2017-05-15T08:21:58-05:00 2016-06-30 990 2015-07-01 222519596 DARTMOUTH-HITCHCOCK CLINIC % DANIEL JANTZEN DART 6036531155 ONE MEDICAL CENTER DRIVE LEBANON NH 03756 DANIEL JANTZEN CFO 6036505634 2017-05-11 2015 2021-01-29 14:40:06Z James Weinstein DO MS One Medical Center Drive Lebanon NH 03756 422464782 false X www.dartmouth-hitchcock.org X 1983 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 19 13 4868 480 230170 1357 0 0 323150656 358769170 329033 220008 78062583 62807862 401542272 421797040 824075 768846 0 0 269903825 270618980 0 0 103715 138495237 145504269 409223137 416892095 -7680865 4904945 256167630 254449524 445362999 479637591 -189195369 -225188067 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 330473544 768846 419623067 Dartmouth-Hitchcock Clinic (the Clinic) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. The Clinic and subsidiaries, a multispecialty physician practice group which operates clinics throughout New Hampshire and Vermont, provides, among other things, medical services to patients, medical education and research. Health care services in 2016 resulted in 1,334,411 office visits recorded by Clinic personnel. The promotion of health through the medical practice activities of the Clinic provides the basis for the organization's tax exempt activities. The Clinic operates as an integral component of Dartmouth-Hitchcock Medical Center (DHMC), a New Hampshire nonprofit corporation organized for the exploration and coordination of matters of mutual interest among its members: the Clinic, Mary Hitchcock Memorial Hospital (the Hospital), Geisel School of Medicine (GSM), a component of Dartmouth College, and the Veterans Affairs Medical Center in White River Junction, Vermont. The 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 Clinic and Hospital 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. Its strategic operating plan lays out a path to creating a "sustainable health system to improve the lives of the people and communities we serve, for generations to come." The focus of this work, across the Dartmouth-Hitchcock organization, i.e. all Hospital and Clinic sites, is in three main areas: Improving Population Health; Delivering Value Based Care; and Developing and Implementing New Payment Models. Consistent with this mission, and in partnership with Mary Hitchcock Memorial Hospital, the Clinic 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 Clinic actively supports community-based health care and promotes the coordination of services among health care providers and social services organizations. The Clinic also seeks to work collaboratively with other area health care providers to improve the health status of the region. Effective with fiscal year 2000, the Clinic and the Hospital began filing an annual Community Benefit Report with the State of New Hampshire which outlines the community and charitable benefits they provide. The complete and updated Community Benefit Reports are available upon request or can be found on Dartmouth-Hitchcock's web site (www.dartmouth-hitchcock.org). The broad categories used in the Community Benefit Report to summarize these benefits are as follows: 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, 2016, the Clinic provided financial assistance to 14,649 patients in the amount of $9,383,369 as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2016 was $2,686,459. The Clinic also routinely provides services to Medicaid patients at reimbursement levels that are below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the years ended June 30, 2016 was $30,285,542. 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 Granite State Fit Kids health program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, 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 Clinic also provides a significant amount of uncompensated care to its patients that is reported as provision for bad debts, which is not included in the amounts reported above. For the year ended June 30, 2016, the Clinic reported a provision for bad debts of approximately $16,187,676. 