistance. In addition, receptionists and clinicians in all areas are educated to refer patients to the financial assistance process in the event patients express concerns with their ability to pay for services. The application information is posted on the intranet and brochures describing the program are readily available to patients. There are signs posted in Registration and throughout the facility informing patients about financial assistance. Patients are informed of the program availability on any invoices they receive and individuals who attempt to collect patient balances are also trained to refer patients to the financial assistance process. The financial assistance application process is comprehensive and evaluates a patient's eligibility for a variety of federal, state, and local government programs in addition to The Cheshire Medical Center's internally funded financial assistance program. Community information Form 990, Schedule H, Part VI, Line 4 The Medical Center is the only hospital in its primary service area ("PSA). Management defines its PSA as the City of Keene and 19 geographically proximate communities. Towns and cities included in the PSA include Alstead, Chesterfield, Fitzwilliam, Gilsum, Harrisville/Chesham, Keene, Marlborough, Marlow, Nelson/Munsonville, Richmond, Roxbury, Stoddard, Sullivan, Surry, Swanzey, Troy, Walpole, Westmoreland and Winchester, all located in Cheshire County. Based on US Census Bureau population estimates in July 2016: -Medical Centers PSA represented approximately 4.52% of New Hampshires population. -The PSAs total population is 59,612 with 23,406 residing in Keene, the largest community in the service area. -The median age of residents in Cheshire County is 42.0 with: -15,112 or 19.6% less than 18 years of -50,663 or 65.7% between the ages of 18-64 -11,342 or 14.7% over the age of 64 -In 2016, the poverty rate for Cheshire County was 9.9% as compared to 8.4% for the State of New Hampshire. The median household income is $57,782 compared to the state average of $66,779. According to the 2016 Bureau of Labor Statistics, the State had an unemployment rate of 2.8% compared to Cheshire Countys rate of 2.7% (not seasonally-adjusted). Promotion of community health Form 990, Schedule H, Part VI, Line 5 The Medical Center plays an active role in promoting community health and offers educational programs including classes and workshops. CMC/DH offers a variety of health promotion and education programs for the community spanning a broad spectrum of health and wellness topics. Our clinical staff works closely with the staff of the Center for Population Health to develop programs that cover emerging health concerns and are delivered at the right literacy level for our community. The programs offered a variety of chronic disease and wellness topics such as: stress management and resiliency, nutrition, physical education and exercise, high blood pressure prevention and monitoring, diabetes prevention and monitoring, advanced directive planning, memory loss, tobacco cessation and writing as tool to manage stress. A total of 1,008 community members participated in the 81 educational programs offered. All programs are offered free of charge. In addition, the Medical Center offers several community programs including: Cheshire Smiles, a school-based dental health program for children in grades K-3, provides screening, prevention and restorative dental care for children in Cheshire County schools. Cheshire Medical Center /Dartmouth-Hitchcock also works in partnership with other community health and human service organizations to meet the dental health needs of underserved populations such as the chronically mentally ill, pregnant women who cannot afford dental care, children identified through the school based Cheshire Smiles Program, and others. The Medical Center sponsors patient visits at Dental Health Works, a public/private program serving underserved residents of Cheshire County. The Medical Center also provides leadership and support to the Dental Public Health Task Force, a coalition of dental staff, hospital staff and concerned citizens addressing the oral health needs of adults. Cheshire Medical Center is committed to supporting healthy and resilient living for all members of the community. In addition to health information