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CHESHIRE MEDICAL CENTER: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CHESHIRE MEDICAL CENTER (EIN 02-0354549)
Tax period
2021-07-01 to 2022-06-30
Filed
2023-05-09
IRS object ID
202301299349300045
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-05-09T13:31:15+00:00ReturnTs
Tax Period End2022-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line19600 Brownsboro Road Suite 400AddressLine1Txt
CityLouisvilleCityNm
State AbbreviationKYStateAbbreviationCd
ZIP402413902ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020354549EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Cheshire Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCHESBusinessNameControlTxt
Phone6033545400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580 - 590 Court StreetAddressLine1Txt
CityKeeneCityNm
State AbbreviationNHStateAbbreviationCd
ZIP034315400ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDaniel J GrossPersonNm
Person TitleCFOPersonTitleTxt
Signature2023-05-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDaniel JPersonFirstNm
Person LastGrossPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRachel SpurlockPreparerPersonNm
PTINP00520729PTIN
Phone5023263996PhoneNum
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1DON CARUSOBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580 - 590 Court StreetAddressLine1Txt
CityKeeneCityNm
State AbbreviationNHStateAbbreviationCd
ZIP034315400ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$264,934,375GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttps://www.cheshiremed.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1980FormationYr
Legal Domicile StateNHLegalDomicileStateCd
Activity Or MissionTO LEAD OUR COMMUNITY TO OPTIMAL HEALTH AND WELLNESS THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee1369TotalEmployeeCnt
Total Volunteers132TotalVolunteersCnt
Total Gross UBI$226,755TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$26,871NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$12,479,448PYContributionsGrantsAmt
CY Contributions Grants$20,335,260CYContributionsGrantsAmt
PY Program Service Revenue$232,080,526PYProgramServiceRevenueAmt
CY Program Service Revenue$242,040,743CYProgramServiceRevenueAmt
PY Investment Income$264,042PYInvestmentIncomeAmt
CY Investment Income$309,882CYInvestmentIncomeAmt
PY Other Revenue$2,574,788PYOtherRevenueAmt
CY Other Revenue$2,248,490CYOtherRevenueAmt
PY Total Revenue$247,398,804PYTotalRevenueAmt
CY Total Revenue$264,934,375CYTotalRevenueAmt
PY Grants And Similar Paid$389,532PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$719,543CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$98,907,039PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$106,429,952CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$758,490CYTotalFundraisingExpenseAmt
PY Other Expenses$141,498,493PYOtherExpensesAmt
CY Other Expenses$163,981,425CYOtherExpensesAmt
PY Total Expenses$240,795,064PYTotalExpensesAmt
CY Total Expenses$271,130,920CYTotalExpensesAmt
PY Revenues Less Expenses$6,603,740PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$6,196,545CYRevenuesLessExpensesAmt
Total Assets BOY$168,346,405TotalAssetsBOYAmt
Total Assets EOY$152,302,112TotalAssetsEOYAmt
Total Liabilities BOY$87,920,426TotalLiabilitiesBOYAmt
Total Liabilities EOY$79,884,192TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$80,425,979NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$72,417,920NetAssetsOrFundBalancesEOYAmt
MissionTHE MISSION OF CHESHIRE MEDICAL CENTER IS TO LEAD OUR COMMUNITY TO OPTIMAL HEALTH AND WELLNESS THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$249,616,511ExpenseAmt
Grant$719,543GrantAmt
Revenue$242,644,713RevenueAmt
DescTHE CHESHIRE MEDICAL CENTER (CMC) IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE. CMC 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 IS AFFILIATED WITH DARTMOUTH-HITCHCOCK HEALTH ("D-HH"), A NOT-FOR-PROFIT TAX-EXEMPT CORPORATION WITH A PRINCIPAL PLACE OF BUSINESS AT ONE MEDICAL CENTER DRIVE, LEBANON, NEW HAMPSHIRE. CONSISTENT WITH THE D-HH VISION AND STRATEGY TO CREATE A SUSTAINABLE HEALTH SYSTEM, CMC AND D-HH SHARE A COMMON COMMITMENT TO IMPROVING POPULATION HEALTH, VALUE-BASED CARE, AND CREATING NEW PAYMENT MODELS FOR THE BENEFIT OF THE CITIZENS OF NEW HAMPSHIRE AND VERMONT. CMC PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A COMMUNITY HOSPITAL. THESE INCLUDE A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, AND REHABILITATION. DURING FY22, CMC PROVIDED 237,506 PROVIDER VISITS AND HAD 3,641 HOSPITAL ADMISSIONS AND DISCHARGES. THE EMERGENCY DEPARTMENT WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 23,867 ER PATIENT VISITS. THERE ARE A TOTAL OF 226 PROVIDERS CONSISTING OF 141 PHYSICIANS AND 85 ASSOCIATE PROVIDERS. EACH YEAR CHESHIRE MEDICAL CENTER FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS CMC PROVIDES. THE MOST RECENT COMMUNITY BENEFIT REPORTS ARE AVAILABLE UPON REQUEST OR CAN BE FOUND ON CMC'S WEBSITE (https://www.cheshiremed.org/about/reports-community). THE COMMUNITY HEALTH ACTIVITIES INCLUDE THE COST OR VALUE OF SEVERAL DIFFERENT TYPES OF PROGRAMS INCLUDING THE COST OF COMMUNITY-BASED EDUCATION PROGRAMS INVOLVING A VARIETY OF CHRONIC DISEASE AND WELLNESS TOPICS SUCH AS STRESS MANAGEMENT AND RESILIENCY, NUTRITION, PHYSICAL EDUCATION AND EXERCISE, HIGH BLOOD PRESSURE PREVENTION AND MONITORING, DIABETES PREVENTION AND MONITORING, ADVANCED DIRECTIVE PLANNING, AND OTHERS. IN TOTAL, CMC PROVIDED ALMOST $18 MILLION IN COMMUNITY BENEFITS INCLUDING UNREIMBURSED CHARITY CARE, HEALTH SERVICES, HEALTH PROFESSION EDUCATION, SUBSIDIZED HEALTH SERVICES, AND COMMUNITY-BUILDING ACTIVITIES. THESE CONTRIBUTIONS ARE IN ADDITION TO THE OVER $16.6 MILLION DOLLARS IN UNREIMBURSED MEDICARE COSTS ABSORBED BY CMC.Desc
Total Program Service Expenses$249,616,511TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document208IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1369EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Daniel J GrossBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6033545400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580-590 COURT STREETAddressLine1Txt
CityKEENECityNm
State AbbreviationNHStateAbbreviationCd
ZIP034315400ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Barbara Duckett
Trustee/Secretary (As of 1/1/22)0.50.5Yes (X)Yes (X)$0$0$0
CLAIRE FABIAN MD
Trustee/ Medical Staff President0.540.5Yes (X)Yes (X)$0$340,559$58,447
DON CARUSO MD
TRUSTEE/CEO/PRESIDENT - CMC1.041.0Yes (X)Yes (X)$0$532,018$60,924
MARK GAVIN
TRUSTEE/TREAS(Through 12/31/21)Vice Chair(As of 1/1/22)1.00.5Yes (X)Yes (X)$0$0$0
NATHALIE HOUDER
TRUSTEE/CHAIR (Through 12/31/21)1.00.5Yes (X)Yes (X)$0$0$0
ROBERT MITCHELL
TRUSTEE / Secretary(Through 12/31/21) Treasurer (As of 1/1/22)0.50.5Yes (X)Yes (X)$0$0$0
SUSAN ABERT
TRUSTEE/VICE CHAIR(Through 12/31/21) Chair(As of 1/1/22)1.00.5Yes (X)Yes (X)$0$0$0
ANDREW TREMBLAY MD
TRUSTEE / Department Chair1.040.0Yes (X)$0$317,478$63,484
ASHOK BAHL
TRUSTEE (Through 2/17/22)0.50Yes (X)$0$0$0
Cherie Holmes MD
Trustee / Physician1.040.0Yes (X)$0$511,050$47,026
Elizabeth Cotter
Trustee0.50.5Yes (X)$0$0$0
H ROGER HANSEN
TRUSTEE (Through 12/31/21)1.00.5Yes (X)$0$0$0
Maria Padin MD
TRUSTEE / CGP Chief Medical Officer1.041.0Yes (X)$0$522,010$64,127
Mark Bodin
Trustee0.50Yes (X)$0$0$0
Michael Farhm
Trustee (As of 1/1/22)0.50Yes (X)$0$0$0
MICHAEL KAPILOFF
TRUSTEE1.00Yes (X)$0$0$0
Michael Waters
Trustee / Treasurer0.540.0Yes (X)$0$262,094$20,598
RACHEL LOVINS MD
TRUSTEE (Through 8/21/21) / Medical Director0.540.0Yes (X)$0$472,635$40,585
Stephen Leblanc
Trustee / Chief Strategy Officer0.542.5Yes (X)$0$813,774$59,990
Susan Howard
Trustee (As of 6/1/22)0.50Yes (X)$0$0$0
AMY MATTHEWS
CHIEF NURSING OFFICER40.00Yes (X)$217,678$0$20,232
Daniel Gross
Chief Financial Officer40.01.0Yes (X)$185,717$0$26,972