20390261 As a component of an integrated academic medical center, the Clinic provides significant support for academic and research programs through its support of The Geisel School of Medicine at Dartmouth (GSM). DHC provides support for Physicians' unpaid teaching time as part of its Community Benefit Initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, the Clinic 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 Hospital 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. 350863805 true false false true false false false false false true true false false true true false false true false true true false false false false false false true true true true false false false false false true true false true true false false false false false true true true false false true 0 0 4868 true true true true BD false false false false false false false false X 19 13 true false false false true true true true true false false true true true true true true true true false NH X DANIEL JANTZEN 6036505634 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 X James N Weinstein DO MS Trustee Ex-Officio/CEO 18.75 42.76 X X 1332138 0 162531 Vincent S Conti MHA Trustee 0.75 1.25 X 0 0 0 Barbara Couch MS Trustee/Board Secretary 0.75 1.25 X X 0 0 0 Anne-Lee Verville Trustee/Board Chr eff. 1/1/16 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 eff. 1/1/16 1.5 2.5 X X 0 0 0 Richard I Rothstein MD Trustee end 12/31/15 12.75 28.75 X 556900 0 71864 Denis A Cortese MD Trustee 0.75 1.25 X 0 0 0 Matthew B Dunne Trustee end 12/31/15 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 Steven A Paris MD Trustee end 12/31/15 12.75 31.76 X 375697 0 53636 Richard J Powell MD Trustee end 12/31/15 12.75 29.55 X 466328 0 117201 Paul P Danos PhD Trustee/BD Trsr end 12/31/15 1.5 2.5 X X 0 0 0 Barbara C Jobst MD Trustee 12.75 28.75 X 321341 0 85446 Troyen Brennan MD MPH Trustee 0.75 1.25 X 0 0 0 R William Burgess Jr MBA Trustee 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 Trustee 12.75 28.75 X 231626 0 64481 Charles G Plimpton MBA Trustee/BD Treasr eff. 1/1/16 1.5 2.5 X X 0 0 0 Jeffrey A Cohen MD Trustee eff. 12/4/15 12.75 29.05 X 402436 0 136011 Timothy D Scherer MD Trustee eff. 12/4/15 12.75 28.75 X 500250 0 63440 Brian C Spence MD MHCDS Trustee eff. 12/4/15 12.75 28.75 X 419847 0 44863 Robin Kilfeather-Mackey CPA Chief Financial Officer 18.75 43.76 X 550797 0 175125 Daniel Jantzen CPA Chief Operating Officer 18.0 45.0 X 0 676831 151921 Stephen LeBlanc Exec VP Strtgy & Ntwrk Rltns 18.75 44.76 X 616651 0 179153 Edward Merrens MD Chief Medical Officer 18.0 42.0 X 469611 0 67752 John Birkmeyer MD Chf Clncl Offr/EVP Entprs Sup 18.0 44.5 X 791471 0 59542 Maria Padin MD Chf Med Ofcr eff. 11/9/15 18.0 42.0 X 372362 0 183439 Vincent Fusca III Chief of Staff 18.0 43.0 X 0 329987 40558 George Blike MD Chief Quality & Value Officer 18.0 42.0 X 449299 0 210887 John S Malanowski MILR Chief HR Officer 18.0 42.0 X 0 506482 56423 Terrence P Carroll PHD Chf Innvtn Ofcr end 8/29/15 18.0 42.0 X 0 654526 55371 Gay Landstrom PhD RN NEA-BC Chf Nursing Offr 18.75 42.75 X 0 597242 44070 Robert Greene MD MHCDS FACP Chf Popul Mgmt Ofr 18.0 42.0 X 557843 0 38671 John Kacavas JD Chief Legal Officer 18.0 43.0 X 0 242425 29942 Peter D Solberg MD Chf Mdcl Info Ofcr eff. 9/2/15 18.0 42.0 X 339723 0 48738 Karen Clements RN BSN MSB FACHE Actg Chf Nrsg Ofr eff 6/15/16 18.0 42.0 X 0 158313 18474 Thomas J Siepka Chief Pharmacy Offr eff 1/4/16 18.0 42.0 X 0 216867 16136 David Roberts MD Physician 12.0 28.0 X 823949 0 96347 Nathan Simmons MD Physician 12.0 28.0 X 818995 0 67032 Thomas Colacchio MD Former Officer/Phys 12.0 29.0 X 1021525 0 81611 