FURP.ORG / PUBLIC DATA EXPLORER

MARY HITCHCOCK MEMORIAL HOSPITAL: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MARY HITCHCOCK MEMORIAL HOSPITAL (EIN 02-0222140)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-15
IRS object ID
201821359349305052
Schema version
2016v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-15T11:01:13-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PRICEWATERHOUSECOOPERS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SEAPORT BLVDAddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02210ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020222140EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DANIEL JANTZENInCareOfNm
Business Name ControlMARYBusinessNameControlTxt
Phone6036505000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANIEL JANTZENPersonNm
Person TitleCFOPersonTitleTxt
Phone6036505634PhoneNum
Signature2018-05-10SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonPaul TanisPreparerPersonNm
PTINP01441612PTIN
Phone6175305000PhoneNum
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJoanne Conroy MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,455,886,548GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.dartmouth-hitchcock.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1889FormationYr
Legal Domicile StateNHLegalDomicileStateCd
Activity Or MissionAdvancing Health Through Research, Education, Clinical Practice, Community Partnerships, providing each person the best care in the right place, at the right time,every time.ActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee6019TotalEmployeeCnt
Total Volunteers511TotalVolunteersCnt
Total Gross UBI$4,456,335TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$189,812NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$7,326,385PYContributionsGrantsAmt
CY Contributions Grants$41,242,528CYContributionsGrantsAmt
PY Program Service Revenue$994,071,500PYProgramServiceRevenueAmt
CY Program Service Revenue$1,095,054,593CYProgramServiceRevenueAmt
PY Investment Income$86,360PYInvestmentIncomeAmt
CY Investment Income$20,952,650CYInvestmentIncomeAmt
PY Other Revenue$51,273,295PYOtherRevenueAmt
CY Other Revenue$25,430,069CYOtherRevenueAmt
PY Total Revenue$1,052,757,540PYTotalRevenueAmt
CY Total Revenue$1,182,679,840CYTotalRevenueAmt
PY Grants And Similar Paid$2,204,568PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,744,685CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$635,248,980PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$679,834,438CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$309,409CYTotalFundraisingExpenseAmt
PY Other Expenses$448,365,775PYOtherExpensesAmt
CY Other Expenses$469,945,438CYOtherExpensesAmt
PY Total Expenses$1,085,819,323PYTotalExpensesAmt
CY Total Expenses$1,152,524,561CYTotalExpensesAmt
PY Revenues Less Expenses-$33,061,783PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$30,155,279CYRevenuesLessExpensesAmt
Total Assets BOY$1,312,172,799TotalAssetsBOYAmt
Total Assets EOY$1,322,008,676TotalAssetsEOYAmt
Total Liabilities BOY$787,785,889TotalLiabilitiesBOYAmt
Total Liabilities EOY$737,988,485TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$524,386,910NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$584,020,191NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$906,709,992ExpenseAmt
Grant$2,744,685GrantAmt
Revenue$1,070,756,177RevenueAmt
DescMary Hitchcock Memorial Hospital (the Hospital), is an acute and tertiary care teaching hospital located in Lebanon, New Hampshire. The Hospital 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. The Hospital 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). These include a full range of services in both acute and critical medicine, surgery, psychiatry and rehabilitation for infants, children and adults. During FY 2017 the Hospital provided 126,886 acute patient days of inpatient service and had 27,786 total acute care discharges, while the Hospital's emergency room was open to the public 24 hours per day, 7 days per week and had 31,387 discharges. Dartmouth-Hitchcock Clinic provides the physician staff to 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 the Hospital and Clinic 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 the Dartmouth-Hitchcock Clinic, the Hospital 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. The Hospital actively supports community-based health care and promotes the coordination of services among health care providers and social services organizations. Through formal affiliations and other clinical collaborations, the Hospital 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, on which construction began in 2016 and which will admit its first patients in December, 2017, will coordinate the clinical, educational, and research efforts of the Hospital and visiting nurse alliances around the region, to offer much-needed care for patients at the end of life, in a clinical setting that meets the needs of patients and their families. The Hospital also continues to build its telemedicince program to provide care across its rural region and in particular to make specialist consultation and care available to community hospitals. This allows caregivers at remote locations to access specialists at Dartmouth-Hitchcock and bring them "virtually" to the patient's bedside. D-H's Connected Care Center in Lebanon offers a 24/7 team of physicians, pharmacists, and nurses supporting care in 40+ specialties to 11 facilities in New Hampshire and Vermont. Acute care telehealth service lines, which include TeleEmergency, TelePharmacy, TeleNeurology, and TeleICU, bring together pools of doctors and nurses from all over the country and the world. During FY17, TelePsychiatry and TeleUrgentCare were added as services within the D-H Connected Care Center. In an effort to integrate behavioral health and primary care, the Hospital is the lead convener for the State of New Hampshire 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 states strained mental health system. This work began in July 2016 and will continue through December 31, 2020. In addition to the Hospital, Dartmouth-Hitchcock Clinic and Cheshire Medical Center are playing leadership roles in this initiative. The Hospital files an annual Community Benefits Report with the State of New Hampshire which outlines the community and charitable benefits they provide. The most recent Community Benefits Reports are available upon request or can be found on Dartmouth-Hitchcock's web site (www.dartmouth-hitchcock.org). 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, 2017 the Hospital provided financial assistance to 5,417 patients in the amount of $15,421,451, as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2017 was $6,453,877. The Hospital also routinely provides services to Medicaid patients at reimbursement levels that are below the cost of the care provided. The Community health activities includes 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 also includes financial contributions and the contribution of time and services to community programs, hospitals and agencies. The Hospital also provides a significant amount of uncompensated care to its patients reported as provision for bad debt, which is not included in the amounts reported above. During the year ended June 30, 2017, the Hospital reported a provision for bad debt of approximately $23,850,195.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$66,660,983ExpenseAmt
Revenue$42,094,323RevenueAmt
DescAs a component of New Hampshires only integrated academic medical center, the Hospital provides the Geisel School of Medicine at Dartmouth (GSM) support for Physicians' unpaid teaching time as part of its Community Benefit Initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, 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 the Clinic 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. Beginning in FY17, Dartmouth-Hitchcock began a transition of research activities and management from the Geisel School to D-H. This transition saw the recruitment of a new Vice President for Research Operations to develop the research enterprise.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$973,370,975TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficeYes (true)ForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgYes (true)MoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonYes (true)GrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1085IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee6019EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountYes (true)ForeignFinancialAccountInd
Foreign CountryBDForeignCountryCd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldNHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDANIEL JANTZENPersonNm
Phone6036505634PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (60 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Vincent S Conti MHA
Trustee0.751.25Yes (X)$0$0$0
Anne-Lee Verville
Trustee/Board Chair1.52.5Yes (X)$0$0$0Yes (X)
Barbara Couch MS
Trustee/Board Secretary1.52.5Yes (X)$0$0$0Yes (X)
William J Conaty
Trustee0.751.25Yes (X)$0$0$0
Robert A Oden Jr PhD
Trustee/Vice Chair1.52.5Yes (X)$0$0$0Yes (X)
James N Weinstein DO MS
Trustee Ex-Officio/CEO38.5522.96Yes (X)$0$1,364,537$108,831Yes (X)
Denis A Cortese MD
Trustee0.751.25Yes (X)$0$0$0
Senator Judd A Gregg
Trustee0.750.75Yes (X)$0$0$0
Laura K Landy MBA
Trustee0.751.25Yes (X)$0$0$0
Paul P Danos PhD
Trustee0.751.25Yes (X)$0$0$0
Barbara C Jobst MD
Physician/Trustee end 12/31/1628.7512.75Yes (X)$0$378,003$98,251
Troyen Brennan MD MPH
Trustee0.751.25Yes (X)$0$0$0
R William Burgess Jr MBA
Trustee end 8/5/160.751.25Yes (X)$0$0$0
Duane A Compton PhD
Trustee/Ex-Officio0.751.56Yes (X)$0$0$0
M Brooke Herndon MD MS
Trustee/Staff Physician28.7512.75Yes (X)$0$207,121$63,250
Charles G Plimpton MBA
Trustee/Board Treasurer1.52.5Yes (X)$0$0$0Yes (X)
Jeffrey A Cohen MD
Trustee/VP Service Line28.7513.05Yes (X)$0$435,115$104,921
Timothy D Scherer MD
Trustee/Physician28.7512.75Yes (X)$0$521,117$71,960
Brian C Spence MD MHCDS
Trustee/Staff Physician28.7512.75Yes (X)$0$482,267$48,788
Kari M Rosenkranz MD
Trustee eff 1/1/17/Physician28.7512.75Yes (X)$0$496,839$29,887
Robin Kilfeather-Mackey CPA
CFO end 7/15/1639.022.01$0$609,409$12,922Yes (X)
Daniel P Jantzen CPA
COO end, CFO eff 7/16/1639.024.01$1,223,270$0$134,426Yes (X)
Stephen Leblanc
Chief Administrative Officer39.023.01$0$671,595$128,833Yes (X)
Edward Merrens MD
Chief Clinical Officer42.020.0$0$521,421$58,731Yes (X)
Richard Rothstein MD
Chf Academic Offcr eff 1/1/1742.018.0$0$555,623$76,713Yes (X)
John Birkmeyer MD
CCO/EVP Entprs Sp end 10/14/1642.019.0$0$881,467$39,333Yes (X)
Maria Padin MD
Chief Medical Officer42.020.0$0$409,356$197,804Yes (X)
Sowmya Viswanathan MD
Chief ACO Officer eff 7/5/1642.018.0$0$161,497$18,258Yes (X)
Susan A Reeves EdD RN
Chf Nrsng Exctve eff 6/19/1742.018.0$0$0$0Yes (X)
Vincent Fusca III
Chief of Staff end 2/10/1728.013.0$330,998$0$27,365Yes (X)
George Blike MD
Chief Quality & Value Officer42.019.0$0$455,044$247,012Yes (X)
John S Malanowski MILR
Chief HR Officer end 2/10/1742.018.0$519,057$0$40,178Yes (X)
Gay Landstrom PhD RN NEA-BC
Chf Nursing Offcr end 1/10/1742.019.5$579,445$0$39,835Yes (X)
Robert Greene MD MHCDS FACP
Chf Popul Mgmt Ofr end 4/7/1742.018.0$0$593,926$43,931Yes (X)
John Kacavas JD
Chief Legal Officer42.019.0$430,324$0$39,835Yes (X)
Peter D Solberg MD
Chf Medical Information Ofcr42.018.0$0$375,391$45,978Yes (X)
Karen Clements RN BSN MSB FACHE
Chief Nursing Officer42.018.0$268,642$0$29,037Yes (X)
Thomas J Siepka
Chief Pharmacy Officer42.018.0$299,311$0$22,505Yes (X)
Aimee M Giglio
Int Chf HR Offcr eff 2/10/1742.018.0$225,784$0$29,216Yes (X)
Sandra Wong MD
Department Chair Surgery28.012.0$0$671,891$29,887Yes (X)
Bruce King MSPH FHFMA
Pres & CEO New London Hosp0.050.0$380,123$0$74,057Yes (X)
Roderic Young
VP Communications & Marketing28.013.0$313,027$0$42,229Yes (X)
Martin Purcell MBA
VP IS Operations28.012.0$330,319$0$136,408Yes (X)
Kimberly Troland JD
Fmr Intrm GC/Deputy Gen Cnsl28.012.0$369,596$0$39,760Yes (X)
David Gladstone MD
Chf Clncl Physcn - Radiology28.012.0$293,945$0$94,056Yes (X)
Carl Dematteo MD
Fmr Chf Ql Compl Ofr/Physician28.012.0$0$120,556$1,384Yes (X)
John Butterly MD
Former Officer/EVP Med Affairs28.014.0$0$138,766$13,418Yes (X)
Thomas Colacchio MD
Former Officer/Physician28.013.0$0$667,401$54,165Yes (X)
Darlene A Saler MBA RN
Frmr Actg Chf Nrsg Ofr28.012.0$170,541$0$84,517Yes (X)
Mary Oseid MHCDS
Fmr Key Emp/VP Enterprise Svcs28.013.0$0$252,760$194,385Yes (X)
Christine Schon MPA
Fmr Key Emp/Adm VP Prmry Care0.050.01$0$246,045$40,335Yes (X)
Tina Naimie CPA MHCDS
Fmr Key Emp/VP Corp Finance28.014.5$238,714$0$19,881Yes (X)
Wendy Fielding MBA
Fmr Key Emp/VP Finance Plnning28.013.0$236,246$0$39,755Yes (X)
Terrence P Carroll PHD
Former Chf Innvtn Ofcr42.018.0$380,765$0$0Yes (X)
Thomas Dodds MD
Former Key Emp/Dept Chr Anesth28.012.0$0$483,551$99,159Yes (X)
Wendy Wells MD
Fmr Key Emp/Dpt Chr Pathology28.012.0$0$487,848$129,279Yes (X)
Jocelyn Chertoff MD
Fmr Key Emp/Dpt Chr Dgnstc Rad28.012.0$0$582,114$132,793Yes (X)
Edward Catherwood MD MS
Former Key Emp/Ctr Dir Hrt/Vsc28.012.0$0$458,562$66,904Yes (X)
Steven Boyce
Fmr Key Emp/Adm. VP Med Spclts28.012.0$0$219,795$70,039Yes (X)
Jeffrey OBrien MHA
Fmr Key Emp/VP Oncology28.012.0$282,679$0$42,181Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$6,872,786TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$13,449,017TotReportableCompRltdOrgAmt
Total Other Compensation$3,162,392TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K427IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
TRUSTEES OF DARTMOUTH COLLEGE
37 DEWEY FIELDHANOVERNH03755ADMIN & DIR SUPPORT$14,595,826
Cross Country Staffing
PO Box 404674ATLANTAGA303844674Staffing Services$9,868,531
Accretive Health
401 N Michigan Ave Ste 2700CHICAGOIL60611REVENUE MGMT$10,714,960
Conifer Revenue Cycle Solutions LL
1500 S Douglass Road Ste 200ANAHEIMCA92806Revenue Mgmt$31,846,576
American Healthcare Services Associ
PO Box 945TRAVERSE CITYMI49685Staffing Services$5,998,789
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K125CntrctRcvdGreaterThan100KCnt
Government Grants$16,397,795GovernmentGrantsAmt
All Other Contributions$24,844,733AllOtherContributionsAmt
Noncash Contributions$616,610NoncashContributionsAmt
Total Contributions$41,242,528TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE621110$1,049,239,675$1,048,020,642$1,219,033
RESEARCH RELATED ACTIVITIES621110$9,042,849$9,042,849
PHARMACY INCOME621110$36,772,069$36,653,332$118,737
FieldValueIRS element (for citing)
Total Program Service Revenue$1,095,054,593TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,155,077TotalRevenueColumnAmt
Unrelated Business Revenue-$118,403UnrelatedBusinessRevenueAmt
Exclusion$4,273,480ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,075,977RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$956,802RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$119,175RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$119,175TotalRevenueColumnAmt
Exclusion$119,175ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$289,023,744SecuritiesAmt
Other$23,735OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$272,221,935SecuritiesAmt
Other$27,971OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$16,801,809SecuritiesAmt
Other-$4,236OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,797,573TotalRevenueColumnAmt
Exclusion$16,797,573ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
MEANINGFUL USE621110$1,107,117$1,107,117
NEAH AND PROGRAM RELATED INVESTMENTS621110$2,200,657$1,069,941$1,130,716
CAFETERIA621110$2,940,249$2,940,249

