2011-08-12T16:13:02-04:00 2010-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2380 INDIANAPOLIS IN 46204 990 2009-10-01 020222140 Mary Hitchcock Memorial Hospital MARY 6036505000 One Medical Center Drive Lebanon NH 03756 Robin Kilfeather-Mackey 6036505668 2011-08-05 3176817000 2009 2016-02-24 21:20:13Z Nancy Formella One Medical Center Drive Lebanon NH 03756 967764999 false X www.DHMC.org X 1889 NH ADVANCING 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. 15 13 5299 625 2387817 0 11292032 10252966 763807270 815774940 -4532676 18049083 12220001 37950598 782786627 882027587 64159 990807 0 0 334679148 534789852 0 0 2862920 435321872 315249387 770065179 851030046 12721448 30997541 994607674 1129681214 595784153 675063960 398823521 454617254 ADVANCING 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 759554475 990807 830845586 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 community hospital, a major teaching hospital and a tertiary care referral hospital. These include a full range of services in both acute and critical medicine, surgery, psychiatry and rehabilitation for infants, children and adults. During 2010 the Hospital provided 119,663 acute patient days of inpatient service and had 24,165 total acute care discharges, while the Hospital's emergency room was open to the public 24 hours per day, 7 days per week and provided care during 31,589 visits. The Hospital operates as an integral component of the Dartmouth Hitchcock Medical Center (DHMC), a New Hampshire nonprofit corporation organized for the exploration and coordination of matters of mutual interest among its members which consist of the Hospital, Dartmouth-Hitchcock Clinic (the Clinic), Dartmouth Medical School (DMS), 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 mission of the 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. Consistent with this mission and in partnership with the 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. The Hospital also seeks to work collaboratively with other area health care providers to improve the health status of the region. As a component of an integrated academic medical center, the Hospital provides significant support for academic and research programs through its support to DMS as discussed below. Effective with fiscal year 2000, the Hospital and the Clinic 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 Report for 2010 is available upon request or can be found on Dartmouth-Hitchcock's web site (www.dhmc.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 September 30, 2010 the Hospital provided financial assistance to 8,132 patients in the amount of $30,403,000, as measured by gross charges. The estimated cost of providing this care for the year ended September 30, 2010 was $13,103,693. The Hospital 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 year ended September 30, 2010 was $39,286,552. The Hospital, in conjunction with the Clinic and DMS, provides financial support for medical and other professional education to Dartmouth Medical School to support the costs of operations. Physicians' unpaid teaching time consists of the time physicians spend providing clinical supervision and education for residents and medical students. 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 Hospital. 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 FitKids health program for elementary schools, the Women's Health Resource Centers in Manchester and 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. Other community benefit initiatives include the costs of providing medical and clinical education to professionals across New Hampshire, Vermont and beyond and the uncompensated costs of research. The Hospital 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. During the years ended September 30, 2010, the Hospital reported a provision for bad debts of approximately $22,372,057. 759554475 true true false true false false false false true true false true false true true false false false true false true true true true true false false false false false true false true true true true false false false true true true false false true 852 0 true 5299 true true true true BD false false false true true false false false 15 13 false false true false true true true true true false true false true true true true true true true true true true NH X ROBIN KILFEATHER-MACKEY 6036505668 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 Michael J Goran MD 1.0 X 0 0 0 Alfred L Griggs 1.0 X 0 0 0 Stephen P Barba 2.0 X X 0 0 0 Alan C Keiller 2.0 X X 0 0 0 Stephen F Christy 1.0 X 0 0 0 Wayne G Granquist 1.0 X 0 0 0 William R Green PhD 1.0 X 0 0 0 Jennie L Norman 