KATHRYN WILLBARGER
Chief Operating Officer40.00.5Yes (X)$307,365$0$25,720
David Quigley
VP - Clinical Operations at CMC0.040.0$0$258,744$27,974Yes (X)
ERLI CHEN
PHYSICiST40.00$255,516$0$41,250Yes (X)
Melissa Siciliano
Pharmacy Director40.00$163,231$0$9,464Yes (X)
Richard Crowe Jr
Pharmacy Manager40.00$162,568$0$44,316Yes (X)
SANDRA PHIPPS
VP PHILANTHROPY/COMM RELATIONS40.00.5$164,505$0$29,980Yes (X)
Shawn V Lafrance
VP Population Health40.00$192,864$0$51,929Yes (X)
JENNIFER DINUBILA DO
Former President of Medical Staff0.040.5$0$396,259$60,208Yes (X)
Michael Ormont MD
Former TRUSTEE/Medical Staff Pres-CMC0.040.0$0$393,259$57,512Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,649,444TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,819,880TotReportableCompRltdOrgAmt
Total Other Compensation$810,738TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K73IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmtAddress Line2ContractorAddress/USAddress/AddressLine2Txt
CONIFER REVENUE CYCLE SOLUTIONS
PO BOX 655025DALLASTX752655025Revenue Management$6,889,522
Mary Hitchcock Memorial Hospital
ONE MEDICAL CENTER DRIVELEBANONNH03756Healthcare Services$2,607,986
American Healthcare Staffing Association
PO Box 670529DallasTX752670529Healthcare Staffing Services$1,963,383
Avant Healthcare Professionals LLC
1211 Semoran BlvdCasselberryFL32707Healthcare Staffing Services$815,178Suite 227
Dartmouth-Hitchcock Clinic
ONE MEDICAL CENTER DRIVELebanonNH03756Healthcare Services$693,262
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K22CntrctRcvdGreaterThan100KCnt
Related Organizations$3,235,033RelatedOrganizationsAmt
Government Grants$16,248,477GovernmentGrantsAmt
All Other Contributions$851,750AllOtherContributionsAmt
Total Contributions$20,335,260TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE622110$239,590,853$239,590,853
PHARMACY REVENUE446110$2,334,317$2,259,943$74,374
Laboratory Services621500$115,573$115,573

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$242,040,743TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$309,882TotalRevenueColumnAmt
Unrelated Business Revenue$36,808UnrelatedBusinessRevenueAmt
Exclusion$273,074ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$18,188RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$18,188RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,188TotalRevenueColumnAmt
Exclusion$18,188ExclusionAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
Rebates and Discounts622110$527,029$527,029
Food Services722514$920,670$920,670
Childcare Revenue624410$515,715$515,715

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$266,888TotalRevenueColumnAmt
Related Or Exempt Func Income$266,888RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$2,230,302OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$264,934,375TotalRevenueColumnAmt
Related Or Exempt Func Income$242,644,713RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$226,755UnrelatedBusinessRevenueAmt
Exclusion$1,727,647ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$620,710TotalAmt
Program Services$620,710ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$98,833TotalAmt
Program Services$98,833ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,028,001TotalAmt
Program Services$28,344ProgramServicesAmt
Management And General$981,815ManagementAndGeneralAmt
Fundraising$17,842FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$144,095TotalAmt
Program Services$144,095ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$75,497,424TotalAmt
Program Services$67,864,485ProgramServicesAmt
Management And General$7,229,983ManagementAndGeneralAmt
Fundraising$402,956FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,034,945TotalAmt
Program Services$1,829,619ProgramServicesAmt
Management And General$194,541ManagementAndGeneralAmt
Fundraising$10,785FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$23,223,803TotalAmt
Program Services$20,880,521ProgramServicesAmt
Management And General$2,220,196ManagementAndGeneralAmt
Fundraising$123,086FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$4,501,684TotalAmt
Program Services$4,047,464ProgramServicesAmt
Management And General$430,361ManagementAndGeneralAmt
Fundraising$23,859FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$418,198TotalAmt
Management And General$418,198ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$9,250TotalAmt
Program Services$9,250ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$77,041,765TotalAmt
Program Services$75,842,243ProgramServicesAmt
Management And General$1,084,753ManagementAndGeneralAmt
Fundraising$114,769FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$284,898TotalAmt
Program Services$281,351ProgramServicesAmt
Fundraising$3,547FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,524,227TotalAmt
Program Services$1,191,760ProgramServicesAmt
Management And General$323,035ManagementAndGeneralAmt
Fundraising$9,432FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$576,826TotalAmt
Program Services$575,986ProgramServicesAmt
Management And General$180ManagementAndGeneralAmt
Fundraising$660FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$6,837,829TotalAmt
Program Services$6,625,958ProgramServicesAmt
Management And General$211,871ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$82,209TotalAmt
Program Services$61,680ProgramServicesAmt
Management And General$12,568ManagementAndGeneralAmt
Fundraising$7,961FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$913,731TotalAmt
Program Services$913,731ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$8,546,245TotalAmt
Program Services$6,575,313ProgramServicesAmt
Management And General$1,970,932ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,595,360TotalAmt
Program Services$2,171,786ProgramServicesAmt
Management And General$423,574ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$43,302,337$43,302,337
MEDICAID ENHANCEMENT & PILOT TAXES$9,468,525$9,468,525
FOOD AND CAFETERIA EXPENSES$1,000,126$1,000,126
EQUIPMENT RENTAL AND MAINTENANCE$5,491,555$4,275,366$1,216,189

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,888,344TotalAmt
Program Services$1,807,028ProgramServicesAmt
Management And General$4,037,723ManagementAndGeneralAmt
Fundraising$43,593FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$271,130,920TotalAmt
Program Services$249,616,511ProgramServicesAmt
Management And General$20,755,919ManagementAndGeneralAmt
Fundraising$758,490FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$35,146,503BOYAmt
EOY$20,164,964EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$248EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$13,325,989BOYAmt
EOY$18,220,184EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$432,873EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,330,484BOYAmt
EOY$4,019,770EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$961,554BOYAmt
EOY$890,395EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$252,368,620LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$189,301,754LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$64,101,724BOYAmt
EOY$63,066,866EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$28,147,145EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$1,774,315BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$49,705,836BOYAmt
EOY$17,359,667EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$168,346,405BOYAmt
EOY$152,302,112EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$22,589,586BOYAmt
EOY$20,877,088EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$412,505BOYAmt
EOY$394,847EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$23,617,565BOYAmt
EOY$22,732,055EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$41,300,770BOYAmt
EOY$35,880,202EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$87,920,426BOYAmt
EOY$79,884,192EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$65,213,770BOYAmt
