2015-05-15T12:50:04-05:00 2014-06-30 PRICEWATERHOUSECOOPERSLLP 125 HIGH STREET BOSTON MA 02110 990 2013-07-01 222715483 Dartmouth-Hitchcock Medical Center % TINA NAIMIE DART 6036531155 One Medical Center Drive Suite Lebanon NH 037560001 Tina Naimie Treasurer 2015-05-14 Gwen Spencer P00641463 2013 2016-02-25 16:41:14Z Tina Naimie ONE MEDICAL CENTER DRIVE Lebanon NH 03756 6971925 false X www.dhmc.org X 1983 NH Provides health care admin & planning to supported orgs, advance & strengthen activities such as regl programs, education, research,gov't & public relations,fundraising & other svcs 10 7 0 7 0 871037 1670403 3995121 5157588 400 2175 194228 121171 5060786 6951337 862979 1655446 0 0 0 0 0 0 4810031 4135974 5301045 4998953 6956491 61833 -5154 3951669 4050300 567508 673536 3384161 3376764 X DARTMOUTH-HITCHCOCK MEDICAL CENTER'S MISSION IS TO OFFER ADMINISTRATIVE, PLANNING, AND OTHER SERVICES DESIGNED TO PROMOTE, ADVANCE, AND STRENGTHEN THE INTERDEPENDENT AND SYNERGISTIC ACTIVITIES OF THE INDEPENDENT SUPPORTED ORGANIZATIONS IN THE AREAS OF HEALTHCARE, EDUCATION AND RESEARCH, GOVERNMENT AND PUBLIC RELATIONS, CHARITABLE FUNDRAISING AND OTHER RESOURCE DEVELOPMENT ACTIVITIES NOT INCONSISTENT WITH THE PURPOSES OF THE SUPPORTED ORGANIZATIONS. false false 2146460 1655446 5278725 Promotion of multidisciplinary and regional health care programs, education and research, government and public relations, charitable fundraising and other resource development activities. 2146460 true true false false false false false false false false true false false false true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true 0 0 0 false false false false false false false false false false false X 10 7 false false false false true true false true true false false true true true true true true false false false NH X TINA NAIMIE 6036531155 ONE MEDICAL CENTER DRIVE LEBANON NH 037560001 X Peter M Fahey Trustee 0.01 X 0 0 0 Wayne G Granquist Vice Chair/Trustee 0.01 2.0 X X 0 0 0 Alfred L Griggs Chair/Trustee 0.01 X X 0 0 0 Alan C Keiller Trustee 0.01 2.0 X 0 0 0 James N Weinstein DO MS Trustee Secretary/D-H CEO 0.01 61.0 X X 0 1010719 23574 William W Wyman Trustee 0.01 X 0 0 0 William W Helman IV Trustee 0.01 2.0 X 0 0 0 Wiley Souba MD ScD Ex-Officio 0.01 42.0 X 0 936729 34121 Deborah Amdur MSW Trustee End 0.01 X 0 0 0 Carol Folt PhD Trustee 0.01 40.0 X 0 554523 22950 Tina E Naimie CPA Treasurer/VP Corp Finance D-H 1.5 40.0 X 0 217915 20157 Anne Page CPA Frmer Treasurer/VP Reg Finance 40.0 X 0 225842 39097 0 2945728 139899 0 true true false Trustees of Dartmouth College 1 Rope Ferry Road HANOVER NH 03755 Devlpmnt and Fundrsg 4810030 1 1670403 21175 1670403 ASSESSMENTS TO MEMBERS FOR SERVICES 900099 5157588 5157588 5157588 2195 2195 0 0 0 0 0 20568 20588 -20 -20 -20 0 0 0 REIM OF PROP TAXES BY SUPPORTED ORGS 900099 121137 121137 INCOME FROM ANNUITIES 900099 34 34 121171 6951337 5278725 2209 X 1655446 1655446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4091023 4091023 0 156044 1913 154131 73313 73313 0 396724 396724 65179 65179 0 29661 29661 0 0 20812 20812 0 PROPERTY TAXES 468289 468289 6956491 2146460 0 4810031 0 0 898853 719818 0 0 58333 410341 0 0 0 0 0 0 0 0 81225 85708 3204415 529236 2695991 2675179 72969 0 0 0 0 0 0 0 144298 159254 3951669 4050300 564370 670523 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3138 3013 567508 673536 X 3239863 3217510 144298 159254 0 0 3384161 3376764 3951669 4050300 X -5154 -2243 X false true X false true true X X X false false false MARY HITCHCOCK MEMORIAL HOSPITAL 020222140 03 true 348910 DARTMOUTH-HITCHCOCK CLINIC 222519596 0 true 156757 TRUSTEES OF DARTMOUTH COLLEGE 020222111 02 true 816497 VETERANS AFFAIRS MEDICAL CENTER 741612229 02 true 0 4 1322164 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2675179 2675179 355231 355231 174005 174005 2675179 0 ANNUITY LIABILITY 3013 3013 Schedule D, Part X, Line 2 Audited Financial Statement Footnote Regarding FIN48 (ASC 740) The organization's audited financial statements did not include a footnote relating to FIN48 (ASC 740) since there have been no changes since inception. true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 501(c)3 348910 FMV Gen support Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 501(c)3 816497 FMV Gen support Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 509(a)(2) 333283 FMV Gen Support Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 501(C)(3) 156757 FMV Gen Support 4 Schedule I, Part I, Question 2 The majority of the DHMC board members are nominated by the board members of the supported organizations. All assistance represents fundraising proceeds raised on the behalf of DHMC's supported organizations and is given for general and unrestricted operating use. false true false false false false false false false James N Weinstein DO MS Trustee Secretary/D-H CEO 0 945851 0 200 0 64668 0 2250 0 21324 0 1034293 0 0 Wiley Souba MD ScD Ex-Officio 0 789935 0 98800 0 47994 0 22950 0 11171 0 970850 0 0 Tina E Naimie CPA Treasurer/VP Corp Finance D-H 0 217604 0 200 0 111 0 17993 0 2164 0 238072 0 0 Anne Page CPA Frmer Treasurer/VP Reg Finance 0 220533 0 200 0 5109 0 30843 0 8254 0 264939 0 0 Carol Folt PhD Trustee 0 463039 0 78000 0 13484 0 22950 0 0 0 577473 0 0 Severance Payments Part I Line 4B The following individuals received the following amounts from the Dartmouth-Hitchcock Supplemental Retirement Plan (see below for terms): James Weinstein $63,480 Terms of the Dartmouth-Hitchcock Supplemental Retirement Plan: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (which consists of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic), 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 Sections 401(a)(17) and/or IRC Section 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 contribution as a result of limitations imposed by IRC Sections 401(a)(17) and/or IRC Section 415. Organization Members Form 990 Part VI Section A Line 6 & 7a DHMC has four Members, referred to as components: Dartmouth College/Geisel School of Medicine; Dartmouth-Hitchcock Clinic; Mary Hitchcock Memorial Hospital; and the Veterans Affairs Center. The components shall be represented, respectively, by the Dean of Geisel School of Medicine, President of the Clinic, President of the Hospital, and Director of the Veterans Affairs, all of whom shall be Ex-Officio. The College/Medical School, Clinic, and Hospital shall each be represented by two individuals (component trustees), nominated by their respective Boards of Trustees and elected by the DHMC Board. Such individuals should normally be trustees of the component boards, but is not a requirement. All members of the board, both elected and ex-officio, shall have voting rights. In addition, the DHMC board may elect as many as five Non-Component Trustees. IRS Form 990 Review Process Form 990 Part VI Section B Line 11B After preparation and review by internal tax staff and external consultants, the return is reviewed by the Treasurer. The final form 990 is shared electronically with the Trustees prior to filing, and the trustees are provided an opportunity to review, ask questions, and recommend changes before filing of the return. Conflict of Interest Policy Form 990 Part VI Section B Line 12C The Dartmouth-Hitchcock Medical Center Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock Compliance and Audit Services Department conducts an annual survey of all officers and trustees and performs other procedures as considered necessary to report on compliance with the Dartmouth-Hitchcock Medical Center conflict of interest policy. 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 shall 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. Compensation Review Form 990 Part VI Section B Line 15A The organization's treasurer is compensated by Mary Hitchcock Memorial Hospital (MHMH), a related and supported organization of DHMC. As part of their role at MHMH, their compensation is reviewed by external parties and MHMH's compensation committee. Availability of Documents Form 990 Part VI Section C Line 19 The Organization makes its audited financial statements, governing documents, and conflict of interest policy available upon request in hardcopy form. Reported Compensation Form 990 Part VII Section A, Line 1 The compensation paid by related organizations was for services provided to those related organizations and not the filing organization. Although the individuals worked