2.0 X X 0 0 0 Richard S Shreve 1.0 X 0 0 0 Hugh C Smith MD 1.0 X 0 0 0 Barbara T Blough 1.0 X 0 0 0 Vincent S Conti 1.0 X 0 0 0 Anne-Lee Verville 1.0 X 0 0 0 Nancy Formella 60.0 X X 757755 0 26839 Thomas Colacchio MD 60.0 X X 0 689964 54510 Barbara Couch 1.0 X 0 0 0 Carl Dematteo MD 60.0 X 0 580673 25232 Peter Johnson 60.0 X 0 436389 28051 Stephen LeBlanc 60.0 X 0 513431 26730 Daniel Jantzen 60.0 X 509597 0 30776 Linda von Reyn 60.0 X 301480 0 28875 Lawrence Dacey MD 60.0 X 0 593092 32714 Robin Kilfeather-Mackey 60.0 X 0 242462 21418 Brian Lally 60.0 X 0 0 0 John C Collins 60.0 X 0 454119 53423 Richard Showalter 60.0 X 632576 0 26596 William Mroz 60.0 X 251179 0 44656 Sandra Dickau 60.0 X 248179 0 17093 Mary Kay Boudewyns 60.0 X 210567 0 12651 Gail Dahlstrom 60.0 X 214412 0 14910 William Geraghty 60.0 X 380854 0 26274 Bruce King 60.0 X 268537 0 19980 Ronald Sliwinski 60.0 X 445874 0 27256 Susan Reeves 60.0 X 284192 0 49840 Neil Castaldo 60.0 X 582634 0 49061 Victoria George X 0 454555 28709 Richard Davis X 0 103498 23799 5087836 4068183 669393 308 true true false ACCRETIVE HEALTH 401 N MICHIGAN AVE SUITE 2700 CHICAGO IL 60611 REVENUE MNGT SERVICE 29475253 TRUSTEES OF DARTMOUTH COLLEGE 37 DEWEY FIELD HANOVER NH 03755 ADMIN & DIR SUPPORT 19090108 CROSS COUNTRY STAFFING INC PO BOX 404674 ATLANTA GA 30384 TRAVELING NURSE SVC 8156026 Pizzagalli Construction Company 50 Joy Drive SOUTH BURLINGTON VT 05403 CONSTRUCTION SVCS 11608688 NEW HAMPSHIRE IMAGING SERVICES INC ONE PILLSBURY ST SUITE 200 CONCORD NH 60122 Imaging Services 5799201 167 4020542 562107 5670317 410675 10252966 PATIENT SERVICE REVENUE 621110 812723611 812723611 FEE FOR SERVICE GRANTS, OTHER, RESEARCH 621110 2513500 2513500 MOBILE ECHO CARD REVENUE 621110 529366 529366 HOLTERSCAN REVENUE 621110 8463 8463 815774940 8082942 8082942 0 0 805019 566019 239000 238999 238999 94775167 63109 84855419 16716 9919748 46393 9966141 171682 4020542 299258 -127576 0 0 CAFETERIA 722212 3780599 3780599 MANAGEMENT SERVICES 622110 767491 767491 PHARMACY INCOME 622110 16734919 134806 16600113 16556166 15070646 1485520 37839175 882027587 830845586 2387817 28702653 583085 583085 407722 407722 0 0 3090662 978793 1740076 371793 0 385253204 341380875 42193142 1679187 55989576 49830723 6158853 63396121 56422548 6973573 27060289 24083657 2976632 0 3290920 3290920 290076 290076 0 0 0 61873562 54195918 7390352 287292 2211076 66332 2144744 126884635 126437965 287060 159610 3100610 2728537 372073 0 11448088 9218255 2023519 206314 1760456 1119751 576841 63864 0 118193 100464 17729 11859302 10436186 1423116 0 31814073 27996384 3817689 9216046 8202281 1013765 PROVISION FOR BAD DEBTS 22372057 22372057 EQUIP RENTAL & MAINTENANCE 9744349 8185253 1559096 RECRUITMENT COSTS 1287203 1287203 OTHER EDUCATIONAL COSTS 753863 497550 256313 GME TEACHING & SUPPORT 428043 428043 16796835 13882096 2819879 94860 851030046 759554475 88612651 2862920 87395 82299 46440142 49127873 129122311 135997590 215534 457401 3401466 2503233 10998280 13257671 4603809 4420595 639987857 308919356 295682501 331068501 377202458 453576706 78914878 81461317 2395314 2238669 45543586 55489359 994607674 1129681214 153865737 170120779 295106649 362562261 6816615 5544170 139995152 136836750 595784153 675063960 X 327428226 378725214 41317134 48353644 30078161 27538396 398823521 454617254 994607674 1129681214 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 128432 false false 128432 false LOBBYING ACTIVITY EXPLANATION SCHEDULE C, PART II, B MARY HITCHCOCK MEMORIAL HOSPITAL EMPLOYS TWO FULL TIME STAFF WHOSE DUTIES INCLUDE LOBBYING. THE EXPENSES ASSOCIATED WITH THE LOBBYING ACTIVITIES INCLUDE STAFF SALARY, TRAVEL, MEMBERSHIP FEES AND DUES. FOR THE FISCAL YEAR ENDED SEPTMEBER 30, 2010, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $128,432 IN CONJUCTION WITH THIS ACTIVITY. 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 TYPICAL ACTIVITIES MAY INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. 49493627 3040219 2769857 1193056 54110647 49870808 4146452 -3921625 602008 49493627 0.30000 0.70000 0.00000 false false 9300875 16188908 25489783 358116213 185344697 172771516 3749460 3144106 605354 252632402 120430554 132201848 331068501 PRIVATE EQUITY FUNDS 36156109 F HEDGE FUNDS 45305208 F 81461317 0 THIRD PARTY SETTLEMENTS 25490198 ACCRUED POST RETMNT PENS & MED 100133820 INTEREST RATE SWAP 11212732 136836750 Intended use of Endowment Funds Schedule D Part V Line 4 The intended use of the endowment funds is to promote and advance the following: healthcare services, research, charity care and health education. ASC 740 (FIN 48) Footnote 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 1 0 Program Services