Daniel Stewart MD Physician 12.0 28.0 X 1027018 0 59736 Faramarz Samie MD Physician 12.0 28.0 X 894256 0 20605 Carl DeMatteo MD Fmr Chf Ql Compl Ofr/Physician 12.0 28.0 X 130501 0 1482 John Butterly MD Fmr Offr/Exec VP Med Affairs 12.0 30.0 X 482349 0 63446 Jeanine Arden-Ornt Fmr General Counsel 0.0 25.0 X 0 213499 0 Darlene A Saler MBA RN Fmr Actg Chf Nrsg Ofr 12.0 28.0 X 0 193999 115514 Clifford J Belden MD Fmr Chf Clncl Offr 12.0 28.0 X 722128 0 29907 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 12.0 28.0 X 0 371724 38986 Mary Oseid MHCDS Fmr Key Emp/VP Ambulatory Care 12.0 28.0 X 263800 0 189207 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 12.0 28.01 X 235521 0 57261 Gail Dahlstrom Fmr Key Emp/VP Facilities Mgmt 12.0 28.0 X 0 165977 44038 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 12.0 29.5 X 0 234879 23643 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 12.0 30.5 X 0 234382 56833 Mary Kay Boudewyns Fmr Key Emp/VP Rev Mgmt 12.0 28.0 X 0 229591 141496 Thomas Dodds MD Fmr Key Emp/Dept Chr Anesth 12.0 28.0 X 552374 0 106025 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 12.0 28.0 X 448323 0 124193 Jocelyn Chertoff MD Fmr Key Emp/Dpt Chr Dgnstc Rad 12.0 28.0 X 544464 0 179487 Edward Catherwood MD MS Fmr Key Emp/Ctr Dir Hrt/Vsc 12.0 28.0 X 465442 0 72895 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 12.0 28.0 X 255054 0 75059 Jeffrey OBrien MHA Fmr Key Emp/VP Oncology 12.0 28.0 X 0 277541 41301 17440019 5304265 3861779 1209 true true false See Schedule O 0 0 NET PATIENT SERVICE REVENUE 621110 358769170 358769170 358769170 125732 -820 126552 0 0 1249690 207268 147371 27363 1102319 179905 1282224 1282224 6407 580877 4122 488886 2285 91991 94276 94276 0 0 0 CONTRACTED REVENUE 621110 59207098 58976108 230990 CAFETERIA INCOME 621110 440751 440751 ALLOCATED OTHER REVENUE 621110 1877789 1877789 61525638 421797040 419623067 230170 1943803 353884 353884 414962 414962 0 0 4774218 1979714 2700135 94369 3075211 2673625 392444 9142 203866785 172781686 31085099 20076614 17015382 3061232 24764341 20988336 3776005 14061811 11917701 2144110 0 909047 19393 889654 283138 283138 16500 16500 0 0 37645264 24044138 13601126 1286254 13528 1272726 5765023 4898388 866635 4394509 3911113 483396 0 6020923 5339825 681098 1583593 787173 796420 0 43359 39754 3605 5497992 4893213 604779 0 2933164 2610450 322714 1295776 1295776 MEDICAL SUPPLIES 71075488 71019096 56392 EQUIP REPAIR & MAINT 5352107 4763375 588732 ACADEMIC,GME,TEACHING & SPT 2819234 1920174 899060 ALLOCATED OTHER EXPENSES -1417102 -2816881 1399575 204 416892095 350863805 65924575 103715 296113 105508 0 0 0 0 43289761 66654927 609545 559918 0 0 4523347 3707997 72717 71769 0 0 128927130 101381713 31053629 27545417 195671 374219 0 775606 1060068 2870183 0 0 175066779 151783980 256167630 254449524 162970145 166352788 0 0 0 0 52859936 50924782 0 0 0 0 13486290 11875837 0 0 216046628 250484184 445362999 479637591 X -190437406 -226522803 243578 336277 998459 998459 -189195369 -225188067 256167630 254449524 X 4904945 -57445 -40840198 X X false true X true true true X 0 0 12 0 0 12 298584597 402775030 306275720 323150656 358769170 1689555173 0 0 0 298584597 402775030 306275732 323150656 358769170 1689555185 0 0 0 0 0 1689555185 -66568 86263 3644660 2741634 1411061 7817050 0 -66568 86263 3644660 2741634 1411061 7817050 905573 5244 103904 230170 1244891 75358696 61525638 136884334 299423602 402866537 309920392 401354890 421936039 1835501460 0.92049 0.95174 0.00426 0.00532 X false true false false false false true 63612 false true 31111 94723 false Lobbying activity explanation FORM 990, SCHEDULE C, PART II-B, LINES 1B & 1G Dartmouth-Hitchcock Clinic 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, Dartmouth-Hitchcock Clinic, 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 Clinic and its ability to carry out its mission. The typical activities may include sending letters to, calling, and meeting with government officials and legislators. For the fiscal year ended June 30, 2016, Dartmouth-Hitchcock Clinic incurred $63,612 in conjunction with these activities. Form 990, Schedule C, Part II-B, Line 1I DHC pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. 