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,062,871TotalRevenueColumnAmt
Related Or Exempt Func Income$16,956,619RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,106,252UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$25,310,894OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,182,679,840TotalRevenueColumnAmt
Related Or Exempt Func Income$1,112,850,500RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$4,456,335UnrelatedBusinessRevenueAmt
Exclusion$24,130,477ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,213,365TotalAmt
Program Services$1,213,365ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$1,524,228TotalAmt
Program Services$1,524,228ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$7,092TotalAmt
Program Services$7,092ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$12,208,024TotalAmt
Program Services$4,816,559ProgramServicesAmt
Management And General$7,113,669ManagementAndGeneralAmt
Fundraising$277,796FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$3,840,780TotalAmt
Program Services$1,341,661ProgramServicesAmt
Management And General$2,468,122ManagementAndGeneralAmt
Fundraising$30,997FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$521,903,196TotalAmt
Program Services$453,291,812ProgramServicesAmt
Management And General$68,611,384ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$47,682,417TotalAmt
Program Services$41,413,905ProgramServicesAmt
Management And General$6,268,512ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$58,925,343TotalAmt
Program Services$51,178,793ProgramServicesAmt
Management And General$7,746,550ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$35,274,678TotalAmt
Program Services$30,637,334ProgramServicesAmt
Management And General$4,637,344ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,156,896TotalAmt
Program Services$44,833ProgramServicesAmt
Management And General$2,112,063ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$622,302TotalAmt
Management And General$622,302ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$42,000TotalAmt
Management And General$42,000ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$84,589,094TotalAmt
Program Services$72,496,879ProgramServicesAmt
Management And General$12,092,215ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,012,699TotalAmt
Program Services$33,443ProgramServicesAmt
Management And General$1,979,256ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$13,112,427TotalAmt
Program Services$8,767,227ProgramServicesAmt
Management And General$4,345,061ManagementAndGeneralAmt
Fundraising$139FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$11,193,922TotalAmt
Program Services$9,962,591ProgramServicesAmt
Management And General$1,231,331ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$15,604,387TotalAmt
Program Services$13,814,231ProgramServicesAmt
Management And General$1,790,156ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$3,683,970TotalAmt
Program Services$2,119,230ProgramServicesAmt
Management And General$1,564,740ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$71,932TotalAmt
Program Services$71,592ProgramServicesAmt
Management And General$340ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$14,254,082TotalAmt
Program Services$12,686,133ProgramServicesAmt
Management And General$1,567,949ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$63,944,578TotalAmt
Program Services$20,481,793ProgramServicesAmt
Management And General$43,462,785ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,660,400TotalAmt
Program Services$1,378,196ProgramServicesAmt
Management And General$1,282,204ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$179,969,906$179,752,244$217,662
MEDICAID ENHANCEMENT TAX$50,118,059$50,118,059
EQUIPMENT RENTAL & MAINT$13,693,258$9,540,847$4,152,411
ACDMC, GME, TEACHING, & EDU$7,024,644$5,946,124$1,078,520