from our medical and nursing staff, our website links to reliable and up-to-date sources of health information and provides details regarding health and wellness programs offered at no charge. Cheshires community benefits report and service quality information are shared on the website for public viewing. The website incorporates "Healthwise", a searchable health information database. During Fiscal Year 2017 the website had a total of 326,908 visits and 867,616 page views for an average of 27,242 visits and 72,301 page views per month. Health + Wellness, an electronic newsletter, delivering timely medical news, useful health tips, and wellness information is distributed to an average of 1,600 patients and community members monthly. In addition to the website, Cheshires Facebook page serves as a tool to distribute health and wellness information. As of June 30, 2017, our FaceBook page has 1,948 "likes". Cheshire Medical Center has 666 followers on Twitter as of June 30,2017. The Cheshire Medical Center YouTube channel has 79 videos and an estimated 65,495 minutes watched during the 2017 fiscal year. The Cheshire Coalition for Tobacco Free Communities addresses the use of tobacco products by people who live and work in the communities served by CMC/DHK. The Coalition is comprised of hospital staff, healthcare providers, community members and representatives of schools and colleges, law enforcement, clergy and the general public. The group meets monthly working to engage schools and the greater community with tobacco prevention initiatives which include retailer education and enforcement of tobacco laws. The Program Manager, a CMC/DHK employee, actively engages in tobacco-free activities in our local community and coordinates with state agencies and organizations. Major accomplishments of the Coalition during this period were initiatives to increase access to services through "Butt Stops" staged at 13 sites around the community prior to the Great American Smoke-out and a "Bag the Butts" campaign to clean up cigarette litter at parks in the region. The "Bag the Butts" campaign complemented our efforts to assist nine communities with their implementation of tobacco free parks and recreation policies. The Medication Assistance Program provides assistance to patients needing help to secure medications because they lack insurance coverage or financial resources to pay for their medications, which now includes elderly residents with Medicare who experience a gap in their Medicare D coverage. Due to Medicaid Expansion and the Health Insurance options as a result of the Affordable Care Act the need for assistance to secure medications continues to decrease. In FY2017 the program supplied 318 prescriptions to 81 individuals valued at $368,384, compared to 1,073 prescriptions to 252 individuals in FY2016. Advocates for Healthy Youth (AFHY) is a community coalition focused on childhood obesity. Through AFHY, CMC/DH works closely with community health providers, Keene State College, Antioch University New England, Keene Family YMCA, Keene Parks and Recreation Center, UNH Cooperative Extension, Keene Housing, the Childrens Museum, and area schools to address the epidemic of childhood obesity. In FY 2017 AFHY supported efforts in several schools, after school programs, and non-profit organizations to implement environmental changes and programs that support healthy eating and physical activity. Senior Passport is a program for area residents aged 60 years and above. It encompasses low cost complete evening and weekend meals; free health education programs oriented to seniors; exercise programs; and the Cheshire Walkers Program, a walking group that takes organized nature and historic walks. Seven to ten walks are offered each spring and fall. Walks are typically led by a community member with participation by CMC/DHK staff and occur at a variety of locations throughout the region. During FY2017 5,409 meals were provided to program members and a total of 413 seniors attended the walking program. This represents about an 8% increase in the number of meals and 76% increase in the number of participants in Cheshire Walkers from last year. Greater Monadnock Public Health Network (GMPHN) is a community health and safety collaborative which works to enhance and improve public health-related