2023-05-09T13:31:15+00:00 2022-06-30 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402413902 990 2021-07-01 020354549 Cheshire Medical Center CHES 6033545400 580 - 590 Court Street Keene NH 034315400 Daniel J Gross CFO 2023-05-09 true Daniel J Gross 999009999 Rachel Spurlock P00520729 5023263996 2021 2023-04-26 12:10:37Z DON CARUSO 580 - 590 Court Street Keene NH 034315400 264934375 false X https://www.cheshiremed.org X 1980 NH TO LEAD OUR COMMUNITY TO OPTIMAL HEALTH AND WELLNESS THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME. 17 10 1369 132 226755 26871 12479448 20335260 232080526 242040743 264042 309882 2574788 2248490 247398804 264934375 389532 719543 0 0 98907039 106429952 0 0 758490 141498493 163981425 240795064 271130920 6603740 -6196545 168346405 152302112 87920426 79884192 80425979 72417920 THE 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. false false 249616511 719543 242644713 THE 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. 249616511 true true false true false false false false false true true false true true false false true false false false false false false false false true true true true true true false false false false false false false false true false false false false false false true true true false false true 208 0 true 1369 true true true false false false false true true false false false false false false X 17 10 false false false false true true true true true false false true true true true true true false true false NH X Daniel J Gross 6033545400 580-590 COURT STREET KEENE NH 034315400 Barbara Duckett Trustee/Secretary (As of 1/1/22) 0.5 0.5 X X 0 0 0 CLAIRE FABIAN MD Trustee/ Medical Staff President 0.5 40.5 X X 0 340559 58447 DON CARUSO MD TRUSTEE/CEO/PRESIDENT - CMC 1.0 41.0 X X 0 532018 60924 MARK GAVIN TRUSTEE/TREAS(Through 12/31/21)Vice Chair(As of 1/1/22) 1.0 0.5 X X 0 0 0 NATHALIE HOUDER TRUSTEE/CHAIR (Through 12/31/21) 1.0 0.5 X X 0 0 0 ROBERT MITCHELL TRUSTEE / Secretary(Through 12/31/21) Treasurer (As of 1/1/22) 0.5 0.5 X X 0 0 0 SUSAN ABERT TRUSTEE/VICE CHAIR(Through 12/31/21) Chair(As of 1/1/22) 1.0 0.5 X X 0 0 0 ANDREW TREMBLAY MD TRUSTEE / Department Chair 1.0 40.0 X 0 317478 63484 ASHOK BAHL TRUSTEE (Through 2/17/22) 0.5 0 X 0 0 0 Cherie Holmes MD Trustee / Physician 1.0 40.0 X 0 511050 47026 Elizabeth Cotter Trustee 0.5 0.5 X 0 0 0 H ROGER HANSEN TRUSTEE (Through 12/31/21) 1.0 0.5 X 0 0 0 Maria Padin MD TRUSTEE / CGP Chief Medical Officer 1.0 41.0 X 0 522010 64127 Mark Bodin Trustee 0.5 0 X 0 0 0 Michael Farhm Trustee (As of 1/1/22) 0.5 0 X 0 0 0 MICHAEL KAPILOFF TRUSTEE 1.0 0 X 0 0 0 Michael Waters Trustee / Treasurer 0.5 40.0 X 0 262094 20598 RACHEL LOVINS MD TRUSTEE (Through 8/21/21) / Medical Director 0.5 40.0 X 0 472635 40585 Stephen Leblanc Trustee / Chief Strategy Officer 0.5 42.5 X 0 813774 59990 Susan Howard Trustee (As of 6/1/22) 0.5 0 X 0 0 0 AMY MATTHEWS CHIEF NURSING OFFICER 40.0 0 X 217678 0 20232 Daniel Gross Chief Financial Officer 40.0 1.0 X 185717 0 26972 KATHRYN WILLBARGER Chief Operating Officer 40.0 0.5 X 307365 0 25720 David Quigley VP - Clinical Operations at CMC 0.0 40.0 X 0 258744 27974 ERLI CHEN PHYSICiST 40.0 0 X 255516 0 41250 Melissa Siciliano Pharmacy Director 40.0 0 X 163231 0 9464 Richard Crowe Jr Pharmacy Manager 40.0 0 X 162568 0 44316 SANDRA PHIPPS VP PHILANTHROPY/COMM RELATIONS 40.0 0.5 X 164505 0 29980 Shawn V Lafrance VP Population Health 40.0 0 X 192864 0 51929 JENNIFER DINUBILA DO Former President of Medical Staff 0.0 40.5 X 0 396259 60208 Michael Ormont MD Former TRUSTEE/Medical Staff Pres-CMC 0.0 40.0 X 0 393259 57512 1649444 4819880 810738 73 true true