INSURANCE 5142216 Central America and the Caribbean 0 0 Program Services Relief Efforts & Suppl 298187 Central America and the Caribbean 0 0 Program Services Medical Supplies Contr 810 Central America and the Caribbean 0 0 Program Services Travel Expenses 16333 East Asia and the Pacific 0 0 Program Services Travel Expenses 904 Europe (Including Iceland and Greenland) 0 0 Program Services Travel Expenses 48802 Europe (Including Iceland and Greenland) 0 0 Program Services Insurance Premiums 272550 Middle East and North Africa 0 0 Program Services Travel Expenses 1028 North America 0 0 Program Services Travel & Progam Reltd 92530 North America 0 0 Program Services Medical Supplies 39512 North America 0 0 Program Services Medical Equipment 214312 South America 0 0 Program Services Travel Expenses 2654 Sub-Saharan Africa 0 0 Program Services Travel Expenses 5803 Europe (Including Iceland and Greenland) 0 0 Program Services Medical Supplies 66189 1 0 6201830 Prouty Ultimate 2945047 2826752 118295 118295 CHAD Marathon 474309 474309 6550 3692 1030 70287 11 772868 719481 53387 1656 9503 4245 19635 7430 56935 4192224 4020542 171682 1656 16053 7937 20665 7430 245517 299258 -127576 true true true true X true true true false true true 13103693 13103693 0.01580 79398976 40112424 39286552 0.04740 0 0 0 0.00000 92502669 40112424 52390245 0.06320 3176730 409717 2767013 0.00330 34306103 9279174 25026929 0.03020 56195 56195 0.00010 871429 871429 0.00110 1326246 1326246 0.00160 39736703 9688891 30047812 0.03630 132239372 49801315 82438057 0.09950 24150 24150 923 923 15453 15453 2289 2289 620 620 133934 23431 110503 0.00010 66270 66270 0.00010 15956 15956 0 0 0.00000 259595 23431 236164 0.00020 false 9029712 0 221104295 212259218 8845077 X true true Mary Hitchcock Memorial Hospital

One Medical Center Drive Lebanon NH 03756

X X X X X X PSYCH UNIT AND TRANSPLANT UNIT Norris Cotton Cancer Center

1080 Hospital Drive St Johnsbury VT 05819

Cancer Center Mary Hitchcock Memorial Hospital (MHMH) and Dartmouth-Hitchcock Clinic (DHC), 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. For purposes of Schedule H, only MHMH numbers were used. All amounts relating to DHC were excluded. The methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, Ratio of Patient Care Cost-to-Charges. The Organization did not include any subsidized health service costs attributable to a physician clinic on Part I, line 7G. Bad debt expense included on Form 990 Part IX Line 25 totaling $22,372,057, was excluded from Total Expenses for the calculation of Net Community Benefits as a percent of Total Expenses. The IRS cost-to-charge ratio was used to determine amounts reported on Part III, Section A, line 2. The Organization used IRS Form 990, Schedule H, Worksheet A to estimate bad debt expense at cost. MHMH's Policy is to exert everything in the Organization's power to obtain sufficient and adequate information to determine eligibility for financial assistance. If the required information is not obtained in order to determine eligibility for financial assistance, then the amount is recognized as bad debt. The costing methodology used to calculate the amounts reported on Part 3, Line 2 is the cost-to-charge ratio as derived from Schedule H, Worksheet 2, Ratio of Patient Care Cost-To-Charges. Audited financial Statement Disclosure for Charity Care and Provision for Bad Debt: 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. The Organization grants credit without collateral to patients, most of whom are local residents and are insured under third-party arrangements. Additions to the allowance for uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, business and economic conditions, trends in federal and state governmental healthcare coverage and other collection indicators. The costing methodology used to calculate the amounts reported as Medicaid Shortfalls was derived from the Internal Revenue Service's Worksheet B as provided for Part III calculations. MHMH had revenues of $16,097,951 and costs of $22,014,131 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 $5,916,180 on the provision of these services and did not include these as part of the community benefit report. 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 who 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 requirements and criteria for consideration for financial assistance are outlined within the Financial Assistance policy. Guidelines for financial assistance qualification are defined as well as the levels of assistance available. 