EOY$53,624,430EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,212,209BOYAmt
EOY$18,793,490EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$80,425,979BOYAmt
EOY$72,417,920EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$168,346,405BOYAmt
EOY$152,302,112EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$6,196,545ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$6,636,670NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$4,825,156OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$33,578OtherActivitiesAmt
Total Lobbying Expenditures$33,578TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYFormAndLineReferenceDesc
ExplanationCHESHIRE MEDICAL CENTER PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION AND A THIRD PARTY REPRESENTING THE RURAL HOSPITAL COALITION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1i REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES TO OUTSIDE ORGANIZATIONS ALONG WITH THE THIRD PARTY REPRESENTATIVE.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$231,151OtherCostOrOtherBasisAmt
Book Value$231,151BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$78,076,862OtherCostOrOtherBasisAmt
Depreciation$57,365,542DepreciationAmt
Book Value$20,711,320BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,504,951OtherCostOrOtherBasisAmt
Depreciation$11,656,439DepreciationAmt
Book Value$18,848,512BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$143,555,656OtherCostOrOtherBasisAmt
Depreciation$120,279,773DepreciationAmt
Book Value$23,275,883BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$63,066,866TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescInvestment in Pooled FundDesc
Book Value$28,147,145BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$28,147,145TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
Due from Affiliate$15,132,462
Deferred 457(b) Plan Assets$881,150
Other Assets$1,346,055
FieldValueIRS element (for citing)
Total Book Value Other Assets$17,359,667TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
PENSION LIABILITY$7,774,212
DUE TO RELATED PARTY$5,107,290
RESERVES FOR ESTIMATED 3RD PARTY SETTLEMENTS$22,998,700
FieldValueIRS element (for citing)
Total Liability$35,880,202TotalLiabilityAmt

Schedule H IRS990ScheduleH

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

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other225FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,277,204TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,277,204NetCommunityBenefitExpnsAmt
Total Expense0.0084TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$31,706,168TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,352,224DirectOffsettingRevenueAmt
Net Community Benefit Expns$14,353,944NetCommunityBenefitExpnsAmt
Total Expense0.0529TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$33,983,372TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,352,224DirectOffsettingRevenueAmt
Net Community Benefit Expns$16,631,148NetCommunityBenefitExpnsAmt
Total Expense0.0613TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,320,329TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$43,362DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,276,967NetCommunityBenefitExpnsAmt
Total Expense0.0047TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,117,361TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,117,361NetCommunityBenefitExpnsAmt
Total Expense0.0078TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,094,302TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$553,188DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,541,114NetCommunityBenefitExpnsAmt
Total Expense0.0057TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$444,169TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$444,169NetCommunityBenefitExpnsAmt
Total Expense0.0016TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$5,976,161TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$596,550DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,379,611NetCommunityBenefitExpnsAmt
Total Expense0.0198TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$39,959,533TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,948,774DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,010,759NetCommunityBenefitExpnsAmt
Total Expense0.0812TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$310,037TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$290,132DirectOffsettingRevenueAmt
Net Community Benefit Expns$19,905NetCommunityBenefitExpnsAmt
Total Expense0.0001TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,135,720TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,135,720NetCommunityBenefitExpnsAmt
Total Expense0.0042TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$1,445,757TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$290,132DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,155,625NetCommunityBenefitExpnsAmt
Total Expense0.0043TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$0BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$94,743,805ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$100,651,441CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$5,907,636MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHESHIRE MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1Txt
CityKEENECityNm
State AbbreviationNHStateAbbreviationCd
ZIP03431ZIPCd
FieldValueIRS element (for citing)
Website Addresshttps://www.cheshiremed.orgWebsiteAddressTxt
State License00014StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherIN-PATIENT REHABOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CHESHIRE MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.cheshiremed.org/about/community-benefits-reportingOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttps://www.cheshiremed.org/about/community-benefits-reportingStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care225.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.0FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttps://www.dartmouth-hitchcock.org/patients-visitors/financial-assistanceFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttps://www.dartmouth-hitchcock.org/patients-visitors/financial-assistanceFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttps://www.dartmouth-hitchcock.org/patients-visitors/financial-assistanceFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3ETHE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WHICH ARE IDENTIFIED THROUGH CHNA.
Schedule H, Part V, Section B, Line 5 Facility , 1Facility , 1 - CHESHIRE MEDICAL CENTER. The hospital took into account a cross-section of community members through an RDD telephone survey conducted by the UNH Survey Center that was analyzed by age, education, income, etc. The Council for a Healthier Community is a group, established in 1995, that includes community leaders representing local and county government, business, education sector, social service agencies, health care and public health organizations, faith-based groups and non-profit organizations providing childcare, mental health and substance abuse prevention. The hospital worked with the Council for a Healthier Community to determine the priorities from our community health needs assessment. Key people involved include: Tim Murphy (Southwest Regional Planning Commission); Ellen Avery (Community Volunteer Transportation Co.); Chris Coates (Greater Monadnock Public Health Advisory Council); Phil Wyzik (Monadnock Family Services); Phil Suter (Greater Keene Chamber of Commerce); NH State Senator Jay Kahn; George Tremblay (Antioch University); Liz LaRose (Monadnock United Way); and others.
Schedule H, Part V, Section B, Line 6a Facility , 1Facility , 1 - CHESHIRE MEDICAL CENTER. THE CHESHIRE MEDICAL CENTER COLLABORATED WITH MONADNOCK COMMUNITY HOSPITAL ALLOWING US TO COMPARE COMMUNITY NEEDS AGAINST A MULTI-HOSPITAL REGION.