services. The GMPHN is one of 13 public health networks in the state of New Hampshire. The GMPHN is housed by CMC/DHK and, in collaboration with Cheshire County, is financed with funds provided by the Centers for Disease Control and Prevention, under an agreement with the State of New Hampshire, Department of Health and Human Services, and Division of Public Health Services and a mix of state funding via the general funds. The GMPHN serves all of Cheshire County and the 10 western-most towns in Hillsborough County. The GMPHN strives to increase collaboration and planning across municipal boundaries and the health and safety sectors. There are three major focuses of the work: 1. Development of a governance structure for the public health advisory board 2. Public health emergency preparedness with all region partners including municipalities, long-term care and assisted living facilities, schools, and businesses. It is made up of members of each of the coalition communities as well as representatives of regional organizations involved in providing for the publics health and safety. 3. Through Monadnock Voices for Prevention, substance misuse prevention and development of a continuum of care to address prevention, intervention, treatment, and recovery services are provided. As of June 30, 2017 there are 51 individuals and/or organizations addressing development of the public health advisory council, 109 member individuals/organizations addressing emergency preparedness and over 1,200 individuals reached through the efforts of Monadnock Voices for Prevention. Included within the GMPHN, is the Greater Monadnock Medical Reserve Corps. Developed initially to build local capacity to address public health emergency response needs, the GMMRC also supports local initiatives to address pressing public health activities. Membership included doctors, nurses, EMT/paramedics, pharmacists, veterinarians, other public health professionals, and non-medical/public health members. As of June 30, 2017 the GMMRC has a membership of over 116 individuals. Affiliated health care system Form 990, Schedule H, Part VI, Line 6 In 2014, the Board of the Medical Center, accompanied by the Board of Dartmouth-Hitchcock Health, approved an affiliation agreement between the Medical Centers. This agreement improves, integrates, and streamlines patient care between the two healthcare systems. The affiliation, which became effective on March 2, 2015, strengthens The Cheshire Medical Center as a regional resource for southwestern New Hampshire and southeastern Vermont. The affiliation will allow more patients to receive care closer to home, will free up bed capacity for tertiary care patients at Dartmouth-Hitchcock Medical Center in Lebanon, and will allow the Cheshire Medical Center to continue its leadership role in population health and the Healthy Monadnock 2020 initiative. Cheshire Medical Center and Dartmouth-Hithcock have worked together since 1998, by means of a Joint Operating Agreement involving Dartmouth-Hitchcock Keene, a multi-specialty group practice that comprises the majority of Cheshire Medical Center's medical staff. This affiliation agreement was seen as a natural step that will enable both organizations to more effectively pursue a common vision of the future of health care that is based on creating a sustainable health system, focusing on population health, delivering value-based care, and embracing the opportunities provided by new payment models. In addition to The Cheshire Medical Center and the Dartmouth-Hitchcock Health, the affiliated health care system includes Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic, The New London Hospital Associaton, Windsor Hospital Corporation, Alice Peck Day Memorial Hospital,Visting Nurse Association and Hospice of New Hampshire and Vermont, and a number of other related organizations whose primary mission is health care in the region. The Cheshire Medical Center and other members of the affiliated health care system operate jointly through interlocking directorates, strategic planning, management, and share indentical missions. State filing of community benefit report Form 990, Schedule H, Part VI, Line 7 The Cheshire Medical Center files its Community Benefit Report with the State of New Hampshire. NH Health Protection Prog (DHHS) 