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,190,882TotalAmt
Program Services$732,804ProgramServicesAmt
Management And General$4,457,601ManagementAndGeneralAmt
Fundraising$477FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,152,524,561TotalAmt
Program Services$973,370,975ProgramServicesAmt
Management And General$178,844,177ManagementAndGeneralAmt
Fundraising$309,409FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,876,637BOYAmt
EOY$24,826,278EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,933,626BOYAmt
EOY$650,122EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$157,353,140BOYAmt
EOY$161,698,558EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$168,957BOYAmt
EOY$175,723EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$579,058BOYAmt
EOY$10,597,854EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$17,379,674BOYAmt
EOY$17,883,224EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$9,333,121BOYAmt
EOY$10,667,649EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,080,847,755LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$656,888,381LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$427,348,813BOYAmt
EOY$423,959,374EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$234,549,775BOYAmt
EOY$279,958,184EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$337,361,745BOYAmt
EOY$326,211,369EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$7,950,879BOYAmt
EOY$1,970,881EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$116,337,374BOYAmt
EOY$63,409,460EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,312,172,799BOYAmt
EOY$1,322,008,676EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$126,756,517BOYAmt
EOY$121,123,993EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$631,346BOYAmt
EOY$3,864,030EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$326,836,101BOYAmt
EOY$325,850,834EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$227,716,877BOYAmt
EOY$188,220,589EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$105,845,048BOYAmt
EOY$98,929,039EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$787,785,889BOYAmt
EOY$737,988,485EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$435,627,969BOYAmt
EOY$485,657,981EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$58,764,416BOYAmt
EOY$68,071,892EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$29,994,525BOYAmt
EOY$30,290,318EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$524,386,910BOYAmt
EOY$584,020,191EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,312,172,799BOYAmt
EOY$1,322,008,676EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$30,155,279ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$33,959,268NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$4,481,266OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementYes (true)PaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (true)DirectContactLegislatorsInd
Direct Contact Legislators$163,355DirectContactLegislatorsAmt
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$82,359OtherActivitiesAmt
Total Lobbying Expenditures$245,714TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
LOBBYING ACTIVITY EXPLANATIONFORM 990, SCHEDULE C, PART II B, LINES 1B & 1G MARY HITCHCOCK MEMORIAL HOSPITAL EMPLOYS TWO 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 THE HOSPITAL 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, 2017, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $163,355 IN CONJUCTION WITH THESE ACTIVITIES.
Form 990 Schedule C, Part II B, Line 1IMHMH 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.

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,754,800BeginningYearBalanceAmt
Contributions$137,888ContributionsAmt
Investment Earnings Or Losses$2,553,792InvestmentEarningsOrLossesAmt
Other Expenditures$651,181OtherExpendituresAmt
End Year Balance$56,795,299EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$72,720,335BeginningYearBalanceAmt
Contributions$378,941ContributionsAmt
Investment Earnings Or Losses-$377,000InvestmentEarningsOrLossesAmt
Other Expenditures$17,967,476OtherExpendituresAmt
End Year Balance$54,754,800EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$74,609,411BeginningYearBalanceAmt
Contributions$208,107ContributionsAmt
Investment Earnings Or Losses-$516,882InvestmentEarningsOrLossesAmt
Other Expenditures$1,580,301OtherExpendituresAmt
End Year Balance$72,720,335EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,935,134BeginningYearBalanceAmt
Contributions$17,029,356ContributionsAmt
Investment Earnings Or Losses$3,029,123InvestmentEarningsOrLossesAmt
Grants Or Scholarships$16,800GrantsOrScholarshipsAmt
Other Expenditures$1,648,675OtherExpendituresAmt
End Year Balance$73,328,138EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$57,050,185BeginningYearBalanceAmt
Contributions$188,155ContributionsAmt
Investment Earnings Or Losses-$357,053InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,322GrantsOrScholarshipsAmt
Other Expenditures$1,940,831OtherExpendituresAmt
End Year Balance$54,935,134EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.28730BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.53330PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.17940TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$46,750,633OtherCostOrOtherBasisAmt
Book Value$46,750,633BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$524,671,083OtherCostOrOtherBasisAmt
Depreciation$310,612,383DepreciationAmt
Book Value$214,058,700BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,111,615OtherCostOrOtherBasisAmt
Depreciation$3,759,712DepreciationAmt
Book Value$351,903BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$472,986,179OtherCostOrOtherBasisAmt
Depreciation$342,516,286DepreciationAmt
Book Value$130,469,893BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$32,328,245OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$32,328,245BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$423,959,374TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
FIXED INCOME$100,571,943F
PRIVATE EQUITIES$27,775,368F
HEDGE FUNDS$40,517,460F
OTHER INVESTMENTS$134,059,358F
FieldValueIRS element (for citing)
Total Book Value Securities$302,924,129TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
THIRD PARTY RESERVES$8,503,761
ACCRUED POST RETMNT PENS & MED$83,520,214
INTEREST RATE SWAP$6,905,064
FieldValueIRS element (for citing)
Total Liability$98,929,039TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceIntended use of Endowment FundsFormAndLineReferenceDesc
ExplanationForm 990, Schedule D, Part V, Line 4 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, and health education. ASC 740 (Fin 48) Footnote Form 990, Schedule D, Part X, Line 2 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.ExplanationTxt

Schedule F IRS990ScheduleF

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Account Activities Outside US AccountActivitiesOutsideUSGrp (24 entries)

RegionRegionTxtType Of Activities ConductedTypeOfActivitiesConductedTxtSpecific Services ProvidedSpecificServicesProvidedTxtRegion Total ExpendituresRegionTotalExpendituresAmtEmployeeEmployeeCnt
North AmericaProgram ServicesAdvertising$17,972
Europe (Including Iceland and Greenland)Program ServicesConferences$15,750
Europe (Including Iceland and Greenland)Program ServicesDues & Licenses$2304
Europe (Including Iceland and Greenland)Program ServicesHonorariums$1,300
North AmericaProgram ServicesHonorariums$790
Sub-Saharan AfricaProgram ServicesHonorariums$656
Sub-Saharan AfricaProgram ServicesMedical Services$75,43110
South AmericaProgram ServicesMedical Services$37,8404
South AsiaProgram ServicesMedical Services$49,6386
Europe (Including Iceland and Greenland)Program ServicesMedical Services$4,8551
Middle East and North AfricaProgram ServicesProgram Support$7,092
East Asia and the PacificProgram ServicesResearch$30,450
Europe (Including Iceland and Greenland)Program ServicesSoftware$56,625
North AmericaProgram ServicesSoftware$202,983
South AsiaProgram ServicesSoftware$27,405
Central America and the CaribbeanProgram ServicesTravel$2,448
East Asia and the PacificProgram ServicesTravel$4,465
Europe (Including Iceland and Greenland)Program ServicesTravel$24,190
Middle East and North AfricaProgram ServicesTravel$2,275
North AmericaProgram ServicesTravel$20,157
South AmericaProgram ServicesTravel$1,503
South AsiaProgram ServicesTravel$1,113
Sub-Saharan AfricaProgram ServicesTravel$869
Central America and the CaribbeanInvestmentsInvestment in Captive$23,533,853
FieldValueIRS element (for citing)
Subtotal Employees25SubtotalEmployeesCnt
Total Employee25TotalEmployeeCnt
Subtotal Spent$535,930SubtotalSpentAmt
Continuation Spent$23,583,960ContinuationSpentAmt
Total Spent$24,119,890TotalSpentAmt

