2018-05-15T11:01:13-05:00 2017-06-30 PRICEWATERHOUSECOOPERS LLP 101 SEAPORT BLVD BOSTON MA 02210 990 2016-07-01 020222140 Mary Hitchcock Memorial Hospital % DANIEL JANTZEN MARY 6036505000 One Medical Center Drive Lebanon NH 03756 DANIEL JANTZEN CFO 6036505634 2018-05-10 Paul Tanis P01441612 6175305000 2016 2022-09-23 18:48:47Z Joanne Conroy MD One Medical Center Drive Lebanon NH 03756 1455886548 false X www.dartmouth-hitchcock.org X 1889 NH Advancing Health Through Research, Education, Clinical Practice, Community Partnerships, providing each person the best care in the right place, at the right time,every time. 18 12 6019 511 4456335 -189812 7326385 41242528 994071500 1095054593 86360 20952650 51273295 25430069 1052757540 1182679840 2204568 2744685 0 0 635248980 679834438 0 0 309409 448365775 469945438 1085819323 1152524561 -33061783 30155279 1312172799 1322008676 787785889 737988485 524386910 584020191 X WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 906709992 2744685 1070756177 Mary 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. 66660983 42094323 As 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. 973370975 true true false true false false false false false true true true false false true false false true false true true true false false false false true true true true true true false false false false false true true false true false true false false false true true true true false false true 1085 0 6019 true true true true BD false false false true true false false false false X 18 12 true false true false true true true true true false false true true true true true true false true true true NH X DANIEL JANTZEN 6036505634 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 X Vincent S Conti MHA Trustee 0.75 1.25 X 0 0 0 Anne-Lee Verville Trustee/Board Chair 1.5 2.5 X X 0 0 0 Barbara Couch MS Trustee/Board Secretary 1.5 2.5 X X 0 0 0 William J Conaty Trustee 0.75 1.25 X 0 0 0 Robert A Oden Jr PhD Trustee/Vice Chair 1.5 2.5 X X 0 0 0 James N Weinstein DO MS Trustee Ex-Officio/CEO 38.55 22.96 X X 0 1364537 108831 Denis A Cortese MD Trustee 0.75 1.25 X 0 0 0 Senator Judd A Gregg Trustee 0.75 0.75 X 0 0 0 Laura K Landy MBA Trustee 0.75 1.25 X 0 0 0 Paul P Danos PhD Trustee 0.75 1.25 X 0 0 0 Barbara C Jobst MD Physician/Trustee end 12/31/16 28.75 12.75 X 0 378003 98251 Troyen Brennan MD MPH Trustee 0.75 1.25 X 0 0 0 R William Burgess Jr MBA Trustee end 8/5/16 0.75 1.25 X 0 0 0 Duane A Compton PhD Trustee/Ex-Officio 0.75 1.56 X 0 0 0 M Brooke Herndon MD MS Trustee/Staff Physician 28.75 12.75 X 0 207121 63250 Charles G Plimpton MBA Trustee/Board Treasurer 1.5 2.5 X X 0 0 0 Jeffrey A Cohen MD Trustee/VP Service Line 28.75 13.05 X 0 435115 104921 Timothy D Scherer MD Trustee/Physician 28.75 12.75 X 0 521117 71960 Brian C Spence MD MHCDS Trustee/Staff Physician 28.75 12.75 X 0 482267 48788 Kari M Rosenkranz MD Trustee eff 1/1/17/Physician 28.75 12.75 X 0 496839 29887 Robin Kilfeather-Mackey CPA CFO end 7/15/16 39.0 22.01 X 0 609409 12922 Daniel P Jantzen CPA COO end, CFO eff 7/16/16 39.0 24.01 X 1223270 0 134426 Stephen Leblanc Chief Administrative Officer 39.0 23.01 X 0 671595 128833 Edward Merrens MD Chief Clinical Officer 42.0 20.0 X 0 521421 58731 Richard Rothstein MD Chf Academic Offcr eff 1/1/17 42.0 18.0 X 0 555623 76713 John Birkmeyer MD CCO/EVP Entprs Sp end 10/14/16 42.0 19.0 X 0 881467 39333 Maria Padin MD Chief Medical Officer 42.0 20.0 X 0 409356 197804 Sowmya