Schedule H, Part V, Section B, Line 6b Facility , 1Facility , 1 - CHESHIRE MEDICAL CENTER. THE CHESHIRE MEDICAL CENTER COLLABORATED WITH THE NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES; GREATER MONADNOCK PUBLIC HEALTH NETWORK; THE NEW HAMPSHIRE HOSPITAL ASSOCIATION; FOUNDATION FOR HEALTHY COMMUNITIES; ANTIOCH UNIVERSITY NEW ENGLAND; AND SOUTHWESTERN REGIONAL PLANNING COMMISSION. THESE ORGANIZATIONS HELPED TO DISSEMINATE SURVEYS, SERVE AS KEY INFORMANTS, AND TO PROVIDE OVERALL ANALYSIS, REVIEW, AND FEEDBACK.
Schedule H, Part V, Section B, Line 7 Facility , 1Facility , 1 - CHESHIRE MEDICAL CENTER. THE NEEDS ASSESSMENT WAS DISTRIBUTED TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE REGION. IT IS ALSO AVAILABLE FROM THE ORGANIZATION UPON REQUEST AND IS POSTED ON THE CMC WEBSITE.
Schedule H, Part V, Section B, Line 11 Facility , 1Facility , 1 - CHESHIRE MEDICAL CENTER. THE CHESHIRE MEDICAL CENTER IS INCREASING AND SUSTAINING REGIONAL PARTNERSHIPS TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2019. THESE NEEDS ARE IN THE AREAS OF BEHAVIORAL HEALTH, SUBSTANCE AND ALCOHOL MISUSE, TOBACCO USE, OBESITY, AND EMERGENCY PREPAREDNESS. IN FY 2022, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN THE FY 2022 COMMUNITY HEALTH IMPROVEMENT PLAN. COLLABORATION WITH COMMUNITY GROUPS HAS ALLOWED SERVICES TO EXPAND INTO NEW AREAS AND BRING FORTH ADDITIONAL RESOURCES TO THE COMMUNITY AND REMOVE BARRIERS TO HEALTHCARE. IN ADDITION, THE HOSPITAL'S AFFILIATION WITH DARTMOUTH HEALTH HAS ALSO PROVIDED SUPPORT FOR THE IDENTIFIED COMMUNITY-BASED NEEDS. THE CHESHIRE MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IS A 3-YEAR DOCUMENT IDENTIFYING ANTICIPATED INVESTMENTS AND ACTIVITIES THAT IT WILL TAKE TO ADDRESS NEEDS IDENTIFIED IN THE MONADNOCK REGION OF NEW HAMPSHIRE. MULTIPLE DEPARTMENTS WITHIN CHESHIRE MEDICAL CENTER ALIGN THEIR EFFORTS TO BEST MEET KNOWN COMMUNITIES NEEDS SUCH AS ACCESS TO TRANSPORTATION AND FOOD ACCESS. WE SUPPORT COMMUNITY PARTNERS SUCH AS MONADNOCK ALLIANCE FOR SUSTAINABLE TRANSPORTATION AND THE COMMUNITY VOLUNTEER TRANSPORTATION COMPANY TO SUPPORT REGIONAL ACCESS TO HEALTHCARE AND OTHER COMMUNITY SUPPORTS SUCH AS THE GROCERY STORE AND PHARMACY. CHESHIRE SUPPORTS MULTIPLE COMMUNITY WORK GROUPS THAT ARE LED BY COMMUNITY ORGANIZATIONS TO CONTINUE TO ADVANCE HEALTH OUTCOMES IN THE MONADNOCK REGION. MANY PARTNERSHIPS WERE CREATED AND DEEPENED THROUGH THE REGIONAL PANDEMIC RESPONSE THAT HAS NOW TRANSITIONED TO MEETING OTHER COMMUNITY NEEDS, SUCH AS BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER CONTINUUM OF CARE.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 1 - Cheshire Medical Center. PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF CMC.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 1 - Cheshire Medical Center. CMC HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY.
Schedule H, Part V, Section B, Line 16 Facility , 1Facility , 1 - Cheshire Medical Center. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON CMC'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. CMC PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. CMC CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, CMC POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. CMC SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, CMC CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHESHIRE MEDICAL CENTER COLLECTING STATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580-590 COURT STREETAddressLine1Txt
CityKEENECityNm
State AbbreviationNHStateAbbreviationCd
ZIP03431ZIPCd
FieldValueIRS element (for citing)
FacilityCOLLECTING STATIONFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (17 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 7g Subsidized Health ServicesThe amount on line 7g, column c, does not include any costs attributable to a physician clinic.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistanceThe costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, ratio of patient care to cost-to-charges for lines 7a and 7b. Lines 7e, 7f, 7g, and 7i are based on actual costs.
Schedule H, Part II Community Building ActivitiesThe Cheshire Medical Center's community building activities include community support for the Greater Monadnock Public Health Network. New Hampshire does not have county run health departments thus Cheshire Medical Center applied for and received a grant through the NH Department of Health and Human Services to provide local public health services. This scope of work is partially offset by grant income; however, Cheshire is committed to the health and wellbeing of its region and commits community benefit support beyond what the grant is able to financially reimburse. These community building activities promote the health of the community by providing free education, technical assistance, trainings, drill/exercises, facilitation, evaluation, and promotion related to local public health needs. CMC utilizes both the community health needs assessment as well as our regional community health improvement plan to help make data-driven decisions to support our community. Over the past year these topics have included behavioral health education and supports, public health emergency preparedness, food access and active living, healthcare access, and protective factors and risk factors to prevention substance use disorders. Cheshire partners with community organizations to promote innovation, demonstrate results, build capacity, and inspire change.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountAS A RESULT OF NEW ACCOUNTING GUIDANCE (STATEMENT 15 AND ASC 606), BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
Schedule H, Part III, Line 3 Bad Debt Expense MethodologyBad Debt is no longer treated as an expense due to accounting guidance (Statement 15 and ASC 606). As a result, an amount attributable to patients eligible under the organization's financial assistance policy is unable to be reasonably estimated.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnoteTHE CHESHIRE MEDICAL CENTER IS INCLUDED IN THE DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. AS A RESULT OF ACCOUNTING CHANGES (ASC 606), BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. THEREFORE, THERE IS NO SEPARATE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsTHE COSTING METHODOLOGY WAS COMPLETED ACCORDING TO GUIDANCE PROVIDED BY THE INTERNAL REVENUE SERVICE. THE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THE CHESHIRE MEDICAL CENTER IS THE ONLY HOSPITAL/MEDICAL CENTER IN CHESHIRE COUNTY, NEW HAMPSHIRE AND IS DESIGNATED BY CMS AS A MEDICARE DEPENDENT HOSPITAL (MDH) DUE TO GREATER THAN HALF OF OUR AVERAGE DAILY CENSUS BEING COMPRISED OF MEDICARE PATIENTS. OUR PRESENCE IN THE COMMUNITY ALLOWS THE RESIDENTS OF CHESHIRE COUNTY, ESPECIALLY THE ELDERLY POPULATION, TO RECEIVE COMPREHENSIVE HOSPITAL AND MEDICAL SERVICES CLOSE TO HOME.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceCHESHIRE MEDICAL CENTER HAS A CREDIT AND COLLECTION POLICY THAT ADDRESSES THE PROCEDURES FOR PATIENTS WHO QUALIFY FOR REDUCED-COST CARE. THE POLICY PROHIBITS USING EXTRAORDINARY COLLECTION PRACTICES OR PLACING AMOUNTS WITH COLLECTION AGENCIES. IF A FINANCIAL-ASSISTANCE-POLICY-ELIGIBLE PATIENT HAS A BALANCE FOR WHICH THEY ARE RESPONSIBLE AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE STANDARD PRACTICES ARE FOLLOWED AS OUTLINED IN THE CREDIT AND COLLECTIONS POLICY.