1128967 102466 -10712 6307 1214414 1113436 16985 1454 1128967 1000483 112492 461 1113436 999533 950 1000483 998459 0 1074 0 0 0 999533 0.82220 0.17780 false false 2501827 7215859 9717686 2493173 72493046 57834376 17151843 27596190 27163535 405655 16654035 16383802 270233 27545417 INVESTMENT IN CAPTIVE - HAMDEN 88337812 BOND ISSUANCE COSTS - NET 150287 DHC 457(B) PLAN ASSETS 51310012 DUE FROM AFFILIATE 11985869 OTHER MISC ASSETS 0 151783980 0 INTEREST RATE SWAP 14677316 ACCRUED POST RETIRMNT PENSION 176429496 RESERVES FOR INSUR. RLTD LOSS 60755223 ESTIMATED THIRD PARTY SETTLEMENTS -1377851 250484184 INTENDED USE OF ENDOWMENT FUNDS FORM 990, SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH-HITCHCOCK CLINIC. ASC 740 (FIN 48) Footnote Form 990, Schedule D, Part X 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. Central America and the Caribbean Program Services Travel Expenses 8903 East Asia and the Pacific 1 Program Services Medical Services 2634 East Asia and the Pacific Program Services Research 22985 East Asia and the Pacific Program Services Travel Expenses 955 Europe (Including Iceland and Greenland) Program Services Dues and Licenses 123 Europe (Including Iceland and Greenland) Program Services Insurance 45000 Europe (Including Iceland and Greenland) Program Services Software 25557 Europe (Including Iceland and Greenland) Program Services Travel 14545 Middle East and North Africa Program Services Travel 4 North America Program Services Advertising 7709 North America Program Services Dues and Licenses 26 North America Program Services Honorariums 809 North America Program Services Publications 141 North America Program Services Services 893 North America Program Services Software 127537 North America Program Services Travel 9403 South America 3 Program Services Medical Services 6365 South America Program Services Travel 478 Sub-Saharan Africa 8 Program Services Medical Services 189230 Sub-Saharan Africa Program Services Travel 1391 Central America and the Caribbean Investments Inv in Ins Captive 88337812 4 8 12 273589 88528911 88802500 true false true true true false true Indian Stream Health Center 141 Corliss Ln Colebrook NH 03756 200999212 501(C)(3) 15000 FMV Program/Clinic Svcs Advance Transit PO Box 1027 Wilder VT 05088 222558708 501(C)(3) 33569 FMV Transportn Subsidy American Cancer Society 250 Williams Street NW Atlanta GA 30303 131788491 501(c)(3) 6750 FMV Program Support American Heart Association 7272 Greenville Avenue Dallas TX 75231 135613797 501(c)(3) 12000 FMV Program Support Vital Communities Inc 195 No Main Street White River Jct VT 05001 030355283 501(c)(3) 6750 FMV Program Support CT River Transit Inc 706 Rockingham Road Bellows Falls VT 05101 861069523 501(c)(3) 9000 FMV Program Support Family Place Inc 319 US Route 5 S Norwich VT 05055 030305264 501(c)(3) 9600 FMV General Support Upper Valley Housing Coalition PO Box 17 Lebanon NH 03766 200363702 501(c)(3) 6000 FMV Program Support The Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 501(c)(3) 152700 FMV Educ and Prog Sppt Twin Pines Housing Trust 240 South Main Street 4 White River Jct VT 05001 222809527 501(c)(3) 6000 FMV Program Support Upper Valley Haven Inc 713 Hartford Ave White River Jct VT 05001 030277908 501(c)(3) 6450 FMV General Support 11 D-H Tuition Reimbursement Program 357 239405 FMV Employee Awards and Educational Assistance 133 165794 FMV Cash Assistance to Patients 193 9763 FMV Description of Organization's Procedures for Monitoring the Use of Grants Form 990, Schedule I, Part I, Line 1 Each