Viswanathan MD Chief ACO Officer eff 7/5/16 42.0 18.0 X 0 161497 18258 Susan A Reeves EdD RN Chf Nrsng Exctve eff 6/19/17 42.0 18.0 X 0 0 0 Vincent Fusca III Chief of Staff end 2/10/17 28.0 13.0 X 330998 0 27365 George Blike MD Chief Quality & Value Officer 42.0 19.0 X 0 455044 247012 John S Malanowski MILR Chief HR Officer end 2/10/17 42.0 18.0 X 519057 0 40178 Gay Landstrom PhD RN NEA-BC Chf Nursing Offcr end 1/10/17 42.0 19.5 X 579445 0 39835 Robert Greene MD MHCDS FACP Chf Popul Mgmt Ofr end 4/7/17 42.0 18.0 X 0 593926 43931 John Kacavas JD Chief Legal Officer 42.0 19.0 X 430324 0 39835 Peter D Solberg MD Chf Medical Information Ofcr 42.0 18.0 X 0 375391 45978 Karen Clements RN BSN MSB FACHE Chief Nursing Officer 42.0 18.0 X 268642 0 29037 Thomas J Siepka Chief Pharmacy Officer 42.0 18.0 X 299311 0 22505 Aimee M Giglio Int Chf HR Offcr eff 2/10/17 42.0 18.0 X 225784 0 29216 Sandra Wong MD Department Chair Surgery 28.0 12.0 X 0 671891 29887 Bruce King MSPH FHFMA Pres & CEO New London Hosp 0.0 50.0 X 380123 0 74057 Roderic Young VP Communications & Marketing 28.0 13.0 X 313027 0 42229 Martin Purcell MBA VP IS Operations 28.0 12.0 X 330319 0 136408 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 28.0 12.0 X 369596 0 39760 David Gladstone MD Chf Clncl Physcn - Radiology 28.0 12.0 X 293945 0 94056 Carl Dematteo MD Fmr Chf Ql Compl Ofr/Physician 28.0 12.0 X 0 120556 1384 John Butterly MD Former Officer/EVP Med Affairs 28.0 14.0 X 0 138766 13418 Thomas Colacchio MD Former Officer/Physician 28.0 13.0 X 0 667401 54165 Darlene A Saler MBA RN Frmr Actg Chf Nrsg Ofr 28.0 12.0 X 170541 0 84517 Mary Oseid MHCDS Fmr Key Emp/VP Enterprise Svcs 28.0 13.0 X 0 252760 194385 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 0.0 50.01 X 0 246045 40335 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 28.0 14.5 X 238714 0 19881 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 28.0 13.0 X 236246 0 39755 Terrence P Carroll PHD Former Chf Innvtn Ofcr 42.0 18.0 X 380765 0 0 Thomas Dodds MD Former Key Emp/Dept Chr Anesth 28.0 12.0 X 0 483551 99159 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 28.0 12.0 X 0 487848 129279 Jocelyn Chertoff MD Fmr Key Emp/Dpt Chr Dgnstc Rad 28.0 12.0 X 0 582114 132793 Edward Catherwood MD MS Former Key Emp/Ctr Dir Hrt/Vsc 28.0 12.0 X 0 458562 66904 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 28.0 12.0 X 0 219795 70039 Jeffrey OBrien MHA Fmr Key Emp/VP Oncology 28.0 12.0 X 282679 0 42181 6872786 13449017 3162392 427 true true false TRUSTEES OF DARTMOUTH COLLEGE 37 DEWEY FIELD HANOVER NH 03755 ADMIN & DIR SUPPORT 14595826 Cross Country Staffing PO Box 404674 ATLANTA GA 303844674 Staffing Services 9868531 Accretive Health 401 N Michigan Ave Ste 2700 CHICAGO IL 60611 REVENUE MGMT 10714960 Conifer Revenue Cycle Solutions LL 1500 S Douglass Road Ste 200 ANAHEIM CA 92806 Revenue Mgmt 31846576 American Healthcare Services Associ PO Box 945 TRAVERSE CITY MI 49685 Staffing Services 5998789 125 16397795 24844733 616610 41242528 NET PATIENT SERVICE REVENUE 621110 1049239675 1048020642 1219033 RESEARCH RELATED ACTIVITIES 621110 9042849 9042849 PHARMACY INCOME 621110 36772069 36653332 118737 1095054593 4155077 -118403 4273480 0 0 1075977 956802 119175 0 119175 119175 289023744 23735 272221935 27971 16801809 -4236 16797573 16797573 0 0 0 0 0 0 0 0 0 MEANINGFUL USE 621110 1107117 1107117 NEAH AND PROGRAM RELATED INVESTMENTS 621110 2200657 1069941 1130716 CAFETERIA 621110 2940249 