129 Pleasant St Concord NH 03301 340119 FMV Healthcare Assist. Healthcare assist. CMC Tuition Reimbursement Program 68 179989 FMV Awards and Educational Assistance 14 24628 FMV X X X X true true false false false false false true false John Birkmeyer MD Trustee end 10/14/16 0 661213 0 0 0 220254 0 20575 0 18758 0 920800 0 0 Judith Boule MD Trustee end 1/1/17 0 280153 0 550 0 37995 0 266199 0 19406 0 604303 0 0 Steven Paris MD Trustee/At Large eff 1/1/17 0 391378 0 0 0 28330 0 36365 0 15440 0 471513 0 0 Leslie Pitts MD Trustee 0 302675 0 250 0 8762 0 183859 0 22238 0 517784 0 0 Don Caruso MD Trustee/CEO 0 394902 0 57630 0 28920 0 222758 0 22400 0 726610 0 0 Robert Cochrane CFO End 2/28/2017 296476 0 0 0 0 0 0 0 21666 0 318142 0 0 0 Cindi Coughlin CNO 220836 0 0 0 0 0 95962 0 19291 0 336089 0 0 0 Paul Pezone VP Facilities & Support Srvcs 190427 0 0 0 11943 0 3711 0 21128 0 227209 0 0 0 Erli Chen Physicist 213052 0 200 0 13942 0 24314 0 20428 0 271936 0 0 0 Latasha Heape Chief CRNA 168596 0 0 0 0 0 0 0 23370 0 191966 0 0 0 Julie Green VP Human Resources 194058 0 0 0 8400 0 8271 0 21045 0 231774 0 0 0 Jose Montero VP Pop Hlth/Sys End 11/13/16 219110 0 0 0 0 0 0 0 23408 0 242518 0 0 0 Denis Fortier Director of Pharmacy 142754 0 0 0 9968 0 12187 0 20733 0 185642 0 0 0 Peter Malloy CIO End 2/3/17 151485 0 0 0 0 0 0 0 17985 0 169470 0 0 0 Cherie Holmes MD Trustee/Ex-Officio 0 404429 0 0 0 16172 0 114995 0 9321 0 544917 0 0 Wendy Fielding Trustee 0 235976 0 0 0 270 0 18219 0 21536 0 276001 0 0 Timothy Fisher MD Trustee end 1/1/17 0 350007 0 0 0 5422 0 20575 0 22322 0 398326 0 0 Maria Padin Trustee eff 1/1/17 0 398748 0 0 0 10608 0 177879 0 19925 0 607160 0 0 Andrew Tremblay MD Trustee eff 1/1/17 0 286217 0 200 0 2802 0 36354 0 21918 0 347491 0 0 Jennifer DiNubila DO Trustee eff 1/1/17 0 350366 0 0 0 4510 0 12345 0 22364 0 389585 0 0 Arthur W Nichols Former President 0 0 0 0 506030 0 60780 0 12705 0 579515 0 0 0 Kathryn Willbarger VP Finance eff 3/1/17 111393 0 0 0 9378 0 15645 0 15114 0 151530 0 0 0 Compensation of top employees Form 990, Schedule J, Part I, Line 3 The CEO is paid by Dartmouth-Hitchcock Clinic, a related organization, which uses a compensation committee, an independent consultant, Form 990 of other organizations, a compensation survey or study, and approval by the Board or compensation committee to establish the CEO's compensation. Severance Payments Form 990, Schedule J, Part I line 4a DURING CALENDAR YEAR 2016, FORMER PRESIDENT ARTHUR NICHOLS RECEIVED A MULTI-YEAR SEVERANCE PACKAGE. CALENDAR YEAR 2016 INCLUDED PAYMENTS TOTALING $506,030 FROM CHESHIRE MEDICAL CENTER. THE PAYMENT REPRESENTS BASE PAY, BENEFITS, AS WELL AS A CASH PAYMENT GROSS UP FOR HEALTH, DENTAL, AND 457B CONTRIBUTIONS. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2016, FORMER TRUSTEE JOHN BIRKMEYER RECEIVED SEVERANCE PAYMENTS TOTALING $129,856 FROM DARTMOUTH-HITCHCOCK, A RELATED ORGANIZATION. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. SCHEDULE J, PART II, COLUMN (B)III. Supplemental Nonqualified Retirement Plan Form 990, Schedule J, Part I, Line 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): Don Caruso $26,826 Leslie Pitts $8,493 Steven Paris $19,684 Timothy Fisher $5,422 Judith Boule $36,165 Cherie Holmes $15,398 Claire Fabian $20,114 Maria Padin $10,074 John Birkmeyer $53,500 Andrew Tremblay $2,533 Jennifer DiNubila $4,330 Dartmouth-Hitchcock Supplemental Retirement Plan Terms and Conditions: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the Plans for the plan year, but are limited by IRC Section 401(a)(17) and/or 415. For eligible employees, the Employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC Sections 401(a)(17) and/or 415. D-H sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable D-H 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. Non-Fixed Payments Form 990, Schedule J, Part I, Line 7 Senior Management is eligible for incentive compensation at the discretion of the Board based on, but not directly related to, overall organizational financial performance and discretionary measures. Note Regarding Compensation Schedule J, Part II Column B, parts I, II, and III represent actual amounts paid to employees. 