award established by Dartmouth-Hitchcock Clinic has written established guidelines and procedures. Award payments are processed in accordance with the specific terms of each of the awards. The Dartmouth Institute Scholarships (TDI) are paid directly to the College on the 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 true true X X X X true true false false false false false false false James N Weinstein DO MS Trustee Ex-Officio/CEO 1239023 0 0 0 93115 0 148835 0 13696 0 1494669 0 0 0 Carl DeMatteo MD Fmr Chf Ql Compl Ofr/Physician 128215 0 0 0 2286 0 355 0 1127 0 131983 0 0 0 Robin Kilfeather-Mackey CPA Chief Financial Officer 513562 0 0 0 37235 0 154998 0 20127 0 725922 0 0 0 Daniel Jantzen CPA Chief Operating Officer 0 514015 0 0 0 162816 0 136497 0 15424 0 828752 0 0 Stephen LeBlanc Exec VP Strtgy & Ntwrk Rltns 480623 0 0 0 136028 0 159027 0 20126 0 795804 0 0 0 John Butterly MD Fmr Offr/Exec VP Med Affairs 433100 0 0 0 49249 0 62386 0 1060 0 545795 0 0 0 David Roberts MD Physician 601475 0 156004 0 66470 0 81448 0 14899 0 920296 0 0 0 Nathan Simmons MD Physician 574005 0 198888 0 46102 0 46895 0 20137 0 886027 0 0 0 Mary Oseid MHCDS Fmr Key Emp/VP Ambulatory Care 251570 0 0 0 12230 0 177906 0 11301 0 453007 0 0 0 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 231714 0 0 0 3807 0 42036 0 15225 0 292782 0 0 0 Gail Dahlstrom Fmr Key Emp/VP Facilities Mgmt 0 160834 0 0 0 5143 0 34912 0 9126 0 210015 0 0 Richard I Rothstein MD Trustee end 12/31/15 553973 0 0 0 2927 0 52990 0 18874 0 628764 0 0 0 Thomas Colacchio MD Former Officer/Phys 612710 0 0 0 408815 0 64362 0 17249 0 1103136 0 0 0 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 0 234308 0 100 0 471 0 21824 0 1819 0 258522 0 0 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 0 234112 0 0 0 270 0 36901 0 19932 0 291215 0 0 Jeanine Arden-Ornt Fmr General Counsel 0 213499 0 0 0 0 0 0 0 0 0 213499 0 0 Vincent Fusca III Chief of Staff 0 319756 0 0 0 10231 0 39074 0 1484 0 370545 0 0 Mary Kay Boudewyns Fmr Key Emp/VP Rev Mgmt 0 211673 0 0 0 17918 0 133729 0 7767 0 371087 0 0 Steven A Paris MD Trustee end 12/31/15 349732 0 0 0 25965 0 39937 0 13699 0 429333 0 0 0 Richard J Powell MD Trustee end 12/31/15 383501 0 60750 0 22077 0 99353 0 17848 0 583529 0 0 0 Edward Merrens MD Chief Medical Officer 453422 0 0 0 16189 0 56876 0 10876 0 537363 0 0 0 George Blike MD Chief Quality & Value Officer 408955 0 0 0 40344 0 190750 0 20137 0 660186 0 0 0 Daniel Stewart MD Physician 957690 0 0 0 69328 0 39589 0 20147 0 1086754 0 0 0 Barbara C Jobst MD Trustee 244137 0 66525 0 10679 0 65024 0 20422 0 406787 0 0 0 Darlene A Saler MBA RN Fmr Actg Chf Nrsg Ofr 0 192969 0 0 0 1030 0 100360 0 15154 0 309513 0 0 John S Malanowski MILR Chief HR Officer 0 487478 0 0 0 19004 0 38575 0 17848 0 562905 0 0 Clifford J Belden MD Fmr Chf Clncl Offr 512238 0 0 0 209890 0 20575 0 9332 0 752035 0 0 0 Terrence P Carroll PHD Chf Innvtn Ofcr end 8/29/15 0 423049 0 0 0 231477 0 44889 0 10482 0 709897 0 0 Faramarz Samie MD Physician 602895 0 262616 0 28745 0 13359 0 7246 0 914861 0 0 0 Thomas Dodds MD Fmr Key Emp/Dept Chr Anesth 520687 0 0 0 31687 0 85898 0 20127 0 658399 0 0 0 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 426814 0 0 0 21509 0 104066 0 20127 0 572516 0 0 0 Jocelyn Chertoff MD Fmr Key Emp/Dpt Chr Dgnstc Rad 494914 0 19500 0 30050 0 159349 0 20138 0 723951 0 0 0 Edward Catherwood MD MS Fmr Key Emp/Ctr Dir Hrt/Vsc 464561 0 0 0 881 0 54196 0 18699 0 538337 0 0 0 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 244566 0 0 0 10488 55141 0 19918 0 330113 0 0 0 Jeffrey OBrien MHA Fmr Key Emp/VP Oncology 0 274194 0 0 0 3347 0 21298 0 20003 0 318842 0 0 M Brooke Herndon MD Trustee 213411 0 17801 0 414 0 46496 0 17985 0 296107 0 0 0 John Birkmeyer MD Chf Clncl Offr/EVP Entprs Sup 790937 0 0 0 534 0 39415 0 20127 0 851013 0 0 0 Gay Landstrom PhD RN NEA-BC Chf Nursing