2940249 19062871 16956619 2106252 25310894 1182679840 1112850500 4456335 24130477 X 1213365 1213365 1524228 1524228 7092 7092 0 12208024 4816559 7113669 277796 3840780 1341661 2468122 30997 521903196 453291812 68611384 47682417 41413905 6268512 58925343 51178793 7746550 35274678 30637334 4637344 0 2156896 44833 2112063 622302 622302 42000 42000 0 0 84589094 72496879 12092215 2012699 33443 1979256 13112427 8767227 4345061 139 11193922 9962591 1231331 0 15604387 13814231 1790156 3683970 2119230 1564740 0 71932 71592 340 14254082 12686133 1567949 0 63944578 20481793 43462785 2660400 1378196 1282204 MEDICAL SUPPLIES 179969906 179752244 217662 MEDICAID ENHANCEMENT TAX 50118059 50118059 EQUIPMENT RENTAL & MAINT 13693258 9540847 4152411 ACDMC, GME, TEACHING, & EDU 7024644 5946124 1078520 5190882 732804 4457601 477 1152524561 973370975 178844177 309409 1876637 24826278 1933626 650122 0 0 157353140 161698558 168957 175723 0 0 579058 10597854 17379674 17883224 9333121 10667649 1080847755 656888381 427348813 423959374 234549775 279958184 337361745 326211369 7950879 1970881 0 0 116337374 63409460 1312172799 1322008676 126756517 121123993 0 0 631346 3864030 326836101 325850834 0 0 0 0 227716877 188220589 0 0 105845048 98929039 787785889 737988485 X 435627969 485657981 58764416 68071892 29994525 30290318 524386910 584020191 1312172799 1322008676 X 30155279 33959268 -4481266 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 163355 false true 82359 245714 false LOBBYING ACTIVITY EXPLANATION FORM 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 1I MHMH pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. 54754800 137888 2553792 651181 56795299 72720335 378941 -377000 17967476 54754800 74609411 208107 -516882 1580301 72720335 54935134 17029356 3029123 16800 1648675 73328138 57050185 188155 -357053 5322 1940831 54935134 0.28730 0.53330 0.17940 false false 46750633 46750633 524671083 310612383 214058700 4111615 3759712 351903 472986179 342516286 130469893 32328245 0 32328245 423959374 FIXED INCOME 100571943 F PRIVATE EQUITIES 27775368 F HEDGE FUNDS 40517460 F OTHER INVESTMENTS 134059358 F 302924129 0 THIRD PARTY RESERVES 8503761 ACCRUED POST RETMNT PENS & MED 83520214 INTEREST RATE SWAP 6905064 98929039 Intended use of Endowment Funds Form 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. true North America Program Services Advertising 17972 Europe (Including Iceland and Greenland) Program Services Conferences 15750 Europe (Including Iceland and Greenland) 4 Program Services Dues & Licenses 230 Europe (Including Iceland and Greenland) Program Services Honorariums 1300 North America Program Services Honorariums 790 Sub-Saharan Africa Program Services Honorariums 656 Sub-Saharan Africa 10 Program Services Medical Services 75431 South America 4 Program Services Medical Services 37840 South Asia 6 Program Services Medical Services 49638 Europe (Including Iceland and Greenland) 1 Program Services Medical Services 4855 Middle East and North Africa Program Services Program Support 7092 East Asia and the Pacific Program Services Research 30450 Europe (Including Iceland and Greenland) Program Services Software 56625 North America Program Services Software 202983 South Asia Program Services Software 27405 Central America and the Caribbean Program Services Travel 2448 East Asia and the Pacific Program Services Travel 4465 Europe (Including Iceland and Greenland) Program Services Travel 24190 Middle East and