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. The policy also addresses that payment plans are available for anyone with a self-pay balance remaining after their reduction. Patients who receive less than 100% approval may appeal the decision through an independent committee for review. If a patient has a self pay balance after financial assistance adjustments are applied they are expected to comply with the agreed upon payment arrangements. If the patient does not follow the payment arrangement, they will be subject to the terms outlined in the Credit and Collections Policy. Every effort is made to work with patients to establish a satisfactory payment arrangement. 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. 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. Description of Community Needs Assessment Dartmouth-Hitchcock participates with other health care charitable trusts and community partners in each of our service areas to complete community health needs assessments. Each of our regions (Lebanon, Concord, Manchester and Nashua) has utilized different approaches, as described below: 1. Lebanon Service Area: In 2005, the Upper Valley region defined a set of 14 specific indicator areas that had been identified in earlier community needs assessments as being key areas of need. These 14 indicator areas offer an opportunity for the region to track progress toward meeting these health needs over time. The 2008 Community Needs Assessment was organized around these needs. For each indicator area, we sought data regarding the indicator by: a. Identifying quantifiable, reliable, regularly collected population data sources, such as Youth Risk Behavior Surveys and the Behavioral Risk Factors Surveillance System. b. Hosting small focus groups of key community stakeholders with long-term knowledge and experience related to each of the key indicator areas. c. Seeking commentary on focus group data from additional key stakeholders in individual interview formats. These activities provided data and analysis needed to compile narrative reports for each key indicator area, including both quantitative population health data and local interpretation and analysis of factors impacting each area of need. In addition Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital solicited input to help prioritize identified community health needs through two additional actions: a. Distributing a brief health needs priority survey to residents attending free public flu clinics in Lebanon and Canaan. b. Asking key leaders of health, human service, and government assistance organizations to complete a Survey Monkey questionnaire which asked them to prioritize the needs of i. Clients they serve ii. The community at-large iii. Barriers to health iv. The community health interventions they desired most from Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital v. The community health interventions they were most likely to implement through their own organizations in the next 1-3 years. 2. Concord Service Area: In 2008, Dartmouth-Hitchcock Concord participated as a member of the Capitol Region Health Needs Assessment. Data gathering methods used in this assessment included: a. Reviewing of population health data from county, state, and hospital data sets. b. Conducting stakeholder interviews with key elected and appointed City and State officials as well as representatives from health constituency groups. c. Hosting focus groups for various constituent groups, including seniors, teens, young parents, educators, clergy, and health care/human service providers. d. Conducting community listening sessions open to the general public in six communities surrounding Concord. e. Administering a random, probabilistic telephone survey of residents in 24 communities surrounding Concord. f. Distributing a written survey to adults and teens in a variety of community locations. g. Posting an online survey using zoomerang.com to gather feedback from respondents. 3. Manchester Area: Dartmouth-Hitchcock Manchester was a collaborator in the 2006 "Community Indicators" project sponsored by Heritage United Way in partnership with Southern New Hampshire University. This project utilized several sources of gathering data regarding community needs: a. Utilizing data from the US Census, the Bureau of Labor Statistics, and research generated by public agencies, institutions, community-based organizations, and academic centers. b. Input from stakeholder groups, including donor groups, business leaders, agencies, clients, local philanthropies, advocates, researchers, and the Heritage United Way Board of Directors. c. Three Community Discussion forums where data and reports generated as part of the Community Indicators Project were presented for discussion at open forums. 