2025-05-13T08:10:01+00:00 2024-06-30 350921680 CROWE LLP 4801 Olympia Park Plaza Suite 4000 Louisville KY 402412098 990 2023-07-01 020354549 Cheshire Medical Center CHES 6033545400 580 - 590 Court Street Keene NH 034315400 Ann Marie Coppo CFO 2025-05-13 true Kim Scifres P01316095 5023263996 2025-05-13 2023 2025-03-06 01:10:19Z Joseph Perras 580 - 590 Court Street Keene NH 034315400 307906797 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 9 1249 88 450503 56196 7005336 10679183 253756281 293860323 209419 261859 2613448 3105432 263584484 307906797 730772 369917 0 108807655 116771894 0 631758 178278747 195449175 287817174 312590986 -24232690 -4684189 146820184 161863854 93638347 86247654 53181837 75616200 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 280597429 369917 294899012 CHESHIRE MEDICAL CENTER (CHESHIRE) IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE. CHESHIRE 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 A MEMBER OF THE DARTMOUTH HEALTH SYSTEM ("DH"), A NOT-FOR-PROFIT TAX-EXEMPT CORPORATION WITH A PRINCIPAL PLACE OF BUSINESS AT ONE MEDICAL CENTER DRIVE, LEBANON, NEW HAMPSHIRE. CONSISTENT WITH THE DH VISION AND STRATEGY TO CREATE A SUSTAINABLE HEALTH SYSTEM, CHESHIRE AND DH 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. CHESHIRE 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 FY24, CHESHIRE PROVIDED 253,893 PROVIDER VISITS AND HAD 3,760 HOSPITAL ADMISSIONS AND DISCHARGES. THE EMERGENCY DEPARTMENT WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 25,410 ER PATIENT VISITS. THERE ARE A TOTAL OF 222 PROVIDERS CONSISTING OF 136 PHYSICIANS AND 86 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 CHESHIRE PROVIDES. THE MOST RECENT COMMUNITY BENEFIT REPORTS ARE AVAILABLE UPON REQUEST OR CAN BE FOUND ON CHESHIRE'S WEBSITE (https://www.cheshiremed.org/about/community-benefits-reporting). Currently, Cheshire's Community Benefit priorities involve improving healthcare access in rural communities, behavioral health supports, substance use disorder prevention and supports, and aging population services. Some examples of community benefit programs provided by Cheshire during FY24 to address the identified community needs include the hosting of a free "Teddy Bear" clinic for pediatric patients and their caregivers, providing local schools with a "Read-A-Marathon" program offering books to over 1,000 children with social emotional health topic focus, distribution of 36 NaloxBoxes and over 2,000 Narcan overdose reversal kits distributed in public facilities across the region, and facilitating a "Healthy Aging" community education series with offerings such as chair-based yoga and silver sneakers to help aging adults with physical activity. IN TOTAL, CHESHIRE PROVIDED more than $20 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 $38 MILLION DOLLARS IN UNREIMBURSED MEDICARE COSTS ABSORBED BY CHESHIRE. 280597429 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 false false false false false false false true true true false false true 188 0 true 1249 true true true false false false false false false false false false false false X 17 9 false false false false true true true true true false false true true true true true true false true false NH X Ann Marie Coppo 6033545400 580-590 COURT STREET KEENE NH 034315400 Barbara Duckett Trustee/Secretary (through 1/24) 0.5 0.5 X X 0 0 0 Joseph L Perras MD Trustee/CEO/President ex-officio (as of 8/7/23) 40.0 1.5 X X 0 620829 33818 KATHRYN F WILLBARGER COO /Trustee and Interim CEO (through 8/6/23) 40.0 1.0 X X 380067 0 34064 Les Pitts MD Trustee/Ex-Officio Med. Staff Pres 0.5 40.5 X X 0 292890 71646 Mark Bodin Trustee / Treasurer 0.5 0.5 X X 0 0 0 MARK GAVIN TRUSTEE / Vice Chair (through12/31/23) / Chair (as of 1/1/24) 1.0 0.5 X X 0 0 0 SUSAN ABERT TRUSTEE / Chair (through 12/31/23) 1.0 0.5 X X 0 0 0 ANDREW G TREMBLAY MD TRUSTEE 1.0 40.0 X 0 311879 66511 Cherie Holmes MD Trustee 1.0 40.0 X 0 454795 50799 Daniel Smith Trustee / Vice Chair (as of 1/20/23) 0.5 0 X 0 0 0 Elizabeth Cotter Trustee/Secretary (as of 1/24) 0.5 1.0 X 0 0 0 Gina OBrien MD Trustee (as of 1/20/23) 0.5 40.0 X 0 410980 26368 Maria Padin MD TRUSTEE / CGP Chief Medical Officer 1.0 41.0 X 0 560847 67853 Michael Chelstowski Trustee 0.5 