Grants To Org Outside US GrantsToOrgOutsideUSGrp

FieldValueIRS element (for citing)
RegionMiddle East and North AfricaRegionTxt
Purpose Of GrantProg SupportPurposeOfGrantTxt
Cash Grant$7,092CashGrantAmt
Manner Of Cash DisbursementWire TrnsfrMannerOfCashDisbursementTxt
Valuation Method UsedFMVValuationMethodUsedDesc
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt
Transfer To Foreign CorpYes (true)TransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipYes (true)ForeignCorpOwnershipInd
Passive Foreign Investmest CoYes (true)PassiveForeignInvestmestCoInd
Foreign PartnershipYes (true)ForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceMONITORING USE OF GRANT FUNDSFormAndLineReferenceDesc
ExplanationFORM 990, SCHEDULE F, PART I, LINE 2 THE HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other225.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,187,086TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,187,086NetCommunityBenefitExpnsAmt
Total Expense0.00530TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$202,536,549TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$118,785,211DirectOffsettingRevenueAmt
Net Community Benefit Expns$83,751,338NetCommunityBenefitExpnsAmt
Total Expense0.07270TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$208,723,635TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$118,785,211DirectOffsettingRevenueAmt
Net Community Benefit Expns$89,938,424NetCommunityBenefitExpnsAmt
Total Expense0.07800TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,137,948TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,965,721DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,172,227NetCommunityBenefitExpnsAmt
Total Expense0.00280TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$44,301,890TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$13,006,055DirectOffsettingRevenueAmt
Net Community Benefit Expns$31,295,835NetCommunityBenefitExpnsAmt
Total Expense0.02720TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,050,042TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$195,323DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,854,719NetCommunityBenefitExpnsAmt
Total Expense0.01570TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,217,737TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$44,588DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,173,149NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$641,565TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$641,565NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$57,349,182TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$15,211,687DirectOffsettingRevenueAmt
Net Community Benefit Expns$42,137,495NetCommunityBenefitExpnsAmt
Total Expense0.04800TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$266,072,817TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$133,996,898DirectOffsettingRevenueAmt
Net Community Benefit Expns$132,075,919NetCommunityBenefitExpnsAmt
Total Expense0.12600TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$18,500TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$18,500NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,673,598TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$842,055DirectOffsettingRevenueAmt
Net Community Benefit Expns$831,543NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$75,339TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$75,339NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$128,205TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$128,205NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,895,642TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$842,055DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,053,587NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$23,850,195BadDebtExpenseAmt
Reimbursed By Medicare$310,067,164ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$319,013,066CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$8,945,902MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.dartmouth-hitchcock.orgWebsiteAddressTxt
State License01799StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Childrens HospitalYes (X)ChildrensHospitalInd
Teaching HospitalYes (X)TeachingHospitalInd
Research FacilityYes (X)ResearchFacilityInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherPsych Unit and Transplant Unit Cancer CenterOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLPlease see Section C, Supplemental InfoOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLPlease see Section C, Supplemental InfoStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care225.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSee Section C, Supplemental InfoFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSee Section C, Supplemental InfoFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSee Sect. C, Spplmntl InfoFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Input From Representatives of Community Served by the Hospital FacilityForm 990, Schedule H, Part V, Section B, Line 5 D-H IS ACTIVELY ENGAGED IN THE DEVELOPMENT OF AN ACTIVE UPPER VALLEY REGIONAL PUBLIC HEALTH ADVISORY COUNCIL (40+ COMMUNITY REPRESENTATIVES) AND BROADER RETHINK HEALTH INITIATIVES (100+ 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 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 WE BOTH PARTICIPATE IN AND BETTER UNDERSTAND THE NEEDS OF OUR COMMUNITY. Mary Hitchcock Hospital contracted with Community Health Institute/JSI to provide consultation and technical expertise to our assessment process. Community Health Institute/JSI is a public health management consulting and research organizations dedicated to improving the health of individuals and communities throughout the world. During the period March through August 2015, a Community Health Needs Assessment in the Mary Hitchcock Memorial Hospital and Alice Peck Day Memorial Hospital service area of New Hampshire and Vermont was conducted by Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital in partnership with New London Hospital, Valley Regional Hospital, and Mt. Ascutney Hospital and Health Center. 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, a concerted effort was made to convene a focus group of local individuals representing both documented and undocumented immigrant populations, with the assistance of a legal aid organization. However, scheduling challenges precluded our ability to convene the group. 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 May 2015 through August 2016 to generate input from 1,566 residents, including 1,185 residents from the 19 towns defined as our Hospital Service Area. Surveys were made available through primary care clinics, free care clinics, a shelter for the homeless, a free community dinner, and numerous other community locations. Residents completing surveys included members of African-American, Hispanic, Native American, and Asian populations. Surveys were distributed through regional health clinics, the regions shelter for homeless populations; the regions low-income housing trust; the Lebanon Housing Authority; senior centers, 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, 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. Based on discussions with a wide variety of community service organization leaders, town officials, and public health officials, there is general agreement that in the region covered by this CHNA, health disparity is far more likely to be driven by household median income, insurance status, and other indicators of poverty than by racial and ethnic minority characteristics. The Upper Valley region is overwhelmingly Caucasian (Grafton County NH; 93.6% white; 0.9% African American, 0.4% Native American, 1.8% Hispanic/Latino, 3.0% Asian, 2014 as per American Factfinder). Compared to other regions, racial and ethnic minority residents in our CHNA region are employed with academic and health care systems, and have relatively high socio-economic status. By comparison, the percent of households with income below 200% of federal poverty level reaches 20.7% in some of the towns in our CHNA area. Through the course of the FY2016 Community Health Needs Assessment, we attempted to, but were unable to identify any advocacy group or other representative leadership serving in an organizing or leadership role for minority populations. Similarly, we scanned for, but were unable to find any neighborhood or geographic region with a high density of racial or ethnic minority populations in our region. In May 2015, our CHNA partner, Alice Peck Day Memorial Hospital, contacted a representative of a regional group representing immigrant residents and had a conversation with that representative, but were not successful in arranging a conversation group with members represented by this organization due to lack of geographic convenience. Additionally, in May 2015 we spoke with a regional English as a Second Language coordinator regarding the challenges impacting the families served by that program. During our assessment process, Mary Hitchcock Memorial Hospital and Alice Peck Day Memorial Hospital made specific efforts to contact and receive input from members of income vulnerable populations, including holding community discussion groups with: -Pregnant and parenting teens participating in an alternative high school environment at The Family Place Parent Child Center (6/2/15). -Residents of The Haven, a shelter for homeless individuals and families (6/8/2015) -Frail older adults and advocates of the Upper Valley Interfaith Project (6/23/15) CHNA Conducted With One Or More Other Hospital Facilities Form 990, Schedule H, Part V, Section B, Line 6A During December of 2015, MHMH partnered with Alice Peck Day Memorial Hospital to complete a community health needs assessment. We also partnered with neighboring hospitals including Valley Regional Hospital, New London Hospital, and Mount Ascutney Hospital and Health Center, using similar community health needs assessment tools and approaches, allowing us to compare community health needs across a broad geographic, multi-hospital region. CHNA Conducted With One Or More Organizations Other Than Hospital Facilities Form 990, Schedule H, Part V, Section B, Line 6B During December 2015, in addition to working with Dartmouth-Hitchcock Clinic, MHMH worked closely with the member organizations of the Public Health Council of the Upper Valley (40+ member organizations) to disseminate surveys, serve as key informants, and to provide overall review and feedback re: findings identified in the community health needs assessment. Community Health Needs Assessment Form 990, Schedule H, Part V, Section B, Line 7a The Community Health Needs Assessment can be found online at http://www.dartmouth-hitchcock.org/about_dh/ community_benefits_program.html Community Health Needs Assessment Form 990, Schedule H, Part V, Section B, Line 7d The Needs Assessment was distributed to non-profit organizations throughout the region including the Public Health Council of the Upper Valley and Granite United Way. It is also available from the Organization
Measures to Publicize Financial Assistance PolicyForm 990, Schedule H, Part V, Section B, Lines 16 A-C The financial assistance policy, application, and plain language summary can be found at: http://www.dartmouth-hitchcock.org/billing-charges/ financial_assistance.html MHMH has brochures available at all admission sites as well as plain language summary posters at all locations. Additionally, MHMH provided brochures to local non-profits to distribute. Financial Assistance Policy availability within the Community Form 990, Schedule H, Part V, Section B, Line 16J MHMH financial assistance policy is posted on MHMH's website, including the verbatim policy and a shorter, more patient-friendly version. MHMH provides the patient friendly brochure version of the policy to all uninsured patients who enter the health system. MHMH continues to notify patients on the back of the billing statement about financial assistance being available to them. Additionally, MHMH posts information about the policy in public areas throughout the facilities including admission offices. MHMH has also made additional changes internally to increase awareness of the policy, including adding information to the back of the patient's statement about financial assistance available to them, posting information about the policy in public areas throughout the facilities, and ensuring financial assistance policy brochures are available 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. Facility information Form 990, Schedule H, Part V, Section D The Hospital has a 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.