false CONIFER REVENUE CYCLE SOLUTIONS PO BOX 655025 DALLAS TX 752655025 Revenue Management 6889522 Mary Hitchcock Memorial Hospital ONE MEDICAL CENTER DRIVE LEBANON NH 03756 Healthcare Services 2607986 American Healthcare Staffing Association PO Box 670529 Dallas TX 752670529 Healthcare Staffing Services 1963383 Avant Healthcare Professionals LLC 1211 Semoran Blvd Suite 227 Casselberry FL 32707 Healthcare Staffing Services 815178 Dartmouth-Hitchcock Clinic ONE MEDICAL CENTER DRIVE Lebanon NH 03756 Healthcare Services 693262 22 3235033 16248477 851750 20335260 NET PATIENT SERVICE REVENUE 622110 239590853 239590853 PHARMACY REVENUE 446110 2334317 2259943 74374 Laboratory Services 621500 115573 115573 0 0 0 0 242040743 309882 36808 273074 18188 0 18188 0 18188 18188 0 0 Rebates and Discounts 622110 527029 527029 Food Services 722514 920670 920670 Childcare Revenue 624410 515715 515715 266888 266888 0 0 2230302 264934375 242644713 226755 1727647 X 620710 620710 98833 98833 1028001 28344 981815 17842 144095 144095 75497424 67864485 7229983 402956 2034945 1829619 194541 10785 23223803 20880521 2220196 123086 4501684 4047464 430361 23859 418198 418198 9250 9250 77041765 75842243 1084753 114769 284898 281351 3547 1524227 1191760 323035 9432 576826 575986 180 660 6837829 6625958 211871 82209 61680 12568 7961 913731 913731 8546245 6575313 1970932 2595360 2171786 423574 MEDICAL SUPPLIES 43302337 43302337 MEDICAID ENHANCEMENT & PILOT TAXES 9468525 9468525 FOOD AND CAFETERIA EXPENSES 1000126 1000126 EQUIPMENT RENTAL AND MAINTENANCE 5491555 4275366 1216189 5888344 1807028 4037723 43593 271130920 249616511 20755919 758490 35146503 20164964 248 13325989 18220184 0 0 0 0 432873 3330484 4019770 961554 890395 252368620 189301754 64101724 63066866 0 28147145 1774315 49705836 17359667 168346405 152302112 22589586 20877088 412505 394847 23617565 22732055 0 0 41300770 35880202 87920426 79884192 X 65213770 53624430 15212209 18793490 80425979 72417920 168346405 152302112 X -6196545 -6636670 0 0 0 4825156 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 33578 33578 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY CHESHIRE 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. 231151 231151 78076862 57365542 20711320 30504951 11656439 18848512 143555656 120279773 23275883 63066866 Investment in Pooled Fund 28147145 F 28147145 Due from Affiliate 15132462 Deferred 457(b) Plan Assets 881150 Other Assets 1346055 17359667 PENSION LIABILITY 7774212 DUE TO RELATED PARTY 5107290 RESERVES FOR ESTIMATED 3RD PARTY SETTLEMENTS 22998700 35880202 true true X true X 225 true X true true false true true 2277204 0 2277204 0.0084 31706168 17352224 14353944 0.0529 0 0 0 0.0 0 0 33983372 17352224 16631148 0.0613 1320329 43362 1276967 0.0047 2117361 0 2117361 0.0078 2094302 553188 1541114 0.0057 0 0 0 0.0 444169 0 444169 0.0016 0 0 5976161 596550 5379611 0.0198 0 0 39959533 17948774 22010759 0.0812 0 0.0 0 0.0 310037 290132 19905 0.0001 0 0.0 0 0.0 1135720 0 1135720 0.0042 0 0.0 0 0.0 0 0.0 0 0 1445757 290132 1155625 0.0043 true 0 0 94743805 100651441 -5907636 X true true 1 1 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 https://www.cheshiremed.org 00014 X X X IN-PATIENT REHAB CHESHIRE MEDICAL CENTER 1 false false true X X X X X X X X X 19 true true true true X https://www.cheshiremed.org/about/community-benefits-reporting X X true 19 true https://www.cheshiremed.org/about/community-benefits-reporting false true X 225.0 300.0 X X X X X X X true true X X X true X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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. 