0 X 0 0 0 Michael Farhm Trustee 0.5 0 X 0 0 0 Michael Waters Trustee / DH Treasurer 0.5 40.0 X 0 311063 24340 Robert Palmer Trustee (as of 1/1/24) 0 X 0 0 0 Stephen Leblanc Trustee 0.5 42.5 X 0 918361 66015 Susan Howard Trustee (through 1/31/24) 0.5 0 X 0 0 0 Tim Ruehr Trustee (through 12/31/23) 0.5 0 X 0 0 0 Anne Tyrol Chief Nursing Officer 40.0 0 X 224304 0 41364 AnnMarie Coppo Interim CFO (as of 5/3/24) 40.0 0.5 X 133274 0 48751 Daniel Gross Chief Financial Officer (through 5/2/24) 40.0 1.5 X 290020 0 44904 ERLI CHEN PHYSICiST 40.0 0 X 259554 0 41630 Kevin Forrest VP Facilities & Support Services 40.0 0 X 170156 0 13855 Lisa Hanamoto RN Baylor-WN-IP/PRCD 40.0 0 X 162732 0 22641 Matthew Borden Pharmacist 40.0 0 X 179218 0 11940 SANDRA M PHIPPS VP PHILANTHROPY/COMM RELATIONS 40.0 0.5 X 165844 0 30679 David Quigley Former Key / VP - Clinical Operations (through 3/7/23) 0.0 40.0 X 0 162207 6458 DON CARUSO MD FORMER CEO/PRESIDENT 1.0 41.0 X 0 229871 19018 JENNIFER L DINUBILA DO Former Med Staff Pres. 0.0 40.0 X 0 395755 54444 Michael Ormont MD Former Medical Staff Pres. 0.0 40.0 X 0 370461 38006 1965169 5039938 815104 97 true true false Prolucent Health inc 10000 N Central Expressway Suite 400 Dallas TX 75231 Workforce Services 8109410 CONIFER REVENUE CYCLE SOLUTIONS PO BOX 655025 DALLAS TX 752655025 Revenue Management 6539839 Walsh Brothers Incorporated 210 Commerical Street Boston MA 02109 Construction Services 5039383 Fastaff LLC PO Box 911452 Denver CO 802911452 Workforce Services 3485661 MARY HITCHCOCK MEMORIAL HOSPITAL One Medical Center Dr Lebanon NH 03756 Health Services 2531057 34 5658122 4462495 558566 10679183 NET PATIENT SERVICE REVENUE 622110 275434182 275434182 PHARMACY REVENUE 446110 18408039 18040538 367501 Laboratory Services 621500 18102 18102 0 0 0 0 293860323 261859 64900 196959 11362 11362 0 11362 11362 0 0 0 Food Services 722514 1006077 1006077 Childcare Revenue 624410 663701 663701 Rebates and Discounts 622110 501528 501528 922764 922764 0 0 3094070 307906797 294899012 450503 1878099 X 198588 198588 171329 171329 1311917 53789 1240526 17602 79037011 71909325 6829595 298091 5522581 5024545 477207 20829 26384493 24005097 2279886 99510 4515892 4108641 390219 17032 149070 149070 11475 11475 49459 49459 93063906 90736997 2225440 101469 146614 146614 1421067 1307572 104580 8915 362089 341153 20936 7030735 1579516 5451219 223464 197110 25850 504 19112 19112 1716679 1716679 9654321 3592883 6061438 3081371 1382963 1698408 MEDICAL SUPPLIES 54715700 54715700 MEDICAID ENHANCEMENT & PILOT TAXES 10045252 10045252 Shared Services - Related Party 4882401 3751711 1130690 EQUIPMENT RENTAL AND MAINTENANCE 4860983 3110522 1750461 4015477 2283802 1684805 46870 312590986 280597429 31361799 631758 14078490 15605587 248 248 17489115 16513441 0 0 0 0 3818437 4904983 965562 1076029 276054454 207984995 69063264 68069459 24779211 27699843 0 16625857 27994264 146820184 161863854 16793861 17484959 5453584 3118884 21821546 20886037 0 0 49569356 44757774 93638347 86247654 X 34388347 40224026 18793490 35392174 53181837 75616200 146820184 161863854 X -4684189 2921558 24196994 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 49459 49459 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. 218161 218161 82799225 60765754 22033471 37647700 15451531 22196169 155389368 131767710 23621658 68069459 Investment in Pooled Fund 27699843 F 27699843 Due from Affiliate 25868943 Deferred 457(b) Plan Assets 477026 Other Assets 1648295 27994264 PENSION LIABILITY DUE TO RELATED PARTY 37970360 RESERVES FOR ESTIMATED 3RD PARTY SETTLEMENTS 6402837 Right of Use Lease Obligations 384577 44757774 true true X true X 225 true X true true false true true 2397129 2397129 0.0077 31710620 21361457 10349163 0.0331 0 0.0 0 0 34107749 21361457 12746292 0.0408 79269 79269 0.0003 5453779 251842 5201937 0.0166 1871470 9689 1861781 0.0060 0 0.0 242460 50000 192460 0.0006 0 0 7646978 311531 7335447 0.0235 0 0 41754727 21672988 20081739 0.0642 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 849467 31300 818167 0.0026 0 0.0 0 0.0 650638 650638 0.0021 0 0 1500105 31300 1468805 0.0047 true 0 0 97148014 135647146 -38499132 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 22 true true true true X