North Africa Program Services Travel 2275 North America Program Services Travel 20157 South America Program Services Travel 1503 South Asia Program Services Travel 1113 Sub-Saharan Africa Program Services Travel 869 Central America and the Caribbean Investments Investment in Captive 23533853 25 25 535930 23583960 24119890 Middle East and North Africa Prog Support 7092 Wire Trnsfr FMV 1 0 true false true true true false MONITORING USE OF GRANT FUNDS FORM 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. true true true X 225. true X true true false true true 6187086 6187086 0.00530 202536549 118785211 83751338 0.07270 208723635 118785211 89938424 0.07800 5137948 1965721 3172227 0.00280 44301890 13006055 31295835 0.02720 5050042 195323 4854719 0.01570 2217737 44588 2173149 0.00180 641565 641565 0.00050 57349182 15211687 42137495 0.04800 266072817 133996898 132075919 0.12600 18500 18500 0.00000 1673598 842055 831543 0.00070 75339 75339 0.00010 128205 128205 0.00010 1895642 842055 1053587 0.00090 false 23850195 310067164 319013066 -8945902 X true true 1 1 Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 www.dartmouth-hitchcock.org 01799 X X X X X X Psych Unit and Transplant Unit Cancer Center Mary Hitchcock Memorial Hospital 1 false false true X X X X X X X X 15 true true true true X Please see Section C, Supplemental Info X X true 16 true Please see Section C, Supplemental Info false true X 225. 300. X X X X X X X true true X X X true X See Section C, Supplemental Info X See Section C, Supplemental Info X See Sect. C, Spplmntl Info X X X X X X X true X false X X X X true X false false Input From Representatives of Community Served by the Hospital Facility Form 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 Policy Form 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. Other factors used in determining eligibility other than FPG Form 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 Methodology Form 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 clinics Form 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 Activities Form 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 Expense Form 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 Provision Form 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 Shortfalls Form 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 Policy Form 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 Assessment Form 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 Assistance Form 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 Health Form 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 Community Form 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 Report Form 990, Schedule H, Part VI, Line 7 MHMH files a Community Benefits Report with the State of New Hampshire jointly with Dartmouth-Hitchcock Clinic. true Advance Transit PO Box 1027 Wilder VT 05088 222558708 501(C)(3) 75740 FMV Transportn Subsidy American Cancer Society 250 Williams Street NW Atlanta GA 30303 131788491 501(c)(3) 32550 FMV Program Support American Heart Association 7272 Greenville Avenue Dallas TX 75231 135613797 501(c)(3) 10500 FMV Program Support The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 501(c)(3) 8050 FMV PROGRAM SUPPORT Good Neighbor Health Clinic 70 N MAIN ST WHITE RIVER JCT VT 05001 030346949 501(c)(3) 45500 FMV Program Support Grafton County Senior Citizens Council 10 CAMPBELL ST LEBANON NH 03766 237248316 501(c)(3) 