1 CHESHIRE MEDICAL CENTER COLLECTING STATION 580-590 COURT STREET KEENE NH 03431 COLLECTING STATION Schedule H, Part I, Line 7g Subsidized Health Services The 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 assistance The 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 Activities The 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 amount AS 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 Methodology Bad 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 footnote THE 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 costs THE 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 assistance CHESHIRE 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 assessment IN 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 assistance THE 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 information THE 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 health CHESHIRE 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 system CHESHIRE 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 report NH true Partners for World Health 40 Walch Drive Portland ME 04101 320276903 501(c)(3) 23225 FMV Medical Supplies Program Support Foundation for Healthy Communities 125 AIRPORT ROAD CONCORD NH 03301 020275078 501(c)(3) 402587 BOOK Program Support Community Volunteer Transportation Company 325 Jaffrey Road Suite 3 PETERBOROUGH NH 03458 262838428 501(c)(3) 19800 BOOK Program Support Monadnock Family Services 64 Main Street KEENE NH 03431 026012230 501(c)(3) 32013 BOOK Program Support DENTAL HEALTH WORKS 69V ISLAND STREET KEENE NH 03431 300275867 501(c)(3) 5000 BOOK Program Support Southwest Region Planning Commission 37 Ashuelot Street KEENE NH 03431 020359624 Government 64750 BOOK Program Support Cheshire County Conservation District 11 INDUSTRIAL PARK DRIVE WALPOLE NH 03608 020300901 Government 68589 BOOK Program Support 7 0 Patient and family support/assistance 398 17285 Book Nursing and healthcare scholarships 29 81548 Book Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALL GRANTS AND ASSISTANCE ARE PAID TO 501(C)(3) ORGANIZATIONS OR GOVERNMENTAL ENTITIES. true true false false false false false false false JENNIFER DINUBILA DO Former President of Medical Staff 0 368098 0 0 0 28161 0 21860 0 38348 0 456467 0 0 Michael Ormont MD Former TRUSTEE/Medical Staff Pres-CMC 0 357103 0 0 0 36156 0 27660 0 29852 0 450771 0 0 DON CARUSO MD TRUSTEE/CEO/PRESIDENT - CMC 0 452207 0 49518 0 30293 0 27660 0 33264 0 592942 0 0 CLAIRE FABIAN MD Trustee/ Medical Staff President 0 337080 0 0 0 3479 0 27660 0 30787 0 399006 0 0 Cherie Holmes MD Trustee / Physician 0 463501 0 0 0 47549 0 27660 0 19366 0 558076 0 0 Stephen Leblanc Trustee / Chief Strategy Officer 0 662682 0 67100 0 83992 0 27660 0 32330 0 873764 0 0 Maria Padin MD TRUSTEE / CGP Chief Medical Officer 0 468432 0 0 0 53578 0 27660 0 36467 0 586137 0 0 ANDREW TREMBLAY MD TRUSTEE / Department Chair 0 312697 0 0 0 4781 0 25714 0 37770 0 380962 0 0 RACHEL LOVINS MD TRUSTEE (Through 8/21/21) / Medical Director 0 239752 0 0 0 232883 0 16523 0 24062 0 513220 0 0 Michael Waters Trustee / Treasurer 0 255398 0 0 0 6696 0 19014 0 1584 0 282692 0 0 KATHRYN WILLBARGER Chief Operating Officer 295942 0 0 0 11423 0 21860 0 3860 0 333085 0 0 0 AMY MATTHEWS CHIEF NURSING OFFICER 216904 0 0 0 774 0 18888 0 1344 0 237910 0 0 0 Daniel Gross Chief Financial Officer 170032 0 15000 0 685 0 11047 0 15925 0 212689 0 0 0 David Quigley VP - Clinical Operations at CMC 0 245268 0 13476 0 0 0 23773 0 4201 0 286718 0 0 ERLI CHEN PHYSICiST 231742 0 0 0 23774 0 24171 0 17079 0 296766 0 0 0 SANDRA PHIPPS VP PHILANTHROPY/COMM RELATIONS 163555 0 0 0 950 0 13228 0 16752 0 194485 0 0 0 Shawn V Lafrance VP Population Health 190467 0 100 0 2297 0 17300 0 34629 0 244793 0 0 0 Richard Crowe Jr Pharmacy Manager 154211 0 0 0 8357 0 13566 0 30750 0 206884 0 0 0 Melissa Siciliano Pharmacy Director 163231 0 0 0 0 0 9464 0 0 0 172695 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE 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 payment Rachel Lovins, who served as a trustee, received severance payments totaling $200,000 in 2021. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Dartmouth 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 A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 644614V48 2012-11-15 30360529 REFUND OF EXISTING DEBT; ACQUISITION false false false A 6180000 30360529 379754 554125 4777102 24649548 2013 true false true true A false true false false 0.0 0.0126 0.0126 false false true A false false true false false false false false true A true ASHLEY COPELAND FAMILY MEMBER of TRUSTEE H. ROGER HANSON 100922 Employment Compensation false ELIZABETH LEHR FAMILY MEMBER OF TRUSTEE H. ROGER HANSON 43173 Employment Compensation false Form 990, Part VI, Line 15a PROCESS TO ESTABLISH CEO COMPENSATION THE 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 committee As 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 stockholders DARTMOUTH-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 body DARTMOUTH-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 stockholders THE 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 body THE 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 policy CHESHIRE 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 employees 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. 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 public THE 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 Revenue Other 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 Fees Contracted 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 balances NET ASSET TRANSFERS - 4825156; Form 990, Part XII, Line 3a FINANCIAL STATEMENTS AND REPORTING THE 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 process CHESHIRE 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. CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE NH 03431 020202220 SUPPORTING ORGANIZATION NH 501(c)(3) Type I CMC true CHESHIRE HEALTH SERVICES 580-590 COURT STREET KEENE NH 03431 473379283 HEALTHCARE NH 501(c)(3) 3 CMC true DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYSICIAN SERVICES NH 501(c)(3) 10 D-HH false DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORGANIZATION NH 501(c)(3) 7 NA false MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(c)(3) 3 D-HH false THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(c)(3) 3 D-HH false WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(c)(3) 3 D-HH false ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(c)(3) 3 D-HH false VISITING NURSE ASSOCIATON AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC 88 Prospect Street White River Junction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE NH 03431 020374999 REAL ESTATE HOLDING NH CMC C Corporation 0 0 1 true KEENE HEALTH REALTY 580 COURT STREET KEENE NH 03431 020374998 REAL ESTATE HOLDING NH CMC C Corporation -74683 483131 1 true KEENE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 020374997 REAL ESTATE HOLDING NH CMC C Corporation 19968 1350693 1 true false false true true true false false false false true true true true true true true true true true Cheshire Health Foundation C 3118104 Book Cheshire Health Foundation Q 95110 Book Cheshire Health Foundation K 72000 Book