https://www.cheshiremed.org/about/community-benefits-reporting X X true 22 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 2022. THESE NEEDS ARE IN THE AREAS OF BEHAVIORAL HEALTH, SUBSTANCE AND ALCOHOL MISUSE, TOBACCO USE, OBESITY, AND EMERGENCY PREPAREDNESS. IN FY 2023, 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 Center for Population Health at Cheshire Medical Center is the state-designated coalition building entity for the Monadnock Regional Public Health Network, which brings together organizations and individuals from around the region to promote and provide for the public health in lieu of a local governmental public health department model. Cheshire Medical Center receives some grant dollars through the New Hampshire Department of Health and Human Services to provide local public health service organization and oversight. However, Cheshire is committed to the health and wellbeing of its region and commits additional community benefit support beyond what the grant is able to financially reimburse, providing additional funding for expert staff support, direct public health programming, and community organizing around public health initiatives. The Regional Public Health Network coalition, known as the Healthy Monadnock Alliance, is driven by a shared set of priority areas identified through community health needs assessment. Currently the priority areas around which coalition members unite concern improving access to healthcare, food access, active living, substance use prevention and supports for youth, emergency preparedness, and behavioral health for community members. 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 Geography: Cheshire Medical Center serves Cheshire County in the southwestern corner of New Hampshire. The county is comprised of 22 towns and 1 city, ranging in population from a few hundred to several thousand, and the county seat is the city of Keene where Cheshire Medical Center's main campus is located. Cheshire County is designated as a rural county with a low-density population, as more than two thirds of people (69%) reside in a rural area. General Population: The latest population estimates put a total county population of 77,703 residents. The county is an aging one, with more than 1 in 5 residents (23%) age 65 or older. There are around 14,000 children under the age of 18 residing in the county, or 18% of the overall population. Most community members identify as non-Hispanic white (93%), with English being the predominantly spoken language (95%). Socioeconomic Factors: The median household income is around $69,000 annually. Most adult residents over the age of 25 have completed high school (94%), and two thirds of residents have completed some college education (68%). 70% of households own their home. 1 in 4 residents age 16-64 are unemployed (26%). 1 out of 10 residents lives in poverty (10%), and the same proportion of residents are experiencing food insecurity (11%), with 1 in 10 children living in poverty and 15% living in single parent homes. 7% of the adult population is not covered by any type of health insurance, while only 4% of children are uninsured. Population Health Epidemiology: The average life expectancy of Cheshire County residents is 78 years, on par with the state average. 15% of the adult population report being in poor or fair health overall, experiencing on average 4 days a month of poor physical health and 5 days a month of poor mental health. 1 in 3 adults are obese (31%), and 1 in 5 residents report having little to no regular physical activity (20%). 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 18 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 ALIGNING 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 Foundation for Healthy Communities 125 Airport Rd Concord NH 03301 020275078 501(c)(3) 188588 Book Program Support Dental Health Works 69V Island Street Keene NH 03431 300275867 501(c)(3) 10000 Book Program Support 2 0 Patient and family support/assistance 88 10652 Book Nursing and healthcare scholarships 39 160677 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. false true false false false false false false false DON CARUSO MD FORMER CEO/PRESIDENT 0 185732 0 0 0 44139 0 16578 0 2440 0 248889 0 0 JENNIFER L