4. Nashua Service Area: Dartmouth-Hitchcock Nashua participated in the development of the 2006 "Greater Nashua Measures Up" community needs assessment project. Methods for gathering information used in this assessment include: a. Collecting population health data from published sources including: i. The 2000 Census of Population and Housing ii. The Mayor's Task Force on Housing iii. Nashua Continuum of Care's point-in-time counts of the homeless iv. Southern New Hampshire Services' 2004-2007 assessment of the needs of low-income individuals v. State and local government data on education, employment, crime, and health status b. Conducting a regional, randomized household telephone survey regarding personal and community health care needs. c. Hosting focus groups of service recipients, including Hispanic-speaking and Portuguese-speaking groups and teen representatives from the Mayor's Taskforce on Youth in Nashua. d. Surveying human service agencies regarding community health needs. All uninsured inpatients, same day surgery, observation, and Emergency Department patients are pro-actively screened using an automated tool to identify potential qualification for other federal, state, and local programs. 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 available at the federal or state level, 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 assistance programs. The website, patient statements, and financial brochures all include information about financial assistance and how to apply. The Organization defines it's service region as New Hampshire and eastern Vermont, with the largest presence in the Lebanon, New Hampshire region, site of Dartmouth-Hitchcock Medical Center which includes Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic's main Northern clinic. 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 Children's Hospital in New Hampshire (Children's Hospital at Dartmouth - CHaD), hosts the only Level III neonatal intensive care nursery and the only pediatric intensive care unit 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. MHMH supports organizations and initiatives that further health by strengthening and developing key community capacities, such as improved housing, economic development initiatives, and healthcare workforce development activities as determined by the Organization's Needs Assessment. In addition, the Organization participates in or provides leadership for a wide array of health-oriented community coalitions, such as the Upper Valley Housing Coalition, the Nashua Tobacco Coalition, the DHMC Outpatient Falls Risk Reduction Task Force, the Community Oral Health Initiative, the Bridges to Prevention substance use prevention coalition, and ServiceLink. MHMH has also provided leadership to the Upper Valley Healthy Eating Active Living (UV HEAL) Partnership, an initiative to reduce the growth of childhood obesity, and has been active in similar partnerships in Nashua and Manchester. Open Medical Staff At MHMH's Lebanon campus, the Hospital extends Professional Staff Privileges to qualified and appropriate physicians who are employees of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, or Dartmouth College and who also hold a faculty appointment at Dartmouth College. Surplus Funds Mary-Hitchcock's Trustees annually set strategic priorities for the institution and approve operating and capital budgets which allocate surplus funds to improvements in patient care, medical education, research, as well as maintenance of a prudent reserve. Examples of these investments include the development of Mary Hitchcock's Patient Safety Training Lab, ongoing Quality and Patient Safety initiatives, purchases of new and emerging medical technologies, awards made to support translational research, and support for undergraduate medical education at Dartmouth Medical School. Community Board Of the fifteen voting members of Dartmouth-Hitchcock's Board of Trustees, eleven live within the geographic region we serve. Fifteen are neither contractors nor employees of MHMH. Community 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 2010 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. In addition, the Clinic provides primary care in rural communities in Vermont and northern New Hampshire. MHMH, DHC sites, and the Dartmouth Medical School (DMS) 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. They share identical missions. The Medical School, which is closely affiliated with the Hospital and Clinic, is focused on medical education and research. NH true The Dartmouth Institute at Dartmouth College 7 Lebanon Street Hanover NH 03755 020222111 501(C)3 242487 Hlth