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Other factors used in determining eligibility other than FPGForm 990, Schedule H, Part I, Line 3c Guidelines D-H uses the FPG guidelines in determining the initial level of financial assistance provided. In addition, D-H 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 selfpay balance is greater than this calculation, the selfpay 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. Community Benefits Report Form 990, Schedule H, Part I, Line 6a 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 2017, DHC and MHMH combined, totaled $182,213,939.
Costing MethodologyForm 990, Schedule H, Part I, Line 7 The costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, Ratio of Patient Care Cost-to-Charges.
Subsidized health services related to physician clinicsForm 990, Schedule H, Part I, Line 7G The Organization did not include any subsidized health service costs attributable to a physician clinic on Part I, line 7G.
Community Building ActivitiesForm 990, Schedule H, Part II 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.
Bad Debt ExpenseForm 990, Schedule H, Part III, Section A, Line 2 The amounts reported on Part III, Section A, line 2 were derived from MHMH's audited financial statements (provision for bad debt). MHMH's Policy is to exert everything in the Organization's power to obtain sufficient and adequate information to determine eligibility for financial assistance. MHMH's discount for uninsured patients is currently 58% (before financial assistance is applied). As part of MHMH's Financial Assistance Policy, MHMH makes information available to patients for eligibility and how to apply for free or discounted care. If the patient does not respond to the hospital's attempts to complete the financial assistance package, these patients may be written off to bad debt. Until 10/1/2015, when D-H changed revenue management service providers, D-H had procedures for presumptive charity review. With the transition to new revenue management providers, D-H is working to begin presumptive charity review for fiscal year 2018.
Audited Financial Stmt Disclosure for Charity Care and Bad Debt ProvisionForm 990, Schedule H, Part III, Section A, Line 4 (Please note that MHMH files a consolidated audited financial statement with Dartmouth-Hitchcock Clinic and other Subsidiaries the amount reported on Schedule H represents MHMH's portion only). 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. Additions to the allowance for uncollectible accounts are made by means of the provision for bad debt. 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.
Medicare ShortfallsForm 990, Schedule H, Part III, Section B, Line 8 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 $35,488,831 and costs of $40,789,767 for services not included on the Medicare Cost Report (Ambulance Services, Laboratory and other fees screens, and Medicare Part C & D services) MHMH incurred a net loss of $5,300,936 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.
Credit and Collection PolicyForm 990, Schedule H, Part III, Line 9b MHMH has a Credit and Collection Policy that addresses the procedures for patients who choose not to make payment or work with MHMH to make payment arrangements for their bill. The Organization has a separate Financial Assistance Policy that addresses those patients who are unable to make payment. MHMH is a charitable health care organization that treats patients that come for medically necessary care, regardless of their financial status. MHMH offers financial assistance in the form of free or discounted care to those patients who have an inability to pay their bills. The Financial Assistance Policy outlines eligibility criteria for financial assistance; the method by which patients may apply for financial assistance; the basis for calculating amounts charged to patients eligible for financial assistance under this policy; D-H's measures to widely publicize the policy within the community served; and the limitation of charges for emergency or other medically necessary care. Patients can qualify for 25%, 50%, 75%, or 100% reduction based on Federal Poverty Levels as well as a catastrophic guideline of 10% of 2 year's income for those that may not qualify based on assets and income, but who have a bill beyond their means to pay. 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.
Needs AssessmentForm 990, Schedule H, Part VI, Line 2 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 FY2016, 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, AND NEW LONDON HOSPITAL 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 FY2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AT A LARGE COMMUNITY MEETING (50+ STAKEHOLDERS) OF THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY AND OTHERS IN DECEMBER 2015 FOR FURTHER COMMENTS AND FEEDBACK. AS PART OF THE NEEDS ASSESSMENT, MHMH REVIEWED: 1. HEALTH, ECONOMIC, AND EDUCATION DATA FROM SOURCES INCLUDING YOUTH RISK BEHAVIOR SURVEYS, THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, PUBLIC HEALTH AND HOSPITAL DISCHARGE DATA AVAILABLE IN NH HEALTH WRQS, CENSUS DATA, AND REPORTS FROM THE NEW ENGLAND COMMON ASSESSMENT PROGRAM. ADDITIONALLY, IT REVIEWED THE 2011 NH STATE HEALTH PROFILE; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS) TO IDENTIFY CONCERNS THAT EMERGED, INTENSIFIED, OR WERE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST SECONDARY DATA WAS COLLECTED. 2. OPINION DATA FROM PROFESSIONAL STAKEHOLDERS USING AN ONLINE OPINION POLL OF REGIONAL LEADERS IN HEALTH, PUBLIC HEALTH, EDUCATION, MUNICIPAL GOVERNMENTS, PUBLIC SAFETY, AND SOCIAL SERVICE PROVIDERS. 69 INFORMED STAKEHOLDERS RESPONDED TO THIS SURVEY. 3. FOCUS GROUP DATA COLLECTED FROM 4 FOCUS GROUPS LARGELY CONSISTING OF LOWER-INCOME CONSUMERS OF HEALTH/SOCIAL SERVICES. 4. OPINION DATA FROM RESIDENTS COLLECTED THROUGH COMMUNITY LIST-SERVS, ASSISTED INTERVIEWS AT HUMAN SERVICE ORGANIZATIONS, HUMAN SERVICE ORGANIZATIONS, PRIMARY CARE AND FREE CARE CLINICS, AND OTHER COMMUNITY SETTINGS. 1,566 RESIDENTS RESPONDED TO SURVEYS. DARTMOUTH-HITCHCOCK REGULARLY MONITORS NEWLY RELEASED HEALTH, ECONOMIC, AND EDUCATION DATA FROM OUR SERVICE REGION TO IDENTIFY EMERGING REGIONAL NEEDS AND CONCERNS, INCLUDING FY 2015 YOUTH RISK BEHAVIOR SURVEYS, THE 2013 NH STATE HEALTH IMPROVEMENT PLAN, NH'S EMERGING STATE PLANS TO ADDRESS SUBSTANCE MISUSE, OPIOID MISUSE, OBESITY, AND CHILDREN'S BEHAVIORAL HEALTH.
Patient Education of Eligibility for AssistanceForm 990, Schedule H, Part VI, Line 3 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. Community Information Form 990, Schedule H, Part VI, Line 4 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 300-13,000 people. These towns are generally considered rural, though the Hanover, NH, Lebanon, NH and Hartford, VT communities are considered to be a micropolitan area. Among the regions 19 towns, median household income varies widely, from $46K-$108K annually. 15.6% of the population is over the age of 65; 4.5% of the population is under the age of 5; 9.7% of children live in households whose median household income is less than 100% of Federal Poverty Level; 27% of children live in households with income less than 200% of Federal Poverty Level; 1.6% of the regions residents have Limited English Proficiency; and 8.2% lacked health insurance. 13% of NH residents and 20% 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.
Promotion of Community HealthForm 990, Schedule H, Part VI, Line 5 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-HITCHCOCKS'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 HITCHCOCKS'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 18 VOTING MEMBERS OF THE MARY HITCHCOCK BOARD OF TRUSTEES AT FY17 END, 12 ARE NEITHER CONTRACTORS NOR EMPLOYEES OF MHMH.
Affiliated Health Care System CommunityForm 990, Schedule H, Part VI, Line 6 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 2017 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. MHMH, DHC, AND THE GEISEL SCHOOL OF MEDICINE FACULTY AND STUDENTS MAKE UP THE DARTMOUTH-HITCHCOCK (D-H) HEALTH CARE SYSTEM. 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.
State filing of Community Benefits ReportForm 990, Schedule H, Part VI, Line 7 MHMH files a Community Benefits Report with the State of New Hampshire jointly with Dartmouth-Hitchcock Clinic.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (21 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescPurpose Of GrantPurposeOfGrantTxt
Advance Transit
PO Box 1027WilderVT05088222558708501(C)(3)$75,740FMVTransportn Subsidy
American Cancer Society
250 Williams Street NWAtlantaGA30303131788491501(c)(3)$32,550FMVProgram Support
American Heart Association
7272 Greenville AvenueDallasTX75231135613797501(c)(3)$10,500FMVProgram Support
The Hitchcock Foundation
One Medical Center DriveLebanonNH03756020222139501(c)(3)$8,050FMVPROGRAM SUPPORT
Good Neighbor Health Clinic
70 N MAIN STWHITE RIVER JCTVT05001030346949501(c)(3)$45,500FMVProgram Support
Grafton County Senior Citizens Council
10 CAMPBELL STLEBANONNH03766237248316501(c)(3)$12,600FMVProgram Support
Mary & John Eliot Charitable Foundation
1070 Holt Ave Unit 1 Ste 2100ManchesterNH03109020512229501(c)(3)$5,250FMVProgram Support
Riverbend Community Mental Health
3 N State StConcordNH03301020264383501(c)(3)$17,570FMVProgram Support
Sullivan County
14 Main StNewportNH03773Gov't$10,500FMVPublic Health
Foundation for Healthy Communities
125 AIRPORT RDCONCORDNH03301020275078501(c)(3)$370,475FMVProgram Support
Southwestern Vermont Health Care Foundation
100 Hospital DrBenningtonVT05201453362785501(c)(3)$7,000FMVProgram Support
Albert Schweitzer Fellowship
330 Brookline AveBostonMA02215131982786501(c)(3)$7,000FMVProgram Support
March of Dimes Foundation
1275 Mamaroneck AveWhite PlainsNY10605131846366501(c)(3)$7,000FMVProgram Support
Southeast Vermont Transit
45 Mill StWilmingtonVT05363030353976501(c)(3)$21,000FMVTransportn Subsidy
Upper Valley Haven
713 Hartford AveWhite River JctVT05001030277908501(c)(3)$17,500FMVProgram Support
Windsor Hospital Corporation
289 County RdWindsorVT05089030183721501(c)(3)$11,725FMVProgram Support
Makin It Happen Coalition for Resilient Yth
27 Lowell St Ste 502ManchesterNH03101020495300501(c)(3)$10,500FMVProgram Support
NH Fisher Cats Charitable Foundation
1 Line DriveManchesterNH03101141973034501(c)(3)$9,870FMVProgram Support
Manchester Community Health Center
145 Hollis StreetManchesterNH03101020458174501(c)(3)$35,000FMVProgram Support
Ottauquechee Health Foundation
PO Box 784WoodstockVT05091030197766501(c)(3)$14,000FMVProgram Support
Granite United Way
22 Concord Street Floor 2ManchesterNH03101026006033501(c)(3)$14,000FMVProgram Support
FieldValueIRS element (for citing)
Total501c3 Org21Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDesc
Awards and Educational Assistance103$825,054FMV
D-H Tuition Reimbursement Program440$615,602FMV
Patient Assistance1599$83,572FMV