the time listed as part of their board of trustee duties, they were not compensated with respect to those hours. The time/hours at the related organization varies by individual and organization, and would be the hours necessary to total to their respective full hours per week. Statement of Functional Expenses Form 990 Part IX Line 11G,Purchased Services The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as Purchased services represent reimbursement for services provided by the College to DHMC. Form 990 Part IX, Line 25, Fundraising Expenses The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as fundraising expenses represent costs incurred raising funds for the Organization as well as fundraising on the behalf of its supported members including Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. During fiscal year 2014, the total costs paid to Dartmouth College for these services were $4,810,030. Total fundraising revenue recognized by DHMC was $1,670,403. All additional fundraising revenue generated by DHMC on behalf of its supported organizations was recognized directly by the Supported Organizations in the amount of $36,707,078. A-133 Audit Form 990 Part XII, Question 3a DURING FISCAL YEAR 2013, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE MINIMUM THRESHHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133, THEREFORE REQUIRING AN AUDIT. DUE TO THE ISSUANCE OF THE COMBINED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING DARTMOUTH-HITCHCOCK CLINIC. Statement Regarding Form 5471 Filing Requirements The Organizations's Form 5471 filing requirements have been or will be satisfied by Dartmouth-Hitchcock Clinic, One Medical Center Drive, Lebanon, New Hampshire, 03756, EIN: 22-2519596, the majority shareholder of Hamden Insurance Company Limited. Dartmouth-Hitchcock Clinic has filed the form 5471 and the applicable schedules with the IRS Service Center, Philadelphia, PA. Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Org NH 501(C)(3) 11 Type II NA false Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Group NH 501(C)(3) 9 D-H Health true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(C)(3) 3 D-H Health true Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 Med. School NH 501(C)(3) 2 NA false Veterans Affairs Med & Regnl Office Cntr 215 North Main Street White River Junction VT 05001 741612229 Hospital VT N/A false Hamden Risk Retention Group 30 Main Street Suite 330 Burlington VT 05401 208530788 Slf Insurance VT 501(C)(3) 11 Type 1 DHC true The Hitchcock Foundation One Medical Center Dr Lebanon NH 03756 020222139 Research Aid NH 501(C)(3) 7 DHC true EverWell Inc One Medical Center Drive Lebanon NH 03756 352506275 Supportng Org NH 501(c)(3) 11 Type I D-HH true The New London Hospital Association Inc 273 County Rd New London NH 03257 020222171 Health Care NH 501(c)(3) 3 D-H Health true OBNET Services LLC 1 Med Ctr Dr Lebanon NH 03756 043746287 Database Serv NH NA Keene Hlth Alliance 580 Crt St Keene NH 03431 300179297 Healthcare NH NA DH Master Invst Prg 1 Med Ctr Dr Lebanon NH 03756 020505863 Investments NH NA The Hitchcock Ptshp 1 Med Ctr Dr Lebanon NH 03756 020514823 Pooled Invst NH NA OneCare VT ACOLLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Pompanoosuc Investment Corp One Medical Center Drive Lebanon NH 03756 020352330 Real Est Hldg NH NA C Corp false Hamden Assurance Co LTD 44 Church Street Hamilton HM EX BD 980121409 Liab Ins BD NA C Corp false Hitchcock Health Connect One Medical Center Drive Lebanon NH 03756 800908979 Telehealth DE NA C Corp false Kearsarge Community Services Inc 273 County Road New London NH 03257 020460136 Rl Estate Hld NH NA C Corp false New London Medical Center East Inc 273 County Road New London NH 03257 020480857 Rl Estate Hld NH NA C Corp false New London Physician Group Inc 273 County Road New London NH 03257 020494420 Physician Group NH NA C Corp false false false false false false false false false false true false true true false true true true false false Mary Hitchcock Memorial Hospital M 348910 FMV Mary Hitchcock Memorial Hospital L 1946756 FMV Dartmouth Hitchcock Clinic L 874630 FMV Dartmouth Hitchcock Clinic M 156757 FMV Dartmouth-Hitchcock Health P 333283 FMV