Institute Sppt Child Health Services 1245 Elm Street Manchester NH 03104 020348711 501(C)3 39675 Program Services Good Neighbor Health Clinic 70 No Main St White River Jct VT 05001 030346949 501(C)3 37950 Programs/Clinic Svcs Manchester Community Health Center 145 Hollis Street Manchester NH 03101 020458174 501(C)3 34500 Program Services The Hitchcock Foundation 1 Medical Center Drive Lebanon NH 03756 020222139 501(C)3 27600 Program Support Cheshire Health Foundation 580 Court Street Keene NH 03431 020202220 501(C)3 23599 Program Support New Hampshire Health Dept 1528 Elm St Manchester NH 03101 City Manchester 17250 Sustainable Access University of New Hampshire 4 Library Way Durham NH 03284 026000937 501(C)3 17250 Citizens Hlth Init Upper Valley United Way 10 Bank Street Lebanon NH 03766 020306103 501(C)3 12721 Corp. Pledge Match Grafton Country Senior Citizens Council P O Box 433 Lebanon NH 03766 237248316 501(C)3 8280 Elder Services HealthFirst Family Care Center Inc 841 Central Street Franklin NH 03235 020492976 501(C)3 6900 Bridges Prev Prog American Heart Association 125 East Bethpage Road Plainview NY 11803 160915734 501(C)3 6900 GRFW Education Vital Communities 104 Railrd Row White River Jct VT 05001 030355283 501(C)3 6900 Program Services Albert Schweitzer Fellowship Inc 10 Sausville Road Etna NH 03750 131982786 501(C)3 6900 Program Services Granite State Fit Kids THF 1 Med Center D Lebanon NH 03756 020519379 501(C)3 5175 Program Services Greater Manchester Family YMCA 30 Mechanic Street Manchester NH 03101 020222248 501(C)3 5175 Program Services 16 Godfrey Nursing Awards 1 2000 E. Hintze Nursing Awards 1 1363 Levine Nursing Awards 9 23973 Smith Promise Nursing Awards 6 9000 Nursing Staff Fund Awards 3 3250 567 FMV Kindle Book Readers Varnum Nursing Awards 34 40000 TDI Scholarships 16 323569 Knox Nursing Award 1 4000 Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants For each of the awards established by Mary Hitchcock Memorial Hospital; Godfrey Nursing Awards, E. Hintze Nursing Awards, Levine Nursing Awards, Smith Promise Nursing Awards, Nursing Staff Fund Awards, Varnum Nursing Awards, there are written established guidelines and procedures. Grant award payments are processed in accordance with the specific terms of each of the grants noted above. 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 X true true false false false false false false false Nancy Formella 651504 0 0 0 106251 0 9188 0 17651 0 784594 0 0 0 Thomas Colacchio MD 0 634464 0 0 0 55500 0 31410 0 23100 0 744474 0 0 John C Collins 0 420024 0 0 0 34095 0 31410 0 22013 0 507542 0 0 Carl Dematteo MD 0 443458 0 60236 0 76979 0 8820 0 16412 0 605905 0 0 Peter Johnson 0 359327 0 46800 0 30262 0 8820 0 19231 0 464440 0 0 Stephen LeBlanc 0 407020 0 51600 0 54811 0 8820 0 17910 0 540161 0 0 Daniel Jantzen 398172 0 51600 0 59825 0 12250 0 18526 0 540373 0 0 0 Richard Showalter 432279 0 57845 0 142452 0 12533 0 14063 0 659172 0 0 0 William Mroz 221445 0 21645 0 8089 0 31410 0 13246 0 295835 0 0 0 Sandra Dickau 225732 0 21692 0 755 0 9167 0 7926 0 265272 0 0 0 Mary Kay Boudewyns 187177 0 18575 0 4815 0 6128 0 6523 0 223218 0 0 0 Linda von Reyn 262642 0 15273 0 23565 0 8638 0 20237 0 330355 0 0 0 Gail Dahlstrom 187106 0 18250 0 9056 0 0 0 14910 0 229322 0 0 0 William Geraghty 288343 0 31500 0 61011 0 12250 0 14024 0 407128 0 0 0 Bruce King 240615 0 0 0 27922 0 0 0 19980 0 288517 0 0 0 Ronald Sliwinski 298901 0 28005 0 118968 0 12250 0 15006 0 473130 0 0 0 Susan Reeves 235101 0 23727 0 25364 0 31410 0 18430 0 334032 0 0 0 Victoria George 0 453367 0 0 0 1188 0 26510 0 2199 0 483264 0 0 Richard Davis 0 99724 0 0 0 3774 0 3801 0 19998 0 127297 0 0 Lawrence Dacey MD 0 524824 0 22878 0 45390 0 8820 0 23894 0 625806 0 0 Robin Kilfeather-Mackey 0 217509 0 21375 0 3578 0 9853 0 11565 0 263880 0 0 Neil Castaldo 453331 0 73600 0 55703 0 31410 0 17651 0 631695 0 0 0 Supplemental Compensation Information 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. Schedule J, Part I - Line 4a Severance Arrangements William Geraghty severance arrangement: Salary & benefits $170,100, career assistance and other $41,580 Victoria George severance arrangement: Salary & benefits $428,400, moving expenses $13,333, career assistance and other $24,000 Ronald Sliwinski severance arrangement Salary & benefits $72,204, career assistance and other $23,421 Supplemental Retirement Information Schedule J, Part III - line 4b The following individuals received payments from a supplemental nonqualified retirement plan: Thomas Colacchio $55,500 from the Dartmouth-Hitchcock Supplemental Retirement Plan.