2025-05-13T08:58:08+00:00 2024-06-30 350921680 CROWE LLP 4801 Olympia Park Plaza Suite 4000 Louisville KY 402412098 990 2023-07-01 020222140 Mary Hitchcock Memorial Hospital MARY 6036505000 One Medical Center Drive Lebanon NH 03756 Wendy E Fielding CFO 6036505000 2025-05-13 true Kim Scifres P01316095 5023263996 2025-05-13 2023 2025-03-06 01:10:19Z JOANNE M CONROY MD One Medical Center Drive Lebanon NH 03756 2264104728 false X WWW.DARTMOUTH-HITCHCOCK.ORG X 1889 NH ADVANCING HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, COMMUNITY PARTNERSHIPS; PROVIDING EACH PERSON THE BEST CARE IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. 16 10 6754 285 89035966 1760857 43697084 29766770 1885742726 2178328478 4755712 2693369 46224691 52716608 1980420213 2263505225 9063920 9196931 0 965969736 1058310342 0 585044 948134836 1151324073 1923168492 2218831346 57251721 44673879 2230963269 2337348189 1231464540 1217610319 999498729 1119737870 WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 1823570926 9196931 2076458250 MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IS AN ACUTE AND TERTIARY CARE TEACHING HOSPITAL LOCATED IN LEBANON, NEW HAMPSHIRE. MHMH PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A MAJOR TEACHING HOSPITAL, A TERTIARY CARE REFERRAL HOSPITAL, AND AS A PROSPECTIVE PAYMENT SYSTEM HOSPITAL (AS DEFINED BY CMS). MHMH PROVIDES A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, PSYCHIATRY AND REHABILITATION FOR INFANTS, CHILDREN AND ADULTS. DURING FY 2024, MHMH PROVIDED 158,898 ACUTE PATIENT DAYS OF INPATIENT SERVICE AND HAD 28,654 TOTAL ACUTE CARE DISCHARGES, WHILE MHMH'S EMERGENCY ROOM WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 33,374 DISCHARGES. DARTMOUTH-HITCHCOCK CLINIC (DHC) PROVIDES THE PHYSICIAN STAFF FOR THE HOSPITAL AND THE SOPHISTICATION ESSENTIAL FOR THE DEVELOPMENT OF THE HOSPITAL AS THE LARGEST ACADEMIC MEDICAL CENTER IN NEW HAMPSHIRE AND THE DESIGNATION BY THE FEDERAL GOVERNMENT AS A RURAL REFERRAL CENTER FOR NORTHERN NEW ENGLAND. THE SHARED MISSION OF MHMH AND DHC IS TO ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. CONSISTENT WITH THIS MISSION AND IN PARTNERSHIP WITH DHC, MHMH PROVIDES HIGH-QUALITY, COST-EFFECTIVE, COMPREHENSIVE, AND INTEGRATED HEALTH CARE TO INDIVIDUALS, FAMILIES, AND THE COMMUNITIES IT SERVES, REGARDLESS OF A PATIENT'S ABILITY TO PAY. THROUGH FORMAL AFFILIATIONS AND OTHER CLINICAL COLLABORATIONS, MHMH ALSO SEEKS TO PARTNER WITH OTHER AREA HEALTH CARE PROVIDERS TO IMPROVE THE HEALTH STATUS OF THE REGION. THE JACK BYRNE CENTER FOR PALLIATIVE & HOSPICE CARE COORDINATES MHMH'S CLINICAL, EDUCATIONAL, AND RESEARCH EFFORTS AND VISITING NURSE ALLIANCES AROUND THE REGION TO OFFER MUCH-NEEDED END-OF-LIFE CARE FOR PATIENTS IN A CLINICAL SETTING THAT MEETS THE NEEDS OF PATIENTS AND THEIR FAMILIES. MHMH ALSO CONTINUES TO BUILD ITS TELE-MEDICINE PROGRAM TO PROVIDE CARE ACROSS ITS RURAL REGION AND IN PARTICULAR TO MAKE