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 as well as any changes in pension actuarial value (if applicable) in a calendar year. Column D represents nontaxable benefits such as the cost of healthcare coverage provided by the organization on behalf of its employees. A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 644614V48 2012-11-15 30360529 Refund of existing debt false false false A 2915000 0 30360529 0 0 0 379754 0 554125 4777102 24649548 0 2013 true false true true A false false false false 0 false false false true A false true false false false false 0 false 0 false false A true Other Spent Proceeds Form 990, Schedule K, Part II, Column A, Line 11 The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. 0 Robert Therrien Business Owner & Trustee 165281 Services provided by owned co false Ed Bergeron Business Owner & Trustee 238425 Services provided by owned co false Ashley Copeland Trustee H. Roger Hansen 45127 Family member employed by CMC false Elizabeth Lehr Trustee H. Roger Hansen 17453 Family member employed by CMC false Business Relationships Form 990, Part VI, Section A, Line 2 Cheshire Medical Center is part of the Dartmouth-Hitchcock Health System, which owns for-profit subsidiaries that provide services and support the mission of the organizations. As a result, some officers of The Cheshire Medical Center may also be officers of related for-profits entities. Classes of members and the nature of their rights Form 990, Part VI, Section A, Line 6 & 7a Dartmouth-Hitchcock Health, a New Hampshire voluntary corporation, is the sole corporate member of The Cheshire Medical Center. D-HH has the power to appoint 1/3 of the members of The Cheshire Medical Center's Board of Trustees. Governance decisions reserved to or subject to approval by persons other than the governing body Form 990, Part VI, Section A, Line 7B The sole member has the right to ratify The Cheshire Medical Center's nomination of 2/3 of the members of the Board of Trustees; remove Trustees after consultation with the Chairperson of the Board; approve the dissolution or liquidation of The Cheshire Medical Center; appoint, evaluate, terminate, and approve the compensation of the President and CEO; and other governance decisions. Process used by management and/or Governing Body to Review 990 Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by an independent accounting firm and CMC's Board of Trustees. A copy of the return is uploaded to the Board portal in advance of filing. Conflict of Interest Policy Form 990, Part VI, Section B, Line 12C Cheshire Medical Center's Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock Compliance and Audit Services Department conducts an annual survey of all officers and trustees 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 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 curcumstances, 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. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR UNDERTAKEN Form 990, Part VI, Section B, Line 15a The Cheshire Medical Center/Dartmouth-Hitchcock Keene has retained Yaffe & Company, Inc. to provide consultation to the Executive Committee of the Board of Trustees regarding executive compensation, benefits, and prerequisites. Yaffe & Company, Inc. is an independent consulting firm with 35 years of service and provides services to not-for-profit hospitals and health systems. Further, Yaffe & Company, Inc. has been engaged directly by the Board of Trustees of The Cheshire Medical Center through its Executive Committee to only provide services to the Board. An Executive Committee d/b/a Compensation Committee Charter and Compensation Philosophy (approved by the Board) documents the compensation review process and guidelines so as to provide an orderly structure for executive total compensation decisions. Annually, a multi-tiered approach using independent comparability data is utilized to gauge appropriate comparative market levels of compensation and benefits. An annual performance evaluation is based on subjective and objective criteria which flows from the strategic plan. By way of questionnaire Board members participate in the performance review process and a summary report is shared with the CEO. Variable pay is awarded based on achievement of specific qualititative and quantitative goals. In conjunction with the Executive Committee, challenging and measurable goals are established for the Office of the President, which provide alignment between executive compensation and achievement of the hospital's strategic goals. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Section C, Line 19 The Cheshire Medical Center makes governing documents, conflict of interest policy, and financial statements available to members of the public upon request, through its annual report, and through state and federal filings. Fundraising Expenses Form 990, Part IX, Column D The Cheshire Health Foundation, a related organization, performs all fundraising activities on behalf of Cheshire Medical Center. All fundraising expenses are reported on the Foundation's Form 990. Reconciliation of Net Assets Form 990, Part XI, Line 9 Other changes in net assets include: Pension Liability Adjustment, net Assets released for capital purchases, and net asset transfers $2,970,389 Audit Committee and Financial Statement Oversight Form 990, Part XII, Question 2c Cheshire Medical Center delegates oversight of the audit to the Finance & Audit subcommittee. The full Board reviews and approves the Audited Financial Statements. The organization is also included in the audit and consolidated financial statements of its parent organization, Dartmouth-Hitchcock Health. Financial Statements and Reporting Form 990, Part XII, Question 3a The Medical Center was included in the consolidated audited financial statements of the Dartmouth-Hitchcock Health System. During Fiscal Year 2017, Mary Hitchcock Memorial Hospital expended federal funding which met the minimum threshold set forth in the Single Audit Act and OMB Circular A-133. Due to the nature of the consolidated financial statements, the audit was performed on the financial information of all organizations, including Cheshire Medical Center. Cheshire Health Foundation 580 Court Street Keene NH 03431 020202220 Supportng Org NH 501(c)(3) 12 TYPE I CMC true Cheshire Health Services 580-590 Court Street Keene NH 03431 473379283 HEALTHCARE NH 501(C)(3) 3 CMC true Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Svcs NH 501(c)(3) 10 D-HH true Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Org NH 501(c)(3) 7 NA false Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) 3 D-HH true The New London Hospital Association Inc 273 County Road New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH true Windsor Hospital Corporation 289 County Road Windsor VT 05089 030183721 Hospital VT 501(c)(3) 3 D-HH true Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 Hospital NH 501(c)(3) 3 D-HH true VNA & Hospice of VT and NH Inc 205 Billings Farm Road 5 Wilder VT 05088 036006494 Hospice VT 501(c)(3) 10 D-HH true Keene Hlth Alliance 580 Court Street Keene NH 03431 300179297 Healthcare NH NA RELATED -1888000 0 false 0 true 0.50000 One Care VT ACO LLC 111 Colchester Avenue Burlington VT 05401 455399218 Shared Saving VT NA false 0 false Hitchcock Health Connect One Medical Center Drive Lebanon NH 03756 800908979 Telehealth NH D-HH C Corp true Keene Health Enterprises 580 Court Street Keene NH 03431 020374999 Real Est Hldg NH KHS C Corp 0 0 1.00000 true Keene Health Realty 580 Court Street Keene NH 03431 020374998 Real Est Hldg NH KHS C Corp -37212 638620 1.00000 true Keene Health Services 580 Court Street Keene NH 03431 020374997 Real Est Hldg NH CHF C Corp -11120 184959 1.00000 true ImagineCare Inc 1 Medical Ctr Dr Lebanon NH 03756 813105071 Software Tech NH D-HH C Corp true false false true true false false false false true true true true true true false true true false Mary Hitchcock Memorial Hospital M 29239512 FMV Mary Hitchcock Memorial Hospital P 669792 FMV Dartmouth-Hitchcock Clinic M 12531219 FMV Dartmouth-Hitchcock Clinic P 287054 FMV The Cheshire Health Foundation C 338618 FMV The Cheshire Health Foundation k 772000 FMV The Cheshire Health Foundation p 1308922 FMV Cheshire Health Services q 1899561 FMV Related Party Controlling Entity Disclosure Form 990, Schedule R, Part II, Line G, and Part IV, column I The Organization has checked "yes" as a section 512(b) controlled entity. Although the filing organization does not directly control each of the organizations listed, as part of its affiliation with Dartmouth-Hitchcock Health (parent organization), all organizations related under D-HH are defined as a controlled entity within the meaning of IRC 512(b)(13).