Offr 0 544531 0 50000 0 2711 0 26823 0 17247 0 641312 0 0 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 0 351563 0 20000 0 161 0 21239 0 17747 0 410710 0 0 Robert Greene MD MHCDS FACP Chf Popul Mgmt Ofr 544537 0 0 0 13306 0 20823 0 17848 0 596514 0 0 0 John Kacavas JD Chief Legal Officer 0 242170 0 0 0 255 0 18978 0 10964 0 272367 0 0 Jeffrey A Cohen MD Trustee eff. 12/4/15 382972 0 0 0 19464 0 115884 0 20127 0 538447 0 0 0 Timothy D Scherer MD Trustee eff. 12/4/15 485809 0 0 0 14441 0 45581 0 17859 0 563690 0 0 0 Brian C Spence MD MHCDS Trustee eff. 12/4/15 315850 0 89300 0 14697 0 24812 0 20051 0 464710 0 0 0 Maria Padin MD Chf Med Ofcr eff. 11/9/15 362321 0 0 0 10041 0 165640 0 17799 0 555801 0 0 0 Peter D Solberg MD Chf Mdcl Info Ofcr eff. 9/2/15 333774 0 0 0 5949 0 37139 0 11599 0 388461 0 0 0 Karen Clements RN BSN MSB FAC Actg Chf Nrsg Ofr eff 6/15/16 0 158112 0 0 0 201 0 10694 0 7780 0 176787 0 0 Thomas J Siepka Chief Pharmacy Offr eff 1/4/16 0 196691 0 15000 0 5176 0 14891 0 1245 0 233003 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. Severance Payments Form 990, Schedule J, Part I line 4a The following listed individuals received Severance and/or change in control payments during calendar year 2015: DURING CALENDAR YEAR 2015, FORMER CHIEF INNOVATION OFFICER TERRENCE CARROLL RECEIVED A ONE-TIME SEVERANCE PACKAGE THAT INCLUDED PAYMENTS TOTALING $169,229 FROM DARTMOUTH-HITCHCOCK. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2015, FORMER CHIEF CLINICAL OFFICER CLIFFORD BELDEN RECEIVED A ONE-TIME $123,333 SEVERANCE PAYMENT FROM DARTMOUTH-HITCHCOCK. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. 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 2015. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. Supplemental Nonqualified Retirement Plan FORM 990 SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): James Weinstein $90,829 Richard Rothstein $1,307 Steven Paris $17,319 Richard Powell $20,775 Robin Kilfeather-Mackey $16,500 Daniel Jantzen $75,081 Stephen Leblanc $109,692 John Butterly $41,875 Edward Merrens $15,775 George Blike $39,930 Mary Oseid $11,722 Cliff Belden $43,010 Daniel Stewart $69,058 David Roberts $55,022 Nathan Simmons $45,832 Thomas Colacchio $88,815 Thomas Dodds $30,913 Wendy Wells $19,679 Jocelyn Chertoff $28,862 Edward Catherwood $881 Faramarz Samie $28,745 Jeffrey OBrien $1,815 Vincent Fusca III $5,587 John Malanowski $18,230 Terrence Carroll $60,398 Gay Landstrom $1,211 Robert Greene $11,212 Jeffrey Cohen $15,576 Timothy Scherer $14,243 Brian Spence $14,697 Maria Padin $9,531 Peter Solberg $5,679 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. DHC sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC 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 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 New Hampshire Health and Ed Facilities Authority 020279866 2015-09-01 41242290 Refund Issue Dated 8/31/2011 false false false A 0 0 50924782 0 0 0 149761 0 0 0 50775021 0 2015 true false true true A false false 0 A false true false false true false 0 false 0 false true A true OTHER SPENT PROCEEDS Form 990, Schedule K, Part II, Column A, Line 11 THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW. 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. Stephen LeBlanc Officer Split Dollar Life X 50207 50207 false true true Mary Oseid Former Key EE Split Dollar Life X 33374 33374 false true true Edward Catherwood Former Key EE Split Dollar Life X 107145 107145 false true true Thomas Colacchio Former Officer Split Dollar Life X 61247 61247 false true true Richard Rothstein Trustee Split Dollar Life X 87580 87580 false true true Peter Johnson Former Officer Split Dollar Life X 76103 76103 false true true Michael Ward Former Key EE Split Dollar Life X 75581 75581 false true true Andrew Gettinger Former Officer Split Dollar Life X 68680 68680 