SPECIALIST CONSULTATION AND CARE AVAILABLE TO CRITICAL ACCESS AND COMMUNITY HOSPITALS. THIS ALLOWS CAREGIVERS AT REMOTE LOCATIONS TO ACCESS SPECIALISTS AT MHMH AND DHC AND TO BRING THEM "VIRTUALLY" TO THE PATIENT'S BEDSIDE. MHMH'S CONNECTED CARE CENTER FOR TELE-HEALTH IN LEBANON OFFERS A 24/7 TEAM OF PHYSICIANS, PHARMACISTS, AND NURSES SUPPORTING THE FOLLOWING ACUTE CARE TELE-HEALTH SERVICE LINES: TELE-EMERGENCY, TELE-PHARMACY, TELE-NEUROLOGY, TELE-ICU, TELE-PSYCHIATRY, AND TELE-NEONATOLOGY; OUTPATIENT TELE-URGENT CARE 7 DAYS/WEEK; AND OUTPATIENT VIRTUAL VISITS IN PEDIATRICS AND MORE THAN 30 SPECIALTY SERVICES TO PATIENTS IN 17 CLINICAL LOCATIONS ALONG WITH PATIENT HOMES. MHMH PARTNERS WITH REGIONAL COLLEGES, INCLUDING COLBY-SAWYER COLLEGE, TO SUPPORT NURSING EDUCATION AND CLINICAL EXPERIENCES FOR STUDENTS AS WELL AS CONTINUING EDUCATION AND CAREER ADVANCEMENT FOR MHMH STAFF. MHMH ALSO PROVIDES TRAINING PROGRAMS FOR ENTRY INTO FRONTLINE HEALTHCARE CAREERS THROUGH THE WORKFORCE READINESS INSTITUTE, A PROGRAM OF MHMH THAT IS A LICENSED CAREER SCHOOL WITH THE STATE OF NEW HAMPSHIRE. MHMH HAS ALSO ESTABLISHED TRAINING PATHWAYS FOR CURRENT HEALTHCARE EMPLOYEES TO ADVANCE THEIR HEALTHCARE CAREERS THROUGH CONTINUED EDUCATION. MHMH OFFERS PAID INTERNSHIP PROGRAMS FOR HIGH SCHOOL AND COLLEGE STUDENTS LOOKING TO EXPLORE HEALTHCARE CAREERS. MHMH ALSO HOSTS THE PROJECT SEARCH PROGRAM FOR STUDENTS WITH INTELLICTUAL DISABILITIES, ALLOWING THESE STUDENTS TO DEVELOP TRANSFERRABLE AND MARKETABLE JOB SKILLS. MHMH AND DHC JOINTLY FILE AN ANNUAL COMMUNITY BENEFITS REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS MHMH AND DHC PROVIDE. THE MOST RECENT COMMUNITY BENEFITS REPORT IS AVAILABLE BY REQUEST. FINANCIAL ASSISTANCE (FORMERLY CALLED "CHARITY CARE") REPRESENTS SERVICES PROVIDED TO PATIENTS WHO CANNOT AFFORD HEALTH CARE SERVICES DUE TO INADEQUATE FINANCIAL RESOURCES WHICH RESULT FROM BEING UNINSURED OR UNDERINSURED. FOR THE YEAR ENDED JUNE 30, 2024, MHMH PROVIDED FINANCIAL ASSISTANCE TO 22,529 PATIENTS IN THE AMOUNT OF $28,734,667 AS MEASURED BY GROSS CHARGES. THE COST OF PROVIDING THIS CARE FOR THE YEAR ENDED JUNE 30, 2023 WAS $17,838,140. MHMH ALSO ROUTINELY PROVIDES SERVICES TO MEDICAID PATIENTS AT REIMBURSEMENT LEVELS THAT ARE BELOW THE COST OF THE CARE PROVIDED. THE COMMUNITY HEALTH ACTIVITIES NOTED INCLUDE THE COST OR VALUE OF SEVERAL DIFFERENT TYPES OF PROGRAMS INCLUDING THE COST OF COMMUNITY-BASED EDUCATION, HEALTH FAIRS, HEALTH SCREENINGS, SUPPORT GROUPS, AND PROGRAMS AND MATERIALS THAT PROMOTE WELLNESS AND PREVENT ILLNESS. EXAMPLES OF THESE TYPES OF EFFORTS INCLUDE PARTNERING WITH THE HEALTHY EATING ACTIVE LIVING NH INITIATIVE, THE WOMEN'S HEALTH RESOURCE CENTER, AND SMOKING PREVENTION AND CESSATION. THIS CATEGORY OF SUPPORT ALSO INCLUDES FINANCIAL CONTRIBUTIONS AND THE CONTRIBUTION OF TIME AND SERVICES TO COMMUNITY PROGRAMS, HOSPITALS AND AGENCIES. MHMH ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO ITS PATIENTS THAT IS REPORTED AS BAD DEBT, WHICH IS NOT INCLUDED IN THE AMOUNTS REPORTED ABOVE. DURING THE YEAR ENDED JUNE 30, 2024, THE HOSPITAL REPORTED EXPENSE FOR BAD DEBT OF $41,336,812. 