Schedule H, Part V, Section B, Line 16a FAP website- CHESHIRE MEDICAL CENTER: Line 16a URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website- CHESHIRE MEDICAL CENTER: Line 16b URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website- CHESHIRE MEDICAL CENTER: Line 16c URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessmentIN ADDITON TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL USES REGULAR FEEDBACK FROM THE COMMUNITY, PROVIDED THROUGHOUT THE YEAR, TO ASSESS ITS HEALTH NEEDS. THE HEALTH STAFF PARTICPATES IN OR LEADS MULTIPLE COMMUNITY COALITIONS AND PROJECTS COLLABORATING AND CONNECTING WITH A WIDE ARRAY OF COMMUNITY-BASED HEALTH, MUNICIPAL, SCHOOL, SERVICE ORGANIZATION, REGIONAL PLANNING AND STATE PUBLIC HEALTH STAKEHOLDERS. WE REGULARLY REVIEW EMERGING NH & VT STATE HEALTH DATA; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS), AND CONVERSATIONS WITH COMMUNITY PARTNERS TO IDENTIFY CONCERNS THAT ARE EMERGING, INTENSIFYING, OR ARE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST CHNA WAS CONDUCTED.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistanceTHE CHESHIRE MEDICAL CENTER IS COMMITTED TO PROVIDING MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PRO-ACTIVELY SCREENED USING PAPER AND/OR AN AUTOMATED TOOL TO IDENTIFY POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. IN ADDITION, SPECIFIC OUTPATIENT ACTIVITIES DEEMED TO HAVE A HIGHER RATE OF NEED ARE SCREENED AS PART OF REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTION REGARDING HOW TO COMPLETE THE QUALIFICATION PROCESS. IN SOME CASES A FINANCIAL COUNSELOR WILL ACT ON BEHALF OF THE PATIENT, AT THEIR SIGNED CONSENT, IN ORDER TO COMPLETE THE APPLICATION PROCESS (FOR EXAMPLE, IN NEW HAMPSHIRE A PATIENT MUST BE PHYSICALLY PRESENT AT THE DISTRICT OFFICE). IF A PATIENT DOESN'T QUALIFY FOR SPECIFIC PROGRAMS, THEY ARE ALSO CONSIDERED FOR FINANCIAL ASSISTANCE AS PART OF THEIR SCREENING. FOR OUTPATIENT SERVICES THAT ARE NOT ROUTINELY SCREENED, STAFF INTERACTING WITH PATIENTS ARE INSTRUCTED TO PROVIDE EITHER A FINANCIAL ASSISTANCE APPLICATION OR CONTACT INFORMATION FOR A FINANCIAL COUNSELOR WHEN A PATIENT EXPRESSES THEIR INABILITY TO MAKE PAYMENT. EVERY APPLICATION IS SCREENED FOR COMPLETED INCOME AND ASSET DOCUMENTATION. APPLICATIONS ARE ALSO SCREENED TO ASSURE THERE ARE NO OTHER POTENTIAL OPTIONS OF FEDERAL, STATE, OR LOCAL PROGRAMS. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY.
Schedule H, Part VI, Line 4 Community informationTHE MEDICAL CENTER IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA ("PSA"). MANAGEMENT DEFINES ITS PSA AS THE CITY OF KEENE AND 19 GEOGRAPHICALLY PROXIMATE COMMUNITIES. TOWNS AND CITIES INCLUDED IN THE PSA INCLUDE ALSTEAD, CHESTERFIELD, FITZWILLIAM, GILSUM, HARRISVILLE/CHESHAM, KEENE, MARLBOROUGH, MARLOW, MUNSON/MUNSONVILLE, RICHMOND, ROXBURY, STODDARD, SULLIVAN, SURRY, SWANZEY, TROY, WALPOLE, WESTMORELAND AND WINCHESTER, ALL LOCATED IN CHESHIRE COUNTY. BASED ON THE US CENSUS BUREAU'S POPULATION ESTIMATES as of July 1, 2021: THE MEDICAL CENTER'S PSA REPRESENTED APPROXIMATELY 4.3% OF NEW HAMPSHIRE'S POPULATION. THE PSA'S TOTAL POPULATION IS 59,373 WITH 23,106 RESIDING IN KEENE, THE LARGEST COMMUNITY IN THE SERVICE AREA. CHESHIRE COUNTY POPULATION IS 77,329. THE MEDIAN AGE OF RESIDENTS IN CHESHIRE COUNTY IS 43.1 WITH: - 16,958 LESS THAN 20 YEARS OF AGE, - 44,110 BETWEEN THE AGES OF 20-64, AND - 15,405 OVER THE AGE OF 64. IN 2021 THE POVERTY RATE FOR CHESHIRE COUNTY WAS 9.8%. THE MEDIAN HOUSEHOLD INCOME IS $90,502. ACCORDING TO THE JUNE 2021 NEW HAMPSHIRE EMPLOYMENT SECURITY, ECONOMIC & LABOR MARKET INFORMATION BUREAU REPORT, CHESHIRE COUNTY HAD AN UNEMPLOYMENT RATES OF 3.9% (NOT SEASONALLY-ADJUSTED). 93.7% of the population of Cheshire County age 25 years and older have graduated from high school.