12600 FMV Program Support Mary & John Eliot Charitable Foundation 1070 Holt Ave Unit 1 Ste 2100 Manchester NH 03109 020512229 501(c)(3) 5250 FMV Program Support Riverbend Community Mental Health 3 N State St Concord NH 03301 020264383 501(c)(3) 17570 FMV Program Support Sullivan County 14 Main St Newport NH 03773 Gov't 10500 FMV Public Health Foundation for Healthy Communities 125 AIRPORT RD CONCORD NH 03301 020275078 501(c)(3) 370475 FMV Program Support Southwestern Vermont Health Care Foundation 100 Hospital Dr Bennington VT 05201 453362785 501(c)(3) 7000 FMV Program Support Albert Schweitzer Fellowship 330 Brookline Ave Boston MA 02215 131982786 501(c)(3) 7000 FMV Program Support March of Dimes Foundation 1275 Mamaroneck Ave White Plains NY 10605 131846366 501(c)(3) 7000 FMV Program Support Southeast Vermont Transit 45 Mill St Wilmington VT 05363 030353976 501(c)(3) 21000 FMV Transportn Subsidy Upper Valley Haven 713 Hartford Ave White River Jct VT 05001 030277908 501(c)(3) 17500 FMV Program Support Windsor Hospital Corporation 289 County Rd Windsor VT 05089 030183721 501(c)(3) 11725 FMV Program Support Makin It Happen Coalition for Resilient Yth 27 Lowell St Ste 502 Manchester NH 03101 020495300 501(c)(3) 10500 FMV Program Support NH Fisher Cats Charitable Foundation 1 Line Drive Manchester NH 03101 141973034 501(c)(3) 9870 FMV Program Support Manchester Community Health Center 145 Hollis Street Manchester NH 03101 020458174 501(c)(3) 35000 FMV Program Support Ottauquechee Health Foundation PO Box 784 Woodstock VT 05091 030197766 501(c)(3) 14000 FMV Program Support Granite United Way 22 Concord Street Floor 2 Manchester NH 03101 026006033 501(c)(3) 14000 FMV Program Support 21 Awards and Educational Assistance 103 825054 FMV D-H Tuition Reimbursement Program 440 615602 FMV Patient Assistance 1599 83572 FMV Description of Organization's Procedures for Monitoring the Use of Grants Form 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. X X true true true true false false false false false false false Carl Dematteo MD Fmr Chf Ql Compl Ofr/Physician 0 116398 0 600 0 3558 0 0 0 1384 0 121940 0 0 Robin Kilfeather-Mackey CPA CFO end 7/15/16 0 295990 0 0 0 313419 0 0 0 12922 0 622331 0 0 Daniel P Jantzen CPA COO end, CFO eff 7/16/16 570275 0 0 0 652995 0 117793 0 16633 0 1357696 0 0 0 Stephen Leblanc Chief Administrative Officer 0 554597 0 0 0 116998 0 107109 0 21724 0 800428 0 0 John Butterly MD Former Officer/EVP Med Affairs 0 82523 0 0 0 56243 0 13274 0 144 0 152184 0 0 Bruce King MSPH FHFMA Pres & CEO New London Hosp 322286 0 0 0 57837 0 57465 0 16592 0 454180 0 0 0 Mary Oseid MHCDS Fmr Key Emp/VP Enterprise Svcs 0 252252 0 0 0 508 0 182218 0 12167 0 447145 0 0 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 0 237487 0 0 0 8558 0 23885 0 16450 0 286380 0 0 James N Weinstein DO MS Trustee Ex-Officio/CEO 0 1268501 0 0 0 96036 0 93402 0 15429 0 1473368 0 0 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 238185 0 0 0 529 0 18042 0 1839 0 258595 0 0 0 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 235976 0 0 0 270 0 18219 0 21536 0 276001 0 0 0 Vincent Fusca III Chief of Staff end 2/10/17 319753 0 0 0 11245 0 25875 0 1490 0 358363 0 0 0 Edward Merrens MD Chief Clinical Officer 0 496852 0 0 0 24569 0 46420 0 12311 0 580152 0 0 George Blike MD Chief Quality & Value Officer 0 414310 0 0 0 40734 0 227077 0 19935 0 702056 0 0 Thomas Colacchio MD Former Officer/Physician 0 179518 0 0 