103415302 64141969 AS A COMPONENT OF NEW HAMPSHIRE'S ONLY INTEGRATED ACADEMIC MEDICAL CENTER, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) PROVIDES THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH (GSM) SUPPORT FOR PHYSICIANS' UNPAID TEACHING TIME AS PART OF ITS COMMUNITY BENEFIT INITIATIVES. THIS SUPPORT CONSISTS OF THE TIME PHYSICIANS SPEND PROVIDING CLINICAL SUPERVISION AND EDUCATION FOR RESIDENTS AND MEDICAL STUDENTS. IN ADDITION, THE HOSPITAL PROVIDES IN-KIND SUPPORT FOR RESEARCH AND OTHER GRANTS REPRESENTING COSTS IN EXCESS OF AWARDS FOR NUMEROUS GRANT-FUNDED HEALTH RESEARCH AND SERVICE INITIATIVES AWARDED TO DARTMOUTH-HITCHCOCK CLINIC (DHC) AND GSM. OTHER COMMUNITY BENEFIT INITIATIVES INCLUDE SUBSIDIZING THE COSTS OF PROVIDING MEDICAL AND CLINICAL EDUCATION TO PROFESSIONALS ACROSS NEW HAMPSHIRE, VERMONT AND BEYOND AS WELL AS UNCOMPENSATED COSTS OF ACADEMIC AND MEDICAL RESEARCH ACTIVITIES. 1926986228 true true false true false false false false true true true false true true false false true false false true true false false false false true true true true true true false false false false false true false false false false true false false false true true true true false false true X 1036 0 true 6754 true true true true BD false false false true true false false false false true false X 16 10 false false true false true true true true true false false true true true true true true false true true true NH X Wendy E Fielding 6036535634 ONE MEDICAL CENTER DRIVE LEBANON NH 03756 Charles G Plimpton MBA Trustee / Treasurer (through 12/31/23) 1.5 2.5 X X 0 0 0 David P Paul Trustee / Secretary/Treasurer 0.8 1.8 X X 0 0 0 Joanne M Conroy MD Trustee, Ex-Officio, CEO 37.8 18.3 X X 0 2078492 50649 ROBERTA L HINES MD TRUSTEE / Chair 1.5 2.0 X X 0 0 0 Carl W Dobson MD Trustee/ Medical Director (through 12/31/23) 40.0 0.8 X 455547 0 59766 Celestina M Dooley-Jones PHD Trustee 0.8 0.8 X 0 0 0 Duane A Compton PHD Trustee / Ex-Officio 0.8 1.7 X 0 0 0 Edward H Stansfield III MA Trustee (through 12/31/23) 0.8 2.3 X 0 0 0 Elof Eriksson MD PhD Trustee (through 12/31/23) 0.8 0.8 X 0 0 0 Gary L Freed MD Trustee / Physician (through 12/31/23) 28.0 12.0 X 0 705498 28710 Gary V Desir Trustee 0.8 0.8 X 0 0 0 Geraldine Bednash PHD RN FAAN Trustee 0.8 1.3 X 0 0 0 Jennifer L Moyer MBA Trustee 0.8 1.3 X 0 0 0 Jonathan B Thyng MD Trustee/Medical Director (as of 1/1/24) 28.0 12.0 X 0 365874 76040 Keith Loud MD Trustee (as of 3/21/24) 0.1 40.0 X 0 434846 67529 Laura Chiang Trustee 28.0 12.0 X 0 361900 55054 M Elyse Allan Trustee (as of 1/1/24) 0 X 0 0 0 Marcus Coe MD Trustee (as of 1/1/24) 0.1 40.0 X 0 825889 65626 Mark S Speers MBA Trustee 0.8 0.8 X 0 0 0 Mark W Begor MBA Trustee (through 12/31/23) 