Schedule H, Part VI, Line 5 Promotion of community healthCHESHIRE MEDICAL CENTER (CMC) PLAYS AN ACTIVE ROLE IN PROMOTING COMMUNITY HEALTH AND OFFERS EDUCATIONAL PROGRAMS INCLUDING CLASSES AND WORKSHOPS. CMC (IN PARTNERSHIP WITH DARTMOUTH HEALTH) OFFERS A VARIETY OF HEALTH PROMOTION, EDUCATIONAL PROGRAMS, AND DIRECT SERVICES FOR THE COMMUNITY SPANNING A BROAD SPECTRUM OF HEALTH AND WELLNESS TOPICS. OUR CLINICAL STAFF WORKS CLOSELY WITH THE STAFF OF THE CENTER FOR POPULATION HEALTH TO DEVELOP PROGRAMS THAT COVER EMERGING HEALTH CONCERNS AND ARE DELIVERED AT THE RIGHT LITERACY LEVEL FOR OUR COMMUNITY. THE PROGRAMS OFFERED INCLUDE A VARIETY OF CHRONIC DISEASE AND WELLNESS TOPICS SUCH AS: STRESS MANAGEMENT AND RESILIENCY, NUTRITION, PHYSICAL EDUCATION AND EXERCISE, HIGH BLOOD PRESSURE PREVENTION AND MONITORING, DIABETES PREVENTION AND MONITORING, ADVANCED DIRECTIVE PLANNING, MEMORY LOSS, TOBACCO CESSATION AND WRITING AS A TOOL TO MANAGE STRESS. ALL PROGRAMS ARE OFFERED FREE OF CHARGE AND OPEN TO ANYONE INTERESTED. IN ADDITION, CMC SUPPORTS SEVERAL COMMUNITY PROGRAMS INCLUDING CHESHIRE SMILES, A SCHOOL-BASED DENTAL HEALTH PROGRAM FOR CHILDREN IN GRADES K-3, WHICH PROVIDES SCREENING, PREVENTION AND RESTORATIVE DENTAL CARE FOR CHILDREN IN CHESHIRE COUNTY SCHOOLS. CHESHIRE MEDICAL CENTER ALSO WORKS IN PARTNERSHIP WITH OTHER COMMUNITY HEALTH AND HUMAN SERVICE ORGANIZATIONS TO MEET THE DENTAL HEALTH NEEDS OF UNDERSERVED POPULATIONS SUCH AS THE CHRONICALLY MENTALLY ILL, PREGNANT WOMEN WHO CANNOT AFFORD DENTAL CARE, CHILDREN IDENTIFIED THROUGH THE SCHOOL-BASED CHESHIRE SMILES PROGRAM, AND OTHERS. OTHER INITIATIVES INCLUDE HOSTING OR LEADING COMMUNITY PARTNERSHIPS TO ADDRESS SUBSTANCE MISUSE AND TREATMENT AND TO IMPROVE PUBLIC HEALTH; AND PARTICIPATION OF OUR STAFF IN OTHER PARTNERSHIPS SUCH AS THE FOUNDATION FOR HEALTHY COMMUNITIES AND THE CHESHIRE COALITION FOR TOBACCO-FREE COMMUNITIES. IN ADDITION, THE HOSPITAL OPERATES HEALTH EDUCATION AND OTHER SUPPORT SERVICES SUCH AS ADVANCE CARE PLANNING, SENIOR PASSPORT, AND VARIOUS HEALTH AND WELLNESS PROGRAMS. CASH CONTRIBUTIONS, CONTRACTED SERVICES, AND IN-KIND CONTRIBUTIONS OF STAFF TIME AND EXPERTISE ARE USED TO SUPPORT THESE STRATEGIES WHICH IMPROVE THE HEALTH OF THE COMMUNITY. CHESHIRE MEDICAL CENTER ALSO SUPPORTS HEALTH PROFESSIONALS' EDUCATION THROUGH TRAININGS AND CERTIFICATIONS FOR DIFFERENT MEDICAL LICENSES SUCH AS LPN, MA, RN, JUST TO NAME A FEW. WE ARE ALSO IN THE BEGINNING STAGES OF STARTING A FAMILY MEDICINE RESIDENCY PROGRAM THAT WILL WELCOME ITS FIRST CLASS OF RESIDENTS IN 2024 TO INCREASE ACCESS TO HEALTHCARE IN THE MONADNOCK REGION. WE ARE COMMITTED TO CONTINUING TO ENGAGE WITH OUR COMMUNITY AND SUPPORT ADVANCING THE HEALTH AND WELLBEING OF OUR REGION. FOR MORE STORIES INCLUDING ADDITIONAL EXAMPLES OF COMMUNITY BENEFIT ACTIVITIES PLEASE VISIT: Annual Reports to the Community | About | Cheshire Medical Center. CMC EXTENDS PROFESSIONAL STAFF PRIVILEGES TO QUALIFIED AND APPROPRIATE PHYSICIANS WHO ARE EMPLOYEES OF DARTMOUTH HITCHCOCK CLINIC, MARY HITCHCOCK MEMORIAL HOSPITAL, AND DARTMOUTH COLLEGE, WHO ALSO HOLD A FACULTY APPOINTMENT AT GEISEL SCHOOL OF MEDICINE. OF THE 17 VOTING MEMBERS OF THE CHESHIRE MEDICAL CENTER BOARD OF TRUSTEES AT THE END OF THE FISCAL YEAR, 10 ARE NEITHER CONTRACTORS NOR EMPLOYEES OF THE HOSPITAL OR ITS AFFILIATES. The majority of Cheshire Medical Center's volunteer Board of Trustees, the governing body of the organization, represents a broad range of interests which exist in the communities it serves. In particular the trustees, who are neither employees nor independent contractors (nor family members thereof) of the Cheshire Medical Center, are representative of the consumer interests of the various neighborhoods and localities which are serviced by the hospital.
Schedule H, Part VI, Line 6 Affiliated health care systemCHESHIRE MEDICAL CENTER IS OWNED BY DARTMOUTH-HICHCOCK HEALTH. THIS RELATIONSHIP ALLOWS THE STREAMLINING OF PATIENT CARE BETWEEN THE TWO HEALTHCARE SYSTEMS AND STRENGTHENS THE CENTER AS A REGIONAL RESOURCE FOR SOUTHWESTERN NEW HAMPSHIRE AND SOUTHEASTERN VERMONT. THE AFFILIATION ALLOWS MORE PATIENTS TO RECEIVE CARE CLOSER TO HOME, FREES UP BED CAPACITY FOR TERTIARY CARE PATIENTS AT DARTMOUTH-HITCHCOCK MEDICAL CENTER IN LEBANON, AND ALLOWS THE CHESHIRE MEDICAL CENTER TO CONTINUE ITS LEADERSHIP ROLE IN POPULATION HEALTH AND THE HEALTHY MONADNOCK 2020 INITIATIVE. CHESHIRE MEDICAL HAS A MULTI-SPECIALTY GROUP PRACTICE THAT COMPRISES THE MAJORITY OF CHESHIRE MEDICAL CENTER'S MEDICAL STAFF AND WITH THE AFFILIATION, IT ENABLES BOTH ORGANIZATIONS TO MORE EFFECTIVELY PURSUE A COMMON VISION OF THE FUTURE OF HEALTH CARE THAT IS BASED ON CREATING A SUSTAINABLE HEALTH SYSTEM, FOCUSING ON POPULATION HEALTH, DELIVERING VALUE-BASED CARE, AND EMBRACING THE OPPORTUNITIES PROVIDED BY NEW PAYMENT MODELS. IN ADDITION TO THE CHESHIRE MEDICAL CENTER AND THE DARTMOUTH-HITCHCOCK HEALTH, THE AFFILIATED HEALTH CARE SYSTEM INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, THE NEW LONDON HOSPITAL ASSOCIATION, WINDSOR HOSPITAL CORPORATION, ALICE PECK DAY MEMORIAL HOSPITAL, VISITING NURSE ASSOCIATION AND HOSPICE OF NEW HAMPSHIRE AND VERMONT, AND A NUMBER OF OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE IN THE REGION. THE CHESHIRE MEDICAL CENTER AND OTHER MEMBERS OF THE AFFILIATED HEALTH CARE SYSTEM OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING, MANAGEMENT, AND SHARE IDENTICAL MISSIONS.