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceDescription of Organization's Procedures for Monitoring the Use of GrantsFormAndLineReferenceDesc
ExplanationForm 990, Schedule I, Part I, Line 2 Each award established by Mary Hitchcock Memorial Hospital has written guidelines and procedures. Award payments are processed in accordance with the specific terms of each award. The Dartmouth Institute Scholarships (TDI) are paid directly to Dartmouth College on behalf of the individuals receiving the award. The coordinators of the program(s) are responsible for assuring that all terms are met, including proper documentation of expenses with receipts.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelYes (X)FirstClassOrCharterTravelInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (46 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Carl Dematteo MD
Fmr Chf Ql Compl Ofr/Physician$0$116,398$0$600$0$3,558$0$0$0$1,384$0$121,940$0$0
Robin Kilfeather-Mackey CPA
CFO end 7/15/16$0$295,990$0$0$0$313,419$0$0$0$12,922$0$622,331$0$0
Daniel P Jantzen CPA
COO end, CFO eff 7/16/16$570,275$0$0$0$652,995$0$117,793$0$16,633$0$1,357,696$0$0$0
Stephen Leblanc
Chief Administrative Officer$0$554,597$0$0$0$116,998$0$107,109$0$21,724$0$800,428$0$0
John Butterly MD
Former Officer/EVP Med Affairs$0$82,523$0$0$0$56,243$0$13,274$0$144$0$152,184$0$0
Bruce King MSPH FHFMA
Pres & CEO New London Hosp$322,286$0$0$0$57,837$0$57,465$0$16,592$0$454,180$0$0$0
Mary Oseid MHCDS
Fmr Key Emp/VP Enterprise Svcs$0$252,252$0$0$0$508$0$182,218$0$12,167$0$447,145$0$0
Christine Schon MPA
Fmr Key Emp/Adm VP Prmry Care$0$237,487$0$0$0$8,558$0$23,885$0$16,450$0$286,380$0$0
James N Weinstein DO MS
Trustee Ex-Officio/CEO$0$1,268,501$0$0$0$96,036$0$93,402$0$15,429$0$1,473,368$0$0
Tina Naimie CPA MHCDS
Fmr Key Emp/VP Corp Finance$238,185$0$0$0$529$0$18,042$0$1,839$0$258,595$0$0$0
Wendy Fielding MBA
Fmr Key Emp/VP Finance Plnning$235,976$0$0$0$270$0$18,219$0$21,536$0$276,001$0$0$0
Vincent Fusca III
Chief of Staff end 2/10/17$319,753$0$0$0$11,245$0$25,875$0$1,490$0$358,363$0$0$0
Edward Merrens MD
Chief Clinical Officer$0$496,852$0$0$0$24,569$0$46,420$0$12,311$0$580,152$0$0
George Blike MD
Chief Quality & Value Officer$0$414,310$0$0$0$40,734$0$227,077$0$19,935$0$702,056$0$0
Thomas Colacchio MD
Former Officer/Physician$0$179,518$0$0$0$487,883$0$43,501$0$10,664$0$721,566$0$0
Barbara C Jobst MD
Physician/Trustee end 12/31/16$0$326,282$0$40,000$0$11,721$0$75,934$0$22,317$0$476,254$0$0
Darlene A Saler MBA RN
Frmr Actg Chf Nrsg Ofr$169,562$0$0$0$979$0$73,887$0$10,630$0$255,058$0$0$0
John S Malanowski MILR
Chief HR Officer end 2/10/17$494,784$0$0$0$24,273$0$20,575$0$19,603$0$559,235$0$0$0
Terrence P Carroll PHD
Former Chf Innvtn Ofcr$0$0$0$0$380,765$0$0$0$0$0$380,765$0$0$0
Roderic Young
VP Communications & Marketing$307,253$0$0$0$5,774$0$20,575$0$21,654$0$355,256$0$0$0
Martin Purcell MBA
VP IS Operations$291,321$0$0$0$38,998$0$134,964$0$1,444$0$466,727$0$0$0
Thomas Dodds MD
Former Key Emp/Dept Chr Anesth$0$450,617$0$0$0$32,934$0$79,202$0$19,957$0$582,710$0$0
Wendy Wells MD
Fmr Key Emp/Dpt Chr Pathology$0$464,676$0$0$0$23,172$0$111,806$0$17,473$0$617,127$0$0
Jocelyn Chertoff MD
Fmr Key Emp/Dpt Chr Dgnstc Rad$0$549,599$0$0$0$32,515$0$117,431$0$15,362$0$714,907$0$0
Edward Catherwood MD MS
Former Key Emp/Ctr Dir Hrt/Vsc$0$458,562$0$0$0$0$0$46,330$0$20,574$0$525,466$0$0
Steven Boyce
Fmr Key Emp/Adm. VP Med Spclts$0$218,978$0$0$0$817$0$48,521$0$21,518$0$289,834$0$0
Jeffrey OBrien MHA
Fmr Key Emp/VP Oncology$278,588$0$0$0$4,091$0$20,575$0$21,606$0$324,860$0$0$0
M Brooke Herndon MD MS
Trustee/Staff Physician$0$205,330$0$0$0$1,791$0$43,822$0$19,428$0$270,371$0$0
Richard Rothstein MD
Chf Academic Offcr eff 1/1/17$0$553,463$0$0$0$2,160$0$59,414$0$17,299$0$632,336$0$0
John Birkmeyer MD
CCO/EVP Entprs Sp end 10/14/16$0$661,213$0$0$0$220,254$0$20,575$0$18,758$0$920,800$0$0
Gay Landstrom PhD RN NEA-BC
Chf Nursing Offcr end 1/10/17$544,439$0$0$0$35,006$0$20,575$0$19,260$0$619,280$0$0$0
Kimberly Troland JD
Fmr Intrm GC/Deputy Gen Cnsl$357,838$0$0$0$11,758$0$20,575$0$19,185$0$409,356$0$0$0
Robert Greene MD MHCDS FACP
Chf Popul Mgmt Ofr end 4/7/17$0$561,538$0$0$0$32,388$0$24,606$0$19,325$0$637,857$0$0
John Kacavas JD
Chief Legal Officer$429,550$0$0$0$774$0$20,575$0$19,260$0$470,159$0$0$0
Maria Padin MD
Chief Medical Officer$0$398,748$0$0$0$10,608$0$177,879$0$19,925$0$607,160$0$0
Peter D Solberg MD
Chf Medical Information Ofcr$0$366,882$0$0$0$8,509$0$32,814$0$13,164$0$421,369$0$0
Karen Clements RN BSN MSB FAC
Chief Nursing Officer$268,238$0$0$0$404$0$20,575$0$8,462$0$297,679$0$0$0
Thomas J Siepka
Chief Pharmacy Officer$299,041$0$0$0$270$0$20,575$0$1,930$0$321,816$0$0$0
Jeffrey A Cohen MD
Trustee/VP Service Line$0$407,294$0$0$0$27,821$0$87,447$0$17,474$0$540,036$0$0
Timothy D Scherer MD
Trustee/Physician$0$506,063$0$0$0$15,054$0$52,024$0$19,936$0$593,077$0$0
Brian C Spence MD MHCDS
Trustee/Staff Physician$0$403,578$0$60,200$0$18,489$0$26,398$0$22,390$0$531,055$0$0
Kari M Rosenkranz MD
Trustee eff 1/1/17/Physician$0$436,264$0$47,618$0$12,957$0$20,575$0$9,312$0$526,726$0$0
Sowmya Viswanathan MD
Chief ACO Officer eff 7/5/16$0$161,292$0$0$0$205$0$10,094$0$8,164$0$179,755$0$0
Aimee M Giglio
Int Chf HR Offcr eff 2/10/17$216,905$0$0$0$8,879$0$10,621$0$18,595$0$255,000$0$0$0
David Gladstone MD
Chf Clncl Physcn - Radiology$274,467$0$5,023$0$14,455$0$74,908$0$19,148$0$388,001$0$0$0
Sandra Wong MD
Department Chair Surgery$0$671,891$0$0$0$0$0$20,575$0$9,312$0$701,778$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Chartered Travel ServicesForm 990, Schedule J, Part I, Line 1a FROM TIME TO TIME, THE ORGANIZATION PROVIDES CHARTERED TRAVEL SERVICES TO THE CEO. THE COST OF PROVIDING THE CHARTERED SERVICE HAS BEEN DEEMED A COST-EFFICIENT MANNER TO ALLOW THE OFFICER TO WORK WHILE TRAVELING VERSUS THE TIME LOST DRIVING, ETC. THIS EXPENSE HAS BEEN DEEMEND AN ORDINARY AND NECESSARY BUSINESS EXPENSE AND NON-TAXABLE TO THE RECIPIENT. ALL REQUESTS ARE APPROVED BEFORE PAYMENT TO ENSURE COMPLIANCE WITH INTERNAL POLICIES. Health or Social Club Dues & Fees Form 990, Schedule J, Part I, Line 1a 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. COMPENSATION OF THE CEO 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 CONSULANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION.
Severance PaymentsForm 990, Schedule J, Part I, Line 4a THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2016: DURING 2012, THOMAS COLACCHIO TRANSITIONED FROM AN OFFICER ROLE TO A STAFF PHYSICIAN ROLE. AS PART OF THIS TRANSITION, THOMAS COLACCHIO RECEIVED A $320,000 CHANGE OF CONTROL PAYMENT FROM DARTMOUTH-HITCHCOCK IN 2016. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2016, FORMER CHIEF INNOVATION OFFICER TERRENCE CARROLL RECEIVED SEVERANCE PAYMENTS TOTALING $380,765 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2016, FORMER CHIEF FINANCIAL OFFICER ROBIN KILFEATHER-MACKEY RECEIVED SEVERANCE PAYMENTS TOTALING $224,351 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2016, FORMER CHIEF CLINICAL OFFICER / EXECUTIVE VP OF ENTERPRISE SUPPORT JOHN BIRKMEYER RECEIVED SEVERANCE PAYMENTS TOTALING $129,856 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. Supplemental Nonqualified Retirement Plan 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)): BARBARA JOBST $9,646 BRIAN SPENCE $18,489 BRUCE KING $27,243 EDWARD MERRENS $24,155 GAY LANDSTROM $33,499 GEORGE BLIKE $40,320 JAMES WEINSTEIN $93,750 JEFFREY COHEN $16,800 JOHN BIRKMEYER $53,500 JOHN MALANOWSKI $23,499 KARI ROSENKRANZ $12,687 KIMBERLY TROLAND $11,603 MARIA PADIN $10,074 MARTIN PURCELL $26,252 PETER SOLBERG $8,095 ROBERT GREENE $28,500 ROBIN KILFEATHER-MACKEY $82,881 RODERIC YOUNG $5,000 STEPHEN LEBLANC $114,904 TIMOTHY SCHERER $14,856 VINCENT FUSCA $6,601 JEFFREY OBRIEN $2,171 JOCELYN CHERTOFF $31,327 JOHN BUTTERLY $30,926 STEVEN BOYCE $43 THOMAS COLACCHIO $81,489 THOMAS DODDS $32,160 WENDY WELLS $21,342 DAVID GLADSTONE $2,642 THE ANNUAL SERP PROGRAM PROVIDES ELIGIBLE PARTICIPANTS WITH AMOUNTS INTENDED TO REPLACE THE REDUCTION IN QUALIFIED RETIREMENT BENEFITS DUE TO THE APPLICATION OF BENEFIT LIMITATIONS IMPOSED BY IRC SECTIONS 401(A) AND/OR 415. IN ADDITION, ONCE ELIGIBLE PARTICIPANTS QUALIFY FOR SPECIAL EARLY RETIREMENT BENEFITS BASED ON YEARS OF SERVICE PLUS AGE - AS PROVIDED IN THE DEFINED BENEFIT PLAN - THE VALUE OF THE SPECIAL EARLY RETIREMENT BENEFIT, DETERMINED WITHOUT REGARD TO LIMITATIONS IN 401(A) AND 415 IS INCLUDED IN THE PAYMENT. THE FOLLOWING INDIVIDUALS QUALIFIED FOR EARLY RETIREMENT BENEFITS DURING CALENDAR YEAR 2016: DANIEL P. JANTZEN $638,098 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. 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.
Note regarding compensationForm 990, Schedule J, Part II Column B, parts I, II, and III represent actual amounts paid to employees by MHMH. 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 D-H on behalf of its employees.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
NH HEALTH & ED FACILITIES AUTHORITY
A020279866644614YU72009-08-19$134,661,088CURRENT REFUND 2008 (A),(B),(C)falsefalsefalse
NH HEALTH & ED FACILITIES AUTHORITY
B020279866644614G292010-06-16$73,647,839CONSTR. OF FACILITY AND EQUIPfalsefalsefalse
NH HEALTH & ED FACILITIES AUTHORITY
C0202798660000000002012-11-28$116,170,000CURRENT REFUND 2002falsefalsefalse
NH HEALTH & ED FACILITIES AUTHORITY
D0202798660000000002014-08-13$41,242,990REFUNDED PORTION OF 2009 ISSUE DATfalsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$77,380,000$0$134,661,088$0$0$0$2,273,111$0$0$0$132,387,977$02010Yes (true)falseYes (true)Yes (true)
B$0$0$73,666,926$0$3,766,049$0$1,168,560$0$0$68,732,317$0$02012falsefalseYes (true)Yes (true)
C$5,110,000$0$116,170,000$0$0$0$520,000$0$0$0$115,650,000$02013Yes (true)falseYes (true)Yes (true)
D$0$0$41,242,990$0$0$0$352,990$0$0$0$40,890,000$02014Yes (true)falseYes (true)Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
Afalsefalsefalsefalse0falsefalsefalseYes (true)
Bfalsefalsefalsefalse0falsefalsefalseYes (true)
C0
Dfalsefalsefalsefalse0falsefalsefalseYes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1TxtGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
AfalsefalseYes (true)falsefalsefalsefalse0falseYes (true)
0
BfalsefalsefalseYes (true)falsefalsefalse0falseYes (true)
0
CfalseYes (true)falsefalsefalsefalsefalse0falseYes (true)
0
DfalseYes (true)falsefalsefalsefalsefalse0falseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)
CYes (true)
DYes (true)