0.8 1.3 X 0 0 0 Nancy M Dunbar MD Trustee / Physician 28.0 12.0 X 0 398149 69215 Pamela Thompson MSRNCENP Trustee (through 12/31/23) 0.8 1.3 X 0 0 0 Paul A Taheri MD MBA Trustee (through 12/31/23) 0.8 1.6 X 0 0 0 Sandra L Wong MD Trustee (through 12/31/23)/SVP Svc Ln & Dept Chair 28.0 12.0 X 0 792829 40194 Sherri C Oberg Trustee 0.8 0.8 X 0 0 0 Thomas Glynn PHD Trustee (through 12/31/23) 0.8 1.3 X 0 0 0 Thomas Raffio Trustee (through 12/31/23) 0.8 1.3 X 0 0 0 Aimee M Claiborne Chief Human Resource Officer 28.0 12.5 X 591866 0 44913 EDWARD J MERRENS MD Chief Clinical Officer 28.0 13.0 X 0 931192 50874 JOHN KACAVAS Chief Legal Officer (as of 1/8/24) 28.0 15.0 X 55362 0 0 Kimberly Troland JD Deputy Gen Counsel / Interim Chief Legal Officer (through 1/7/24) 28.0 12.5 X 632259 0 13885 Matthew Haag Chief Development Officer 28.0 12.0 X 482401 0 42715 Patrick F Jordan III MBA Chief Operating Officer 28.0 15.0 X 979872 0 71266 Stephen Leblanc Chief Strategy Officer 28.0 15.0 X 0 918361 66015 Susan A Reeves EDD RN Executive VP (medical center) 28.0 12.0 X 917950 0 42718 Wendy Fielding Chief Financial Officer 28.0 13.5 X 443212 0 47649 David F Duncan System VP - Facilities Mgmt 28.0 13.0 X 339812 0 46576 Jeffrey Obrien MHA Chief Operating Officer - DHMC 28.0 12.0 X 374775 0 64682 Martin Purcell MBA Chief Information Officer 28.0 12.0 X 566582 0 69259 Samuel Shields System VP - Strtgy & Rgnl Ops 40.0 1.5 X 358191 0 27595 Simon C Hillier Dept. Chair - Anesthesiology 28.0 12.0 X 0 636884 68491 Staci Hermann PHARMD MS Chief Pharmacy Officer (Through March 2024) 28.0 12.0 X 372899 0 42373 Tracy Galvin Chief Nursing Officer 28.0 12.0 X 224744 0 21247 Barbara Vance VP-Research Ops 40.0 0 X 361284 0 31903 Brenda L Blair System VP HR Ops 40.0 0.0 X 350844 0 60462 Christopher L Hubble MD VP Patient Safety 40.0 0.5 X 405376 0 63589 Kenneth Kelliher System VP Supply Chain 0 X 353230 0 22531 Martin T Manion President/CEO NLH 40.0 0.5 X 383541 0 21050 DANIEL P JANTZEN Former Chief Financial Officer 28.0 15.0 X 1105647 0 66965 GEORGE T BLIKE MD MHCDS Former/ Chief Quality & Value Officer (DHC) 10.0 11.5 X 0 106407 7471 Maria Padin MD Chief Medical Officer, CGP 28.0 14.0 X 0 560847 67853 Peter D Solberg MD Chief Health Information Officer 28.0 12.0 X 0 543330 50479 9755394 9660498 1625344 1108 true true false PROLUCENT HEALTH INC 10000 N Central Expressway Suit Dallas TX 75231 Healthcare Staffing 94037341 CONIFER REVENUE CYCLE SOLUTIONS LLC 1500 S Douglas Rd Ste 200 Ananheim CA 92806 Revenue Management Services 49528152 TRACE 3 LLC 4601 DTC Boulevard Suite 400 Denver CO 80237 Licenses and Services 18919098 HINCKLEY ALLEN & SNYDER LLP 650 ELM STREET SUITE 500 MANCHESTER NH 03101 LEGAL SERVICES 14554605 TRUSTEES OF DARTMOUTH COLLEGE DARTMOUTH COLLEGE 6132 MCNUTT RM 103 HANOVER NH 03755 Services 6647209 162 29503924 262846 213258 29766770 NET PATIENT SERVICE REVENUE 622110 1890790340 1885325866 5464474 RESEARCH RELATED