Schedule H, Part VI, Line 7 State filing of community benefit reportNH

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxtCash GrantCashGrantAmt
Partners for World Health
40 Walch DrivePortlandME04101320276903501(c)(3)$23,225FMVMedical SuppliesProgram Support
Foundation for Healthy Communities
125 AIRPORT ROADCONCORDNH03301020275078501(c)(3)BOOKProgram Support$402,587
Community Volunteer Transportation Company
325 Jaffrey Road Suite 3PETERBOROUGHNH03458262838428501(c)(3)BOOKProgram Support$19,800
Monadnock Family Services
64 Main StreetKEENENH03431026012230501(c)(3)BOOKProgram Support$32,013
DENTAL HEALTH WORKS
69V ISLAND STREETKEENENH03431300275867501(c)(3)BOOKProgram Support$5,000
Southwest Region Planning Commission
37 Ashuelot StreetKEENENH03431020359624GovernmentBOOKProgram Support$64,750
Cheshire County Conservation District
11 INDUSTRIAL PARK DRIVEWALPOLENH03608020300901GovernmentBOOKProgram Support$68,589
FieldValueIRS element (for citing)
Total501c3 Org7Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDesc
Patient and family support/assistance398$17,285Book
Nursing and healthcare scholarships29$81,548Book

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I, Part I, Line 2 Procedures for monitoring use of grant funds.FormAndLineReferenceDesc
ExplanationALL GRANTS AND ASSISTANCE ARE PAID TO 501(C)(3) ORGANIZATIONS OR GOVERNMENTAL ENTITIES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JENNIFER DINUBILA DO
Former President of Medical Staff$0$368,098$0$0$0$28,161$0$21,860$0$38,348$0$456,467$0$0
Michael Ormont MD
Former TRUSTEE/Medical Staff Pres-CMC$0$357,103$0$0$0$36,156$0$27,660$0$29,852$0$450,771$0$0
DON CARUSO MD
TRUSTEE/CEO/PRESIDENT - CMC$0$452,207$0$49,518$0$30,293$0$27,660$0$33,264$0$592,942$0$0
CLAIRE FABIAN MD
Trustee/ Medical Staff President$0$337,080$0$0$0$3,479$0$27,660$0$30,787$0$399,006$0$0
Cherie Holmes MD
Trustee / Physician$0$463,501$0$0$0$47,549$0$27,660$0$19,366$0$558,076$0$0
Stephen Leblanc
Trustee / Chief Strategy Officer$0$662,682$0$67,100$0$83,992$0$27,660$0$32,330$0$873,764$0$0
Maria Padin MD
TRUSTEE / CGP Chief Medical Officer$0$468,432$0$0$0$53,578$0$27,660$0$36,467$0$586,137$0$0
ANDREW TREMBLAY MD
TRUSTEE / Department Chair$0$312,697$0$0$0$4,781$0$25,714$0$37,770$0$380,962$0$0
RACHEL LOVINS MD
TRUSTEE (Through 8/21/21) / Medical Director$0$239,752$0$0$0$232,883$0$16,523$0$24,062$0$513,220$0$0
Michael Waters
Trustee / Treasurer$0$255,398$0$0$0$6,696$0$19,014$0$1,584$0$282,692$0$0
KATHRYN WILLBARGER
Chief Operating Officer$295,942$0$0$0$11,423$0$21,860$0$3,860$0$333,085$0$0$0
AMY MATTHEWS
CHIEF NURSING OFFICER$216,904$0$0$0$774$0$18,888$0$1,344$0$237,910$0$0$0
Daniel Gross
Chief Financial Officer$170,032$0$15,000$0$685$0$11,047$0$15,925$0$212,689$0$0$0
David Quigley
VP - Clinical Operations at CMC$0$245,268$0$13,476$0$0$0$23,773$0$4,201$0$286,718$0$0
ERLI CHEN
PHYSICiST$231,742$0$0$0$23,774$0$24,171$0$17,079$0$296,766$0$0$0
SANDRA PHIPPS
VP PHILANTHROPY/COMM RELATIONS$163,555$0$0$0$950$0$13,228$0$16,752$0$194,485$0$0$0
Shawn V Lafrance
VP Population Health$190,467$0$100$0$2,297$0$17,300$0$34,629$0$244,793$0$0$0
Richard Crowe Jr
Pharmacy Manager$154,211$0$0$0$8,357$0$13,566$0$30,750$0$206,884$0$0$0
Melissa Siciliano
Pharmacy Director$163,231$0$0$0$0$0$9,464$0$0$0$172,695$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationTHE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION.
Schedule J, Part I, Line 4a Severance or change-of-control paymentRachel Lovins, who served as a trustee, received severance payments totaling $200,000 in 2021.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planDartmouth Hitchcock Clinic (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 to new participants in 1998. THE FOLLOWING INDIVIDUAL HAS A SPLIT DOLLAR LIFE PLAN ARRANGEMENT AND RESPECTIVE EMPLOYER PREMIUM: STEPHEN LEBLANC $63,791

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1NH HEALTH AND ED FACILITIES AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN020279866BondIssuerEIN
CUSIP644614V48CUSIPNum
Bond Issued2012-11-15BondIssuedDt
Issue Price$30,360,529IssuePriceAmt
PurposeREFUND OF EXISTING DEBT; ACQUISITIONPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$6,180,000RetiredAmt
Total Proceeds$30,360,529TotalProceedsAmt
Issuance Costs From Proceeds$379,754IssuanceCostsFromProceedsAmt
Working Capital Expenditures$554,125WorkingCapitalExpendituresAmt
Capital Expenditures$4,777,102CapitalExpendituresAmt
Other Spent Proceeds$24,649,548OtherSpentProceedsAmt
Substantial Completion2013SubstantialCompletionYr
Refunding Tax Exempt BondsYes (true)RefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsYes (true)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.0PrivateBusUseByOthersPct
Private Bus Concerning UBI0.0126PrivateBusConcerningUBIPct
Total Private Business Use0.0126TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebateYes (true)ExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
ASHLEY COPELAND
FAMILY MEMBER of TRUSTEE H. ROGER HANSON$100,922Employment Compensationfalse
ELIZABETH LEHR
FAMILY MEMBER OF TRUSTEE H. ROGER HANSON$43,173Employment Compensationfalse

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH CEO COMPENSATIONTHE CEO IS PAID BY A RELATED ORGANIZATION. TO ASSIST WITH COMPENSATION DECISIONS, THE ORGANIZATION RETAINED YAFFE & COMPANY, INC. TO PROVIDE CONSULTATION TO THE EXECUTIVE COMMITTEE OF THE CMC BOARD OF TRUSTEES REGARDING EXECUTIVE COMPENSATION, BENEFITS, AND PREREQUISITES. THE EXECUTIVE COMMITTEE HAS A COMPENSATION REVIEW PROCESS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE COMPENSATION DECISIONS. ANNUALLY, THE COMMITTEE USES A MULTI-TIERED APPROACH THAT INCLUDES INDEPENDENT COMPARABILITY DATA TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOWS FROM THE ORGANIZATION'S STRATEGIC PLAN. BY WAY OF QUESTIONNAIRE, BOARD MEMBERS PARTICIPATE IN THE PERFORMANCE REVIEW PROCESS AND A SUMMARY REPORT IS SHARED WITH THE CEO. VARIABLE PAY IS AWARDED BASED ON ACHIEVEMENT OF SPECIFIC QUALITATIVE AND QUANTITATIVE GOALS. IN CONJUNCTION WITH THE EXECUTIVE COMMITTEE, CHALLENGING AND MEASURABLE GOALS ARE ESTABLISHED, WHICH PROVIDE ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC INITIATIVES.