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceADDITIONAL INFORMATIONFormAndLineReferenceDesc
ExplanationFORM 990, SCHEDULE K, PART I, COLUMN F LINE A: CURRENT REFUND 2008 (A), ISSUED 9/4/08, WHICH ADVANCED REFUNDS 1985 CURRENT REFUND 2008 (B), ISSUED 10/31/08, WHICH ADVANCED REFUNDS 1993 CURRENT REFUND 2008 (C), ISSUED 12/19/08 OTHER SPENT PROCEEDS FORM 990, SCHEDULE K, PART II, LINE 11, COLUMNS A,C,&D THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW OTHER SPENT PROCEEDS FORM 990, SCHEDULE K, PART II, LINE 11, COLUMN B THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE INVESTMENT EARNINGS ON THE PROJECT FUND REBATE COMPUTATION DATE FORM 990, SCHEDULE K, PART IV, LINE 2C, COLUMN B THE REBATE CALCULATION WAS PERFORMED ON 6/17/2015ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
NH HEALTH & ED FACILITIES AUTHORITY
A0202798660000000002015-09-01$35,785,218REFUND ISSUE DATED 8/31/2011falsefalsefalse
NH HEALTH AND ED FACILITIES AUTHORITY
B0202798660000000002016-07-01$35,575,000SEE PART VIfalsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$0$0$35,785,218$0$0$0$105,239$0$0$0$35,679,979$02015Yes (true)falseYes (true)Yes (true)
B$0$0$35,575,000$0$0$0$408,058$0$0$15,936,616$19,230,326$02017Yes (true)falseYes (true)Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdPrivate Bus Use By OthersPrivateBusUseByOthersPctOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndEngage Bond Counsel ResearchEngageBondCounselResearchIndTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A0
B0.00100falseYes (true)Yes (true)Yes (true)falsefalse0.00100falsefalsefalseYes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1TxtGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
AfalseYes (true)falsefalseYes (true)falsefalse0falseYes (true)
0
BfalseYes (true)falsefalseYes (true)falsefalse0falseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceDESCRIPTION OF PURPOSEFormAndLineReferenceDesc
ExplanationFORM 990, PART I, LINE B, COLUMN F THE PURPOSE OF THE ISSUE WAS TO REFUND AN ISSUE DATED 10/24/2013 AND FINANCE CAPITAL PROJECTS. OTHER SPENT PROCEEDS FORM 990, PART II, COLUMN A, LINE 11 THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW PRIVATE BUSINESS USE FORM 990, SCHEDULE K, PART III, COLUMN A THE 2015 SERIES, THROUGH A SERIES OF REFUNDINGS, REFUNDS ISSUES DATED PRIOR TO 12/31/2002 AND THEREFORE IS EXEMPT FROM PART III REPORTINGExplanationTxt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)

Relationship With OrgRelationshipWithOrgTxtLoan PurposeLoanPurposeTxtLoan From OrganizationLoanFromOrganizationIndOriginal PrincipalOriginalPrincipalAmtBalance DueBalanceDueAmtDefaultDefaultIndBoard Or Committee ApprovalBoardOrCommitteeApprovalIndWritten AgreementWrittenAgreementInd
DANIEL JANTZEN
OFFICERSPLIT DOLLAR LIFEYes (X)$117,590$117,590falseYes (true)Yes (true)
Deborah Jantzen
FAMILY MEMBERSplit Dollar LifeYes (X)$58,133$58,133falseYes (true)Yes (true)
FieldValueIRS element (for citing)
Total Balance Due$175,723TotalBalanceDueAmt

Grnt Asst Bnft Interested Prsn GrntAsstBnftInterestedPrsnGrp (2 entries)

Relationship With OrgRelationshipWithOrgTxtCash GrantCashGrantAmtType Of AssistanceTypeOfAssistanceTxtAssistance PurposeAssistancePurposeTxt
Karen Clements
Key Employee$69,727ScholarshipMASTERS DEGREE PROGRAM
Jeffrey Obrien
Former Key Employee$34,207ScholarshipMASTERS DEGREE PROGRAM

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Vincent Fusca III
Family member of Key EE Fusca II$85,049Employment Compensationfalse
Linda Billings
Family member of Former KE Mary Oseid$102,608Employment Compensationfalse
Greg DeMatteo
Family member of Former Officer Carl DeMatteo$113,089Employment Compensationfalse

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArtGrp
Art Historical TreasuresArtHistoricalTreasuresGrp
Art Fractional InterestArtFractionalInterestGrp
Books And PublicationsBooksAndPublicationsGrp
Clothing And Household GoodsClothingAndHouseholdGoodsGrp
Cars And Other VehiclesCarsAndOtherVehiclesGrp
Boats And PlanesBoatsAndPlanesGrp
Intellectual PropertyIntellectualPropertyGrp