false true true 559917 Christine Schon Key Employee 35298 Scholarship Masters degree program Jeffrey Obrien Former Key Employee 68748 Scholarship Masters degree program Janice Kilfeather-Mackey Officer Kilfeather-Mac. 102525 Spouse employed by DHC false Roshini C Pinto-Powell Trustee Powell 288925 Spouse employed by DHC false Lynn Butterly Frmr Offcr John Butterly 556185 Spouse employed by DHC false Linda Dacey Frmr Offcr Larry Dacey 170912 Spouse employed by DHC false Nancy Birkmeyer Officer John Birkmeyer 23751 Spouse employed by DHC false Business Relationships FORM 990, PART VI, SECTION A, LINE 2 DARTMOUTH-HITCHCOCK CLINIC 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 DHC and officers of related for-profit entities: Daniel Jantzen - Hamden Assurance, ImagineCare, and Pompanoosuc Investment Corporation James Weinstein - Dartmouth Hitchcock Master Investment Plan and New England Alliance for Health John Kacavas - Dartmouth Hitchcock Master Investment Plan and Hamden Assurance Robert Greene - ImagineCare Robin Kilfeather-Mackey - Hamden Assurance, Hitchcock Health Connect, ImagineCare, and Pompanoosuc Investment Corporation Stephen Leblanc - New England Pharmacy Collaborative Vincent Fusca III - ImagineCare Description of classes of members, persons, and nature of rights Form 990, Part VI, Line 6 & 7a Dartmouth-Hitchcock Health (D-HH) is the sole corporate Member of Dartmouth-Hitchcock Clinic (DHC). D-HH has specific authority and reserved powers, including the power to confirm the election of members of DHC's Board of Trustees and the power to approve significant governance, financial and operational decisions of DHC's Trustees. 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 Clinic 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 DHC's Board of Trustees, to appoint or remove a member of the Clinic's Board of Trustees, assess the Clinic a monetary amount for the payment of the expenses of D-HH, approve the Clinic's budget, approve the borrowings or dispositions of assets by the Clinic, 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 Clinic. 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 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 Dartmouth-Hitchcock Clinic BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK OFFICE OF POLICY SUPPORT, COMPLIANCE AND AUDIT SERVICES 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 COMPLIANCE AND AUDIT SERVICES 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 CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Line 15a Compensation for the CEO is evaluated by an independent third party firm for reasonableness and national data benchmarking. The 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 2016. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, 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 2012 (2016 for VP's and above). 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/or a formal review by compensation committee members. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Line 19 DHC's governing documents are available through the New Hampshire Secretary of State. Certain financial information is disclosed through the Community Benefits Annual Report. The audited financial statements, governing documents, and conflict of interest policy are available upon request either in electronic or hardcopy form. Average Hours Per Week Form 990, Part VII, Section A, Line 1A Column B As part of Dartmouth-Hitchcock Clinic's 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 Mount Ascutney Hospital and Health Center), Mount Ascutney Hospital Community Health Foundation, Historic Homes of Runnemede, Cheshire Medical Center, Cheshire Health Foundation, Cheshire Health Services, The New London Hospital Association, and The Hitchcock Foundation. Independent Contractors Form 990, Part VII, Section B Dartmouth-Hitchcock Clinic is part of the Dartmouth-Hitchcock (D-H) Healthcare System which includes DHC, Mary Hitchcock Memorial Hospital (MHMH) and subsidiaries. MHMH received authority from the Internal Revenue Service to act as DHC's Pay Agent and implemented this process at the beginning of fiscal year 2010. All expenses are paid directly by MHMH and reimbursed by DHC. MHMH manages all required IRS reporting in regards to 1099's for independent contractors. 