0 487883 0 43501 0 10664 0 721566 0 0 Barbara C Jobst MD Physician/Trustee end 12/31/16 0 326282 0 40000 0 11721 0 75934 0 22317 0 476254 0 0 Darlene A Saler MBA RN Frmr Actg Chf Nrsg Ofr 169562 0 0 0 979 0 73887 0 10630 0 255058 0 0 0 John S Malanowski MILR Chief HR Officer end 2/10/17 494784 0 0 0 24273 0 20575 0 19603 0 559235 0 0 0 Terrence P Carroll PHD Former Chf Innvtn Ofcr 0 0 0 0 380765 0 0 0 0 0 380765 0 0 0 Roderic Young VP Communications & Marketing 307253 0 0 0 5774 0 20575 0 21654 0 355256 0 0 0 Martin Purcell MBA VP IS Operations 291321 0 0 0 38998 0 134964 0 1444 0 466727 0 0 0 Thomas Dodds MD Former Key Emp/Dept Chr Anesth 0 450617 0 0 0 32934 0 79202 0 19957 0 582710 0 0 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 0 464676 0 0 0 23172 0 111806 0 17473 0 617127 0 0 Jocelyn Chertoff MD Fmr Key Emp/Dpt Chr Dgnstc Rad 0 549599 0 0 0 32515 0 117431 0 15362 0 714907 0 0 Edward Catherwood MD MS Former Key Emp/Ctr Dir Hrt/Vsc 0 458562 0 0 0 0 0 46330 0 20574 0 525466 0 0 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 0 218978 0 0 0 817 0 48521 0 21518 0 289834 0 0 Jeffrey OBrien MHA Fmr Key Emp/VP Oncology 278588 0 0 0 4091 0 20575 0 21606 0 324860 0 0 0 M Brooke Herndon MD MS Trustee/Staff Physician 0 205330 0 0 0 1791 0 43822 0 19428 0 270371 0 0 Richard Rothstein MD Chf Academic Offcr eff 1/1/17 0 553463 0 0 0 2160 0 59414 0 17299 0 632336 0 0 John Birkmeyer MD CCO/EVP Entprs Sp end 10/14/16 0 661213 0 0 0 220254 0 20575 0 18758 0 920800 0 0 Gay Landstrom PhD RN NEA-BC Chf Nursing Offcr end 1/10/17 544439 0 0 0 35006 0 20575 0 19260 0 619280 0 0 0 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 357838 0 0 0 11758 0 20575 0 19185 0 409356 0 0 0 Robert Greene MD MHCDS FACP Chf Popul Mgmt Ofr end 4/7/17 0 561538 0 0 0 32388 0 24606 0 19325 0 637857 0 0 John Kacavas JD Chief Legal Officer 429550 0 0 0 774 0 20575 0 19260 0 470159 0 0 0 Maria Padin MD Chief Medical Officer 0 398748 0 0 0 10608 0 177879 0 19925 0 607160 0 0 Peter D Solberg MD Chf Medical Information Ofcr 0 366882 0 0 0 8509 0 32814 0 13164 0 421369 0 0 Karen Clements RN BSN MSB FAC Chief Nursing Officer 268238 0 0 0 404 0 20575 0 8462 0 297679 0 0 0 Thomas J Siepka Chief Pharmacy Officer 299041 0 0 0 270 0 20575 0 1930 0 321816 0 0 0 Jeffrey A Cohen MD Trustee/VP Service Line 0 407294 0 0 0 27821 0 87447 0 17474 0 540036 0 0 Timothy D Scherer MD Trustee/Physician 0 506063 0 0 0 15054 0 52024 0 19936 0 593077 0 0 Brian C Spence MD MHCDS Trustee/Staff Physician 0 403578 0 60200 0 18489 0 26398 0 22390 0 531055 0 0 Kari M Rosenkranz MD Trustee eff 1/1/17/Physician 0 436264 0 47618 0 12957 0 20575 0 9312 0 526726 0 0 Sowmya Viswanathan MD Chief ACO Officer eff 7/5/16 0 161292 0 0 0 205 0 10094 0 8164 0 179755 0 0 Aimee M Giglio Int Chf HR Offcr eff 2/10/17 216905 0 0 0 8879 0 10621 0 18595 0 255000 0 0 0 David Gladstone MD Chf Clncl Physcn - Radiology 274467 0 5023 0 14455 0 74908 0 19148 0 388001 0 0 0 Sandra Wong MD Department Chair Surgery 0 671891 0 0 0 0 0 20575 0 9312 0 701778 0 0 Chartered Travel Services Form 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 Payments Form 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 compensation Form 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. A NH HEALTH & ED FACILITIES AUTHORITY 020279866 644614YU7 2009-08-19 134661088 CURRENT REFUND 2008 (A),(B),(C) false false false B NH HEALTH & ED FACILITIES AUTHORITY 020279866 644614G29 2010-06-16 