DINUBILA DO Former Med Staff Pres. 0 370962 0 0 0 24793 0 24990 0 29454 0 450199 0 0 Michael Ormont MD Former Medical Staff Pres. 0 308001 0 0 0 62460 0 31590 0 6416 0 408467 0 0 Les Pitts MD Trustee/Ex-Officio Med. Staff Pres 0 292116 0 0 0 774 0 28590 0 43056 0 364536 0 0 KATHRYN F WILLBARGER COO /Trustee and Interim CEO (through 8/6/23) 354376 0 7570 0 18121 0 31590 0 2474 0 414131 0 0 0 Joseph L Perras MD Trustee/CEO/President ex-officio (as of 8/7/23) 0 448299 0 128661 0 43869 0 29445 0 4373 0 654647 0 0 Cherie Holmes MD Trustee 0 401569 0 11229 0 41997 0 31590 0 19209 0 505594 0 0 Stephen Leblanc Trustee 0 686348 0 122500 0 109513 0 31590 0 34425 0 984376 0 0 Maria Padin MD TRUSTEE / CGP Chief Medical Officer 0 484606 0 35700 0 40541 0 31590 0 36263 0 628700 0 0 ANDREW G TREMBLAY MD TRUSTEE 0 309966 0 0 0 1913 0 30132 0 36379 0 378390 0 0 Michael Waters Trustee / DH Treasurer 0 285002 0 19950 0 6111 0 23033 0 1307 0 335403 0 0 Gina OBrien MD Trustee (as of 1/20/23) 0 410314 0 0 0 666 0 19800 0 6568 0 437348 0 0 Daniel Gross Chief Financial Officer (through 5/2/24) 281572 0 7260 0 1188 0 17854 0 27050 0 334924 0 0 0 Anne Tyrol Chief Nursing Officer 218284 0 5750 0 270 0 14145 0 27219 0 265668 0 0 0 AnnMarie Coppo Interim CFO (as of 5/3/24) 127213 0 355 0 5706 0 9965 0 38786 0 182025 0 0 0 David Quigley Former Key / VP - Clinical Operations (through 3/7/23) 0 81464 0 0 0 80743 0 5751 0 707 0 168665 0 0 ERLI CHEN PHYSICiST 239412 0 0 0 20142 0 23832 0 17798 0 301184 0 0 0 SANDRA M PHIPPS VP PHILANTHROPY/COMM RELATIONS 164870 0 0 0 974 0 12669 0 18010 0 196523 0 0 0 Kevin Forrest VP Facilities & Support Services 157425 0 0 0 12731 0 12408 0 1447 0 184011 0 0 0 Matthew Borden Pharmacist 174078 0 5000 0 140 0 11064 0 876 0 191158 0 0 0 Lisa Hanamoto RN Baylor-WN-IP/PRCD 161555 0 0 0 1177 0 11064 0 11577 0 185373 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 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 $68,044 A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 644614V48 2012-11-15 30360529 REFUND OF EXISTING DEBT; ACQUISITION false false false A 7985000 30360529 379754 554125 4777102 24649548 2013 true false true true A false true false false 0.0001 0.0 0.0001 false false true A false false true false false false false false true A true Schedule K, Part II Bond A Line 11: The Other Spending Proceeds are the refunding proceeds of the issue no longer in escrow. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH CEO COMPENSATION THE CEO IS PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS EVALUATED BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSIDERATION WITH THE INDEPENDENT THIRD-PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2024. 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 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 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 FY24, 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: 500000, Related or Exempt Function Revenue: 500000, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Revenue - Total Revenue: 422764, Related or Exempt Function Revenue: 422764, 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: 71259536, Program Service Expense: 71259536, Management and General Expenses: , Fundraising Expenses: ; Lab and Radiology Services - Total Expense: 1883534, Program Service Expense: 1883534, Management and General Expenses: , Fundraising Expenses: ; Consulting and Other Services - Total Expense: 19920836, Program Service Expense: 17593927, Management and General Expenses: 2225440, Fundraising Expenses: 101469; Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSET TRANSFERS - 24196994; 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 2024, 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. 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 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 HOSPITAL VT 501(c)(3) 3 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 -27663 438520 1 true KEENE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 020374997 REAL ESTATE HOLDING NH CMC C Corporation 11693 1418238 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 5628122 Book Cheshire Health Foundation K 72000 Book Cheshire Health Foundation Q 81896 Book