Securities Publicly Traded SecuritiesPubliclyTradedGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution6ContributionCnt
Noncash Contributions Rpt F990$616,610NoncashContributionsRptF990Amt
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Securities Closely Held StockSecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust IntrstsSecurPrtnrshpTrustIntrstsGrp
Securities MiscellaneousSecuritiesMiscellaneousGrp
Qualified Contrib Hist StructQualifiedContribHistStructGrp
Qualified Contrib OtherQualifiedContribOtherGrp
Real Estate ResidentialRealEstateResidentialGrp
Real Estate CommercialRealEstateCommercialGrp
Real Estate OtherRealEstateOtherGrp
CollectiblesCollectiblesGrp
Food InventoryFoodInventoryGrp
Drugs And Medical SuppliesDrugsAndMedicalSuppliesGrp
TaxidermyTaxidermyGrp
Historical ArtifactsHistoricalArtifactsGrp
Scientific SpecimensScientificSpecimensGrp
Archaeological ArtifactsArchaeologicalArtifactsGrp
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (true)ReviewProcessUnusualNCGiftsInd
Third Parties UsedYes (true)ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule M, Part I, Column BFormAndLineReferenceDesc
ExplanationThe organization reported the number of contributions received in column (b). Use of related organizations to solicit noncash donations Schedule M, Part I, Line 32B The organization uses Dartmouth-Hitchcock Health, MHMH's Parent Organization, for solicitation of contributions and annual fund activities. From time to time, the Hospital may receive non-cash contributions directly from its donors.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Business relationshipsForm 990, Part VI, Section A, Line 2 Trustees, officers and key employees also hold trustee, officer or key employee positions at Dartmouth Hitchock Clinic (DHC), a related organization. Individuals who received related organization compensation (as reported in Part VII) are paid employees of DHC. Mary Hitchcock Memorial Hospital owns for-profit subsidiaries that provide services and support the mission of the organization. The following are current officers, directors, trustees, or key employees of MHMH and officers of Hamden Assurance, LTD., a related for-profit entity: - Daniel Jantzen - Edward Merrens - John Kacavas - Thomas Colacchio - Robin Kilfeather-Mackey Changes to Organizational Documents Form 990, Part VI, Section A, Line 4 On June 23, 2017, the Board of Trustees of Mary Hitcock Memorial Hospital amended its bylaws for the following 2 changes: Amendment 1: The previous Bylaws stated that Public Trustees serve for a term of three (3) years. While terms may be renewed, Trustees are subject to a limit of three (3) full consecutive terms (for a total of nine (9) years). The Bylaws were amended to permit a Trustee to remain on the Boards for an additional one year following the term limit described above, in order to serve as Chair for an additional year, if approved by at least 2/3 (supermajority) of the Trustees. In addition, a Trustee who has served the maximum of three (3) years as Chair may serve an additional year as Chair, if approved by at least 2/3 (supermajority) of the Trustees. Amendment 2: The previous bylaws stated that when a Public Trustee completes three (3) full consecuvtive terms (9 years of service on the Boards), they become ineligible to rejoin the Board. An amendment was approved to allow Public Trustees to become eligible, for re-election to the Board after a one-year break in service, so that reelection may be considered if there is a strong mutual interest in the individual returning to Board service. Description of classes of members, persons, and the nature of their rights Form 990, Part VI, Section A, Lines 6 & 7a Dartmouth-Hitchcock Health (D-HH) is the sole corporate Member of Mary Hitchcock Memorial Hospital (MHMH). 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. Governance decisions reserved to or subject to approval by persons other than the governing body Form 990, Part VI, Section A, Line 7B In addition to reserved powers, Dartmouth-Hitchcock Health (D-HH) shall have the authority to take actions to establish, manage, and govern the System as an integrated health care delivery system in furtherance of the mission of the Hospital and other Organizations. 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 the Hospital's Board of Trustees, assess the Hospital a monetary amount for the payment of the expenses of D-HH, approve the Hospital's budget, approve the borrowings or dispositions of assets by the Hospital, 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 the Hospital.
Process used by management and/or Governing Body to Review 990Form 990, Part VI, Section B, Line 11b THE FORMS 990 AND 990-T ARE REVIEWED BY EXTERNAL TAX ADVISORS, THE DIRECTOR OF CORPORATE FINANCE, VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL 990 AND 990-T COMPLETE ELECTRONIC VERSION IS SENT OUT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS/RESPONSES PRIOR TO OFFICIAL FILING.
Conflict of Interest PolicyForm 990, Part VI, Section B, Line 12C 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 Compliance and Audit Services Department conducts an annual survey of all officers, trustees, and key employees and performs other procedures as considered necessary to report on compliance with the conflict of interest policy. The Department then reports to each board any potential conflicts for their review. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trusteees on an ongoing basis. In the event a conflict arises, the individual 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 UNDERTAKENForm 990, Part VI, Section B, Line 15a 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 2017.
Offices & Positions for Which Process was Used & Year UndertakenForm 990, Part VI, Section B, Line 15b Compensation for officers and key employees are evaluated by internal HR staff using national benchmarking data, along with ongoing evaluations by an independent third party firm for reasonableness, with the last formal process in 2017. 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.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen PublicForm 990, Part VI, Section C, Line 19 MHMH's governing documents are available through the New Hampshire Secretary of State. Certain financial information is disclosed through the Community Benefits Annual Report. The audited financial statements, governing documents, and conflict of interest policy are available upon request either in electronic or hardcopy form. Average Hours Per Week Form 990, Part VII, Section A, Line 1A, Column B 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' 990's even though compensation reported in part VII is based on the entity issuing the W-2. In addition, certain officers spend time on Dartmouth-Hitchcock Health, the sole corporate member of both MHMH and DHC, along with three supporting organizations Dartmouth-Hitchcock Medical Center, Everwell, Inc., 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. Statement of Functional Expenses Form 990, Part IX Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic operate under an affiliation agreement as directed by Dartmouth-Hitchcock Health, the sole Corporate Member of both entities. Due to the integrated operating structure, related mission, and close relationship of the two tax-exempt organizations, expenses are shared between the two entities. All expenses reported within this 990 are the organization's share of expenses as designated by the affiliation agreement.
Financial Statements and ReportingForm 990, Part XI, Line 9 Other Changes in Net Assets Include: Pension-related changes $4,296,921 Unrealized Gain/Loss on Hedge and other ($2,517,109), Net Asset Transfer to Affiliates $2,701,454 Total changes in net assets: ($4,481,266) Audited Financial Statements Form 990, Part XII, Line 2d The organization's financial information is included in the audited financial statements of Dartmouth-Hitchcock Health and Subsidiaries, which consists of the following organizations and their related subsidiaries: Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, Mt Ascutney Hospital and Health Center, Cheshire Medical Center, The New London Hospital Association, Alice Peck Day Memorial Hospital, and VNA & Hospice of VT and NH.
Circular A-133 Audit RequirementForm 990 Part XII, Line 3A DURING FISCAL YEAR 2017, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE $750,000 THRESHOLD SET FORTH IN THE OMB UNIFORM GUIDANCE, THEREFORE REQUIRING AN AUDIT.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
NEW ENGLAND ALLIANCE FOR HEALTH LLC
ONE MEDICAL CENTER DRIVELEBANONNH03756264232401HLTH IMPROVMTNH$388,779$1,573,978MHMH
D-H Specialty Services LLC
One Medical Center DriveLebanonNH03756460876427Shd Svgs PrgmNH$0$0MHMH

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
DARTMOUTH-HITCHCOCK CLINIC
ONE MEDICAL CENTER DRIVELEBANONNH03756222519596PHYS SVCSNH501(c)(3)10D-HHYes (true)
DARTMOUTH-HITCHCOCK MEDICAL CENTER
ONE MEDICAL CENTER DRIVELEBANONNH03756222715483SUPPORTNG ORGNH501(c)(3)12 TYPE INAYes (true)
DARTMOUTH - HITCHCOCK HEALTH
One Medical Center DriveLebanonNH03756264812335PARENT ORGNH501(C)(3)7NAfalse
HAMDEN RISK RETENTION GROUP INC
30 MAIN STREET STE 330BURLINGTONVT05401208530788Self Ins.VT501(c)(3)12 TYPE IDHCYes (true)
The Hitchcock Foundation
One Medical Center DriveLebanonNH03756020222139HLTHCRE RSRCHNH501(c)(3)7DHCYes (true)
EverWell Inc
One Medical Center DriveLebanonNH03756352506275Supportng OrgNH501(c)(3)12 Type INAYes (true)
The New London Hospital Association Inc
273 County RdNew LondonNH03257020222171HospitalNH501(c)(3)3D-HHYes (true)
Windsor Hospital Corporation
289 County RoadWindsorVT05089030183721HospitalVT501(C)(3)3D-HHYes (true)
Cheshire Medical Center
580 Court StreetKeeneNH03431020354549HospitalNH501(C)(3)3D-HHYes (true)
Cheshire Health Foundation
580 Court StreetKeeneNH03431020202220SUPPORTNG ORGNH501(C)(3)12 TYPE ICMCYes (true)
Mt Ascutney Hosp Cmmty Hlth Found
289 County RoadWindsorVT05089030300481FoundationVT501(c)(3)3WHAYes (true)
Historic Homes of Runnemede
289 County RoadWindsorVT05089237396147HealthcareVT501(c)(3)10WHAYes (true)
Cheshire Health Services
580 Court StreetKeeneNH03431473379283HEALTHCARENH501(c)(3)3CMCYes (true)
Alice Peck Day Memorial Hospital
10 Alice Peck Day DriveLebanonNH03766020222791HospitalNH501(c)(3)3D-HHYes (true)
Surgery Center of Greater Nashua
10 Prospect Street Ste 101NashuaNH03060461084049Surgery CtrNH501(c)(3)3falseN/A
VNA & Hospice of VT and NH
205 Billings Farm Road 5WilderVT05088036006494HospiceVT501(c)(3)10D-HHYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndUBI Code VUBICodeVAmtOwnershipOwnershipPct
D-H Mster Invst Prg
1 Med Ctr DrLEBANONNH03756020205863POOLED INVESTNHMHMHEXCLUDED$23,495,562$545,626,793false-$118,4030.90890
OneCare VT ACOLLC
111 COLCHESTER AVEBurlingtonVT05401455399218Shared SavingVTNA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtEINEINControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPct
Charit Remndr Unitrusts (4)
One Medical Center DriveLebanonNH03756Chart. TrustNHMHMHTRUST
Pompanoosuc Investment Corp
1 Medical Ctr DrLebanonNH03756Real Est HldgNHDHCC Corporation020352330Yes (true)
Hamden Assurance Company Limited
Liab Insur.DHCForeign Corp980121409Yes (true)44 Church StHamiltonBDHM 12BD$0$23,533,8520.25800
Hitchcock Health Connect
ONE MEDICAL CENTER DRIVELebanonNH03756TelehealthDED-HHC Corp800908979Yes (true)
Kearsarge Community Services Inc
273 County RoadNew LondonNH03257Real Est HldgNHNLHC Corp020460136Yes (true)
New London Physician Group Inc
273 County RoadNew LondonNH03257Physician GroNHNLHC Corp020494420Yes (true)
New London Medical Center East
273 County RoadNew LondonNH03257Real Est HldgNHNLHC Corp020480857Yes (true)
Keene Health Services
580 Court StreetKeeneNH03431Real Est HldgNHCMCC Corp020374997Yes (true)
Keene Health Realty
580 Court StreetKeeneNH03431Real Est HldgNHCMCC Corp020374998Yes (true)
Keene Health Enterprises
580 Court StreetKeeneNH03431Real Est HldgNHCMCC Corp020374999Yes (true)
ImagineCare
One Medical Center DriveLebanonNH03756Sftwre tchnlgyNHD-HHC Corp813105071Yes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (10 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Dartmouth-Hitchcock Clinic
JKLMN$55,411,719FMV
Hamden Risk Retention Group
M$3,906,630FMV
The Hitchcock Foundation
Q$1,300,099FMV
The New London Hospital Association
Q$2,046,920FMV
Windsor Hospital Corporation
D$8,064,000FMV
Windsor Hospital Corporation
Q$2,092,864FMV
Cheshire Medical Center
Q$669,792FMV
Cheshire Medical Center
L$29,239,512FMV
Alice Peck Day Memorial Hospital
Q$783,977FMV
Dartmouth-Hitchcock Health
P$1,123,885FMV