73647839 CONSTR. OF FACILITY AND EQUIP false false false C NH HEALTH & ED FACILITIES AUTHORITY 020279866 000000000 2012-11-28 116170000 CURRENT REFUND 2002 false false false D NH HEALTH & ED FACILITIES AUTHORITY 020279866 000000000 2014-08-13 41242990 REFUNDED PORTION OF 2009 ISSUE DAT false false false A 77380000 0 134661088 0 0 0 2273111 0 0 0 132387977 0 2010 true false true true B 0 0 73666926 0 3766049 0 1168560 0 0 68732317 0 0 2012 false false true true C 5110000 0 116170000 0 0 0 520000 0 0 0 115650000 0 2013 true false true true D 0 0 41242990 0 0 0 352990 0 0 0 40890000 0 2014 true false true true A false false false false 0 false false false true B false false false false 0 false false false true C 0 D false false false false 0 false false false true A false false true false false false 0 false 0 false true B false false false true false false 0 false 0 false true C false true false false false false 0 false 0 false true D false true false false false false 0 false 0 false true A true B true C true D true ADDITIONAL INFORMATION FORM 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 6/17/2015 A NH HEALTH & ED FACILITIES AUTHORITY 020279866 000000000 2015-09-01 35785218 REFUND ISSUE DATED 8/31/2011 false false false B NH HEALTH AND ED FACILITIES AUTHORITY 020279866 000000000 2016-07-01 35575000 SEE PART VI false false false A 0 0 35785218 0 0 0 105239 0 0 0 35679979 0 2015 true false true true B 0 0 35575000 0 0 0 408058 0 0 15936616 19230326 0 2017 true false true true A 0 B false true true true false false 0.00100 0.00100 false false false true A false true false false true false 0 false 0 false true B false true false false true false 0 false 0 false true A true B true DESCRIPTION OF PURPOSE FORM 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 REPORTING DANIEL JANTZEN OFFICER SPLIT DOLLAR LIFE X 117590 117590 false true true Deborah Jantzen FAMILY MEMBER Split Dollar Life X 58133 58133 false true true 175723 Karen Clements Key Employee 69727 Scholarship MASTERS DEGREE PROGRAM Jeffrey Obrien Former Key Employee 34207 Scholarship MASTERS DEGREE PROGRAM Vincent Fusca III Family member of Key EE Fusca II 85049 Employment Compensation false Linda Billings Family member of Former KE Mary Oseid 102608 Employment Compensation false Greg DeMatteo Family member of Former Officer Carl DeMatteo 113089 Employment Compensation false X 6 616610 Fair Market Value false true true Schedule M, Part I, Column B The 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. Business relationships Form 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 990 Form 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 Policy Form 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 UNDERTAKEN Form 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 Undertaken Form 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 Public Form 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 Reporting Form 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 Requirement Form 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. NEW ENGLAND ALLIANCE FOR HEALTH LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264232401 HLTH IMPROVMT NH 388779 1573978 MHMH D-H Specialty Services LLC One Medical Center Drive Lebanon NH 03756 460876427 Shd Svgs Prgm NH 0 0 MHMH DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYS SVCS NH 501(c)(3) 10 D-HH true DARTMOUTH-HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTNG ORG NH 501(c)(3) 12 TYPE I NA true DARTMOUTH - HITCHCOCK HEALTH One Medical Center Drive Lebanon NH 03756 264812335 PARENT ORG NH 501(C)(3) 7 NA false HAMDEN RISK RETENTION GROUP INC 30 MAIN STREET STE 330 BURLINGTON VT 05401 208530788 Self Ins. VT 501(c)(3) 12 TYPE I DHC true The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 HLTHCRE RSRCH NH 501(c)(3) 7 DHC true EverWell Inc One Medical Center Drive Lebanon NH 03756 352506275 Supportng Org NH 501(c)(3) 12 Type I NA true The New London Hospital Association Inc 273 County Rd New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH true Windsor Hospital Corporation 289 County Road Windsor VT 05089 030183721 Hospital VT 501(C)(3) 3 D-HH true Cheshire Medical Center 580 Court Street Keene NH 03431 020354549 Hospital NH 501(C)(3) 3 D-HH true Cheshire Health Foundation 580 Court Street Keene NH 03431 020202220 SUPPORTNG ORG NH 501(C)(3) 12 TYPE I CMC true Mt Ascutney Hosp Cmmty Hlth Found 289 County Road Windsor VT 05089 030300481 Foundation VT 501(c)(3) 3 WHA true Historic Homes of Runnemede 289 County Road Windsor VT 05089 237396147 Healthcare VT 501(c)(3) 10 WHA true Cheshire Health Services 580 Court Street Keene NH 03431 473379283 HEALTHCARE NH 501(c)(3) 3 CMC true Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 Hospital NH 501(c)(3) 3 D-HH true Surgery Center of Greater Nashua 10 Prospect Street Ste 101 Nashua NH 03060 461084049 Surgery Ctr NH 501(c)(3) 3 N/A false VNA & Hospice of VT and NH 205 Billings Farm Road 5 Wilder VT 05088 036006494 Hospice VT 501(c)(3) 10 D-HH true D-H Mster Invst Prg 1 Med Ctr Dr LEBANON NH 03756 020205863 POOLED INVEST NH MHMH EXCLUDED 23495562 545626793 false -118403 0.90890 OneCare VT ACOLLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Charit Remndr Unitrusts (4) One Medical Center Drive Lebanon NH 03756 Chart. Trust NH MHMH TRUST Pompanoosuc Investment Corp 1 Medical Ctr Dr Lebanon NH 03756 020352330 Real Est Hldg NH DHC C Corporation true Hamden Assurance Company Limited 44 Church St Hamilton BD HM 12 980121409 Liab Insur. BD DHC Foreign Corp 0 23533852 0.25800 true Hitchcock Health Connect ONE MEDICAL CENTER DRIVE Lebanon NH 03756 800908979 Telehealth DE D-HH C Corp true Kearsarge Community Services Inc 273 County Road New London NH 03257 020460136 Real Est Hldg NH NLH C Corp true New London Physician Group Inc 273 County Road New London NH 03257 020494420 Physician Gro NH NLH C Corp true New London Medical Center East 273 County Road New London NH 03257 020480857 Real Est Hldg NH NLH C Corp true Keene Health Services 580 Court Street Keene NH 03431 020374997 Real Est Hldg NH CMC C Corp true Keene Health Realty 580 Court Street Keene NH 03431 020374998 Real Est Hldg NH CMC C Corp true Keene Health Enterprises 580 Court Street Keene NH 03431 020374999 Real Est Hldg NH CMC C Corp true ImagineCare One Medical Center Drive Lebanon NH 03756 813105071 Sftwre tchnlgy NH D-HH C Corp true false true false false false false false false true true true true true true true true true true Dartmouth-Hitchcock Clinic JKLMN 55411719 FMV Hamden Risk Retention Group M 3906630 FMV The Hitchcock Foundation Q 1300099 FMV The New London Hospital Association Q 2046920 FMV Windsor Hospital Corporation D 8064000 FMV Windsor Hospital Corporation Q 2092864 FMV Cheshire Medical Center Q 669792 FMV Cheshire Medical Center L 29239512 FMV Alice Peck Day Memorial Hospital Q 783977 FMV Dartmouth-Hitchcock Health P 1123885 FMV