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 charges and other ($40,840,198) Audited Financial Statements Form 990, Part XII, Line 2c The organization's financial information is included in the audited financial statements of Dartmouth-Hitchcock Health and Subsidiaries, which consists of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, Mount Ascutney Hospital and Health Center, Cheshire Medical Center, The New London Hospital Association, and Alice Peck Day Memorial Hospital. A-133 Audit Form 990, Part XII, Line 3a DURING FISCAL YEAR 2016, 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. DUE TO THE ISSUANCE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF ALL ORGANIZATIONS. Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) 3 D-HH true Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon NH 03756 222715483 SUPPORTNG ORG NH 501(c)(3) 11 TYPE I NA true The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 HLTHCRE RSRCH NH 501(c)(3) 7 DHC true Hamden Risk Retention Group Inc 30 Main Street Suite 330 Burlington VT 05401 208530788 SELF INS. VT 501(c)(3) 11 TYPE I DHC true Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 PARENT ORG NH 501(c)(3) 7 NA false The New London Hospital Association Inc 273 County Rd New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH true EverWell Inc One Medical Center Drive Lebanon NH 03756 352506275 Supportng Org NH 501(c)(3) 11 Type I NA true Windsor Hospital Association 289 Country 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) 11 TYPE I CMC true Mt Ascutney Hosp Cmmty Hlth Found 289 Country Road Windsor VT 05089 030300481 Hospital VT 501(c)(3) 3 WHA true Historic Homes of Runnemede 289 Country Road Windsor VT 05089 237396147 Healthcare VT 501(c)(3) 9 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 OBNET Services LLC 1 Med Ctr Dr Lebanon NH 03756 043746287 Database Serv NH DHC Related 42421 357100 false 0 true 0.50000 D-H Mster Invst Prg 1 Med Ctr Dr Lebanon NH 03756 020505863 Pooled Invest NH NA Excluded 18525 997294 false -820 false 0.00181 Keene Hlth Alliance 580 Court St Keene NH 03431 300179297 Healthcare NH DHC Related -1211000 false 0 true 0.50000 One Care VT ACO LLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Pompanoosuc Investment Corporation One Medical Center Drive Lebanon NH 03756 020352330 Rl Estate Hld NH DHC C CORP -125 75632 1.00000 true Hamden Assurance Company Limited Canons Court 22 Victoria St Hamilton BD HM EX 980121409 Liab Insur. BD DHC Foreign Corp 102707195 0.70200 true Hitchcock Health Connect 1 Medical Ctr Dr Lebanon NH 03756 800908979 Telehealth DE D-HH C Corp true Kearsarge Community Services 273 County Road New London NH 03257 020460136 Real Est Hldg NH NLH C Corp true New London Physician Group 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 Charit Remndr Unitrusts (4) One Medical Center Drive Lebanon NH 03756 Chart. Trust NH MHMH Trust true ImagineCare One Medical Center Drive Lebanon NH 03756 813105071 Sftwre Tchnlgy NH D-HH C Corp true false false false false false false false false false true true true true true true true true true Mary Hitchcock Memorial Hospital MNOPQ 3799702 FMV Dartmouth-Hitchcock Medical Center Q 56010 FMV The Hitchcock Foundation Q 1883440 FMV Hamden Risk Retention Group M 1394689 FMV The New London Hospital Association Q 414795 FMV e Q 832175 FMV Cheshire Medical Center Q 2773729 FMV Alice Peck Day Memorial Hospital Q 99516 FMV