Form 990, Part VI, Line 1a Delegate broad authority to a committeeAs described in the organization's bylaws, the Executive Committee shall consist of the officers of the Board of Trustees of the Corporation and an additional trustee recommended by the Chairperson of the Board and approved by the Board. The Chairperson of the Board of Trustees shall be the Chairperson of the Executive Committee, which shall work at the direction of (and report to) the Board of Trustees, undertaking specific activities assigned to it by the full Board. The Executive Committee shall serve as a resource in the following areas: policy formulation, preparation of background material and analysis for Board deliberations, evaluation of the CEO's performance and recommendations on compensation, and other areas in which the Board requires the deliberation of the officers. The Executive Committee shall have the power to transact all regular business of the Corporation between meetings of the Board. The Executive Committee shall also perform functions of the "Executive Compensation Committee."
Form 990, Part VI, Line 6 Classes of members or stockholdersDARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyDARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER. D-HH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF THE CHESHIRE MEDICAL CENTER'S BOARD OF TRUSTEES.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersTHE SOLE MEMBER HAS THE RIGHT TO RATIFY THE CHESHIRE MEDICAL CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD, APPROVE THE DISSOLUTION OR LIQUIDATION OF THE CHESHIRE MEDICAL CENTER; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyTHE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS AND THE CFO BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO THE OFFICIAL FILING OF OF THE FORMS.
Form 990, Part VI, Line 12c Conflict of interest policyCHESHIRE MEDICAL CENTER'S 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 CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CURCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
Form 990, Part VI, Line 15b Process to establish compensation of other employeesTO ASSIST WITH COMPENSATION DECISIONS, THE ORGANIZATION RETAINED YAFFE & COMPANY, INC. TO PROVIDE CONSULTATION TO THE EXECUTIVE COMMITTEE OF THE CMC BOARD OF TRUSTEES REGARDING EXECUTIVE COMPENSATION, BENEFITS, AND PREREQUISITES. THE EXECUTIVE COMMITTEE HAS A COMPENSATION REVIEW PROCESS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE COMPENSATION DECISIONS. ANNUALLY, THE COMMITTEE USES A MULTI-TIERED APPROACH THAT INCLUDES INDEPENDENT COMPARABILITY DATA TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOWS FROM THE ORGANIZATION'S STRATEGIC PLAN. BY WAY OF QUESTIONNAIRE, BOARD MEMBERS PARTICIPATE IN THE PERFORMANCE REVIEW PROCESS AND A SUMMARY REPORT IS SHARED WITH THE CEO. VARIABLE PAY IS AWARDED BASED ON ACHIEVEMENT OF SPECIFIC QUALITATIVE AND QUANTITATIVE GOALS. IN CONJUNCTION WITH THE EXECUTIVE COMMITTEE, CHALLENGING AND MEASURABLE GOALS ARE ESTABLISHED, WHICH PROVIDE ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC INITIATIVES. DURING FY22, COMPENSATION FOR THE FOLLOWING POSITIONS WERE REVIEWED: CHIEF NURSING OFFICER, CHIEF OPERATING OFFICER, AND THE CHIEF FINANCIAL OFFICER. THE PRESIDENT OF THE MEDICAL STAFF IS PAID BY A RELATED PARTY WHO CONDUCTED A SIMILAR REVIEW.
Form 990, Part VI, Line 19 Required documents available to the publicTHE CHESHIRE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST.
Form 990, Part VIII, Line 11d Other Miscellaneous RevenueOther revenue - Total Revenue: 266888, Related or Exempt Function Revenue: 266888, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other FeesContracted Healthcare Services - Total Expense: 60052991, Program Service Expense: 60052991, Management and General Expenses: , Fundraising Expenses: ; Lab and Radiology Services - Total Expense: 1739415, Program Service Expense: 1739415, Management and General Expenses: , Fundraising Expenses: ; Consulting and Other Services - Total Expense: 15249359, Program Service Expense: 14049837, Management and General Expenses: 1084753, Fundraising Expenses: 114769;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesNET ASSET TRANSFERS - 4825156;
Form 990, Part XII, Line 3a FINANCIAL STATEMENTS AND REPORTINGTHE MEDICAL CENTER WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM. DURING FISCAL YEAR 2022, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FEDERAL FUNDING WHICH MET THE MINIMUM THRESHOLD 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, INCLUDING CHESHIRE MEDICAL CENTER.
Form 990, Part XII, Line 2c Change of oversight process or selection processCHESHIRE MEDICAL CENTER DELEGATES OVERSIGHT OF THE AUDIT TO THE FINANCE & AUDIT SUBCOMMITTEE. THE FULL BOARD REVIEWS AND APPROVES THE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS ALSO INCLUDED IN THE AUDIT AND CONSOLIDATED FINANCIAL STATEMENTS OF ITS PARENT ORGANIZATION, DARTMOUTH-HITCHCOCK HEALTH.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
CHESHIRE HEALTH FOUNDATION
580 COURT STREETKEENENH03431020202220SUPPORTING ORGANIZATIONNH501(c)(3)Type ICMCYes (true)
CHESHIRE HEALTH SERVICES
580-590 COURT STREETKEENENH03431473379283HEALTHCARENH501(c)(3)3CMCYes (true)
DARTMOUTH-HITCHCOCK CLINIC
ONE MEDICAL CENTER DRIVELEBANONNH03756222519596PHYSICIAN SERVICESNH501(c)(3)10D-HHfalse
DARTMOUTH-HITCHCOCK HEALTH
ONE MEDICAL CENTER DRIVELEBANONNH03756264812335PARENT ORGANIZATIONNH501(c)(3)7NAfalse
MARY HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVELEBANONNH03756020222140HOSPITALNH501(c)(3)3D-HHfalse
THE NEW LONDON HOSPITAL ASSOCIATION INC
273 COUNTY ROADNEW LONDONNH03257020222171HOSPITALNH501(c)(3)3D-HHfalse
WINDSOR HOSPITAL CORPORATION
289 COUNTY ROADWINDSORVT05089030183721HOSPITALVT501(c)(3)3D-HHfalse
ALICE PECK DAY MEMORIAL HOSPITAL
10 ALICE PECK DAY DRIVELEBANONNH03766020222791HOSPITALNH501(c)(3)3D-HHfalse
VISITING NURSE ASSOCIATON AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC
88 Prospect StreetWhite River JunctionVT05001036006494HOSPICEVT501(c)(3)10D-HHfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
KEENE HEALTH ENTERPRISES
580 COURT STREETKEENENH03431020374999REAL ESTATE HOLDINGNHCMCC Corporation$0$01Yes (true)
KEENE HEALTH REALTY
580 COURT STREETKEENENH03431020374998REAL ESTATE HOLDINGNHCMCC Corporation-$74,683$483,1311Yes (true)
KEENE HEALTH SERVICES
580 COURT STREETKEENENH03431020374997REAL ESTATE HOLDINGNHCMCC Corporation$19,968$1,350,6931Yes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Cheshire Health Foundation
C$3,118,104Book
Cheshire Health Foundation
Q$95,110Book
Cheshire Health Foundation
K$72,000Book