(See below for terms) John Collins $28,995 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Carl Dematteo $67,859 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Peter Johnson $30,262 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Stephen LeBlanc $18,875 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Nancy Formella $100,544 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Daniel Jantzen $59,555 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Richard Showalter $136,826 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Bruce King $9,078 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Ronald Sliwinski $109,183 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Susan Reeves $6,904 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Lawrence Dacey $44,976 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) William Geraghty $38,284 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) Wiliam Mroz $909 from the Dartmouth-Hitchcock Supplemental Retirement Plan. (See below for terms) 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 two qualified defined benefit plans) 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 eigible 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. NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTH 020279866 644614Y07 2009-08-19 134661088 CURRENT REFUND-2008(A),(B), AND (C false false NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTH 020279866 2009-03-30 5935000 VARIOUS EQUIPMENT false false NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTH 020279866 644614G29 2010-06-16 73647839 CONSTRUCTION OF FACILITY AND EQUIP false false 134841419 2273111 2010 true false false 5935000 5935000 2009 false false false true 73666926 64029760 1168560 4718809 false false false false false false false true 0.00000 0.00000 0.00000 false false false false false true 0.00000 0.00000 0.00000 false false false false false true 0.00000 0.00000 0.00000 false false true true MORGAN STANLEY 29.8 false false false false false false false false false false false false false false false DANIEL JANTZEN SPLIT DOLLAR LIFE X 78454 78454 false true true SUSAN REEVES SPLIT DOLLAR LIFE X 100757 100757 false true true SANDRA DICKAU SPLIT DOLLAR LIFE X 12539 12539 false true true BRUCE KING SPLIT DOLLAR LIFE X 94966 94966 false true true RONALD SLIWINSKI SPLIT DOLLAR LIFE X 109631 109631 false true true DEBORAH JANTZEN SPLIT DOLLAR LIFE X 38805 38805 false true true MARY KING SPLIT DOLLAR LIFE X 9792 9792 false true true SUZANNA SLIWINSKI SPLIT DOLLAR LIFE X 12457 12457 false true true 457401 Hypertherm Trustee Baraba Couch 222812 SEE SCHEDULE O false Ingrid Mroz Key Employee William Mroz 113126 SPOUSE EMPLOYED BY MHMH false X 21 360004 Fair Market Value X Travel/Fuel for Patients 2 50000 FMV X Hring Aids, Prog Rltd 671 671 FMV Nt Prov by Donor 0 false true true Line 32B The organization uses Dartmouth-Hitchcock Medical Center, a supporting Organization, for solicitation of contributions and annual fund activities. From time to time, the Hospital may receive non-cash contributions directly from its donors. Part V - Question 1a Independent Contractors Dartmouth-Hitchcock Clinic (DHC) is part of the Dartmouth-Hitchcock, 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. Part VI, Question 4 Changes in Organizational Documents On August 30, 2010, the board approved a bylaw change to make Dartmouth-Hitchcock Health, a 501(c)3 organization, the sole corporate member of Mary Hitchcock Memorial Hospital. Description of classes of members, persons, and the nature of their rights Form 990, Part VI, Question 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 the MHMH's Board of Trustees and the power to approve significant governance, financial and operational decisions of MHMH's Trustees. Form 990, Part VI, Question 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. Disregarded Entities Form 990, Part VI, Question 10a & 10b MHMH is the sole corporate member of New England Alliance for Health (NEAH), a disregarded entity that consists of community hospitals, behavioral health centers, and home healthcare agencies that come together in a shared commitment to improve the quality, efficiency, and availability of health care in New Hampshire, Vermont, and western Massachusetts. The organization does not have any local chapters, branches, or affiliates that would require written policies and procedures governing the activities. NEAH is run as part of the organization and therefore does not require separate policies and procedures. Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Question 11A The Audit Committee of the MHMH Board of Trustees is presented with a substantially complete Form 990. The Committee members are expected to review these forms before the meeting. AT THE MEETING A HIGH-LEVEL PRESENTATION IS MADE BY THE ORGANIZATION'S TAX ADVISOR AND THE ORGANIZATION'S FINANCE STAFF, WITH TIME ALLOTTED FOR QUESTIONS FROM THE COMMITTEE. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL 990 AND 990-T COMPLETE ELECTRONIC VERSION IS SENT OUT TO EACH BOARD MEMBER PRIOR TO THE OFFICIAL FILING. THE FORMS 990 AND 990-T ARE ALSO REVIEWED BY THE DIRECTOR OF CORPORATE FINANCE, VICE PRESIDENT OF CORPORATE FINANCE AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c The Mary Hitchcock Memorial Hospital Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Compliance and Audit Services Department conducts an annual survey and performs other procedures as considered necessary to report on compliance with the conflict of interest policy. Per the policy any conflicts or otherwise perceived are required to be addressed by the Board of Trustees on an ongoing basis. The policy applies to all trustees, employees, and their immediate family members. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR UNDERTAKEN Form 990, Part VI, Question 15a Compensation for the President 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 last undertaken in 2010. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Question 15b Compensation for the Officers and Key Employees are 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 LAST UNDERTAKEN IN 2010 FOR EACH PERSON IDENTIFIED AS AN OFFICER OR KEY EMPLOYEE. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 MHMH's governing documents are available through the New Hampshire Department 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 in either electronic or hardcopy form. Financial Statements and Reporting Part XI, Question 2d The organization's financial information is included in the audited financial statements of Dartmouth-Hitchcock and Subsidiaries, which consists of Dartmouth-Hitchcock Clinic and subsidiaries, as well as Mary Hitchcock Memorial Hospital. Part XI, Question 3a DURING FISCAL YEAR 2010, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FEDERAL FUNDING WHICH MET THE MINIMUM THRESHHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. DUE TO THE NATURE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE AUDIT WAS PERFORMED ON THE FINANCIAL INFORMATION OF ALL ORGANIZATIONS. Schedule K Part I(f) Issue dates of Bonds on Schedule K: Advance Refund 2008(A), issued 9/4/2008, which advance refunds 1985 Advance Refund 2008(B), issued 10/31/2008, which advance refunds 1993 Advance Refund 2008(c), issued 12/19/2008 Schedule K Part III Line 7 The organization is in the process of formally documenting practices and procedures for post-issuance compliance of its tax-exempt bond liabilities. Description of Transaction SCHEDULE L, PART IV Name of Interested Person: Barbara Couch Relationship: Trustee Description of Transaction: Barbara Couch is a greater than 35% owner of Hypertherm, an entity that conducts business with MHMH. NEW ENGLAND ALLIANCE FOR HEALTH LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264232401 HLTH IMPROVMT NH 2249559 132353 NA DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYSICIAN SVC NH 501(C)3 9 N/A DARTMOUTH-HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTNG ORG NH 501(C)3 11 TYPE I N/A DARTMOUTH - HITCHCOCK HEALTH One Medical Center Drive Lebanon NH 03756 264812335 SUPPORTNG ORG NH 501(C)3 7 NA THE HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 HLTHCRE RSRCH NH 501(C)3 7 DHC HAMDEN RISK RETENTION GROUP INC 30 MAIN STREET STE 330 BURLINGTON VT 05401 208530788 Self Ins VT 501(C)3 11 TYPE I DHC D-H Partnership 1 Med Ctr Dr LEBANON NH 03756 510629117 HEALTHCARE NH NA RELATED 30399034 0 false 438474 false D-H Mster Invst Prg 1 Med Ctr Dr LEBANON NH 03756 020205863 POOLED INVEST NH NA RELATED 10124821 419436155 false -214422 false New Eng Phmcy Col 1 Med Ctr Dr LEBANON NH 03756 263819035 Group Purchasing NH NA RELATED -144950 17681 false 0 true The Hitchcock Ptshp 1 Med Ctr Dr LEBANON NH 03756 020514823 Invst in Ptnr NH NA RELATED 24368 487364 false 0 true DARTMOUTH HITCHCOCK PENSION GROUP TRUST ONE MEDICAL CENTER DRIVE LEBANON NH 03756 202588083 Pension Trust NH NA TRUST POMPANOOSUC INVESTMENT CORPORATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020352330 REAL EST HLDG NH DHC CORPORATION 0 0 HAMDEN ASSURANCE COMPANY LIMITED CANONS COURT 22 VICTORIA ST HM EX HAMILTON BD 980121409 Liab Insurance BD DHC CORPORATION 0 25428454 0.25800 false false false true true false false false false false false false false false true true false false DARTMOUTH - HITCHCOCK CLINIC D & E 5865358 Hamden Risk Retention Group o 5142216