ACTIVITIES 622110 6716214 6716214 PHARMACY INCOME 446110 278947933 207452550 71495383 NEAH & PROGRAM RELATED INVESTMENTS 541900 1873991 909009 964982 0 0 0 0 2178328478 3088843 2100968 987875 570212 510377 59835 0 59835 59835 -306348 89126 -306348 -89126 -395474 -395474 CAFETERIA 722514 3450034 3450034 Other Revenue 622110 49206739 40196580 9010159 0 0 0 0 52656773 2263505225 2140600219 89035966 4102270 8221089 8221089 621719 621719 354123 354123 13563610 4660278 8368552 534780 1971355 957468 999025 14862 811787556 711881483 99906073 54578190 47483025 7095165 123480349 108200111 15280238 52929282 46379479 6514639 35164 2905506 129917 2775589 750039 129611 620428 179525800 161728464 17797336 0 2431247 67132 2364115 23411898 17887312 5524586 29203836 2336307 26867529 24103743 10854465 13249278 3535201 2329441 1205760 364357 317225 47132 22422003 177208 22244795 54999560 19040240 35959320 19519299 15694398 3824901 MEDICAL SUPPLIES 539999881 537919674 2080207 MEDICAID ENHANCEMENT TAX 71161681 71161681 EQUIPMENT RENTAL & MAINT 20461814 8999608 11462206 ACADEMIC, GME, TEACHING & EDUCATIONAL 8618239 7276977 1341262 147909969 142177793 5731938 238 2218831346 1926986228 291260074 585044 641307 645592 234512694 291458793 216322 223089 0 0 14307589 11744790 36309027 45376713 67590040 43864012 1720069472 1088507668 611276099 631561804 51918153 54442256 811886376 896668634 12199798 12362908 390105864 348999598 2230963269 2337348189 240556966 244613274 873024 1435160 25500000 25500000 0 0 73933361 57772058 890601189 888289827 1231464540 1217610319 X 863216474 968951031 136282255 150786839 999498729 1119737870 2230963269 2337348189 X 44673879 94727814 -19000709 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 216572 false true 194254 410826 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINES IB & 1G MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) EMPLOYS THREE FULL TIME STAFF WHOSE DUTIES INCLUDE LOBBYING. TYPICAL EXPENSES ASSOCIATED WITH THE LOBBYING ACTIVITIES INCLUDE STAFF SALARY, TRAVEL, MEMBERSHIP FEES AND DUES. FROM TIME TO TIME, MARY HITCHCOCK MEMORIAL HOSPITAL, THROUGH ITS EMPLOYEES AND THE USE OF CONSULTANTS, CONTACTS GOVERNMENT OFFICIALS AND LEGISLATORS. THIS CONTACT IS FOR THE PURPOSE OF PROPOSING LEGISLATION OR EXPRESSING AN OPINION ON CHANGES IN LEGISLATION THAT AFFECT MHMH AND ITS ABILITY TO CARRY OUT ITS MISSION. THE ACTIVITIES INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. FOR THE FISCAL YEAR ENDED JUNE 30, 2024, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $216,572 IN CONJUCTION WITH THESE ACTIVITIES. LINE 1I MHMH PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1I REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS. 88797563 587329 8400809 472291 97313410 81833643 3189501 2743447 -1030972 88797563 73799593 12519797 -4250857 234890 81833643 61828667 2758262 10467971 1255307 73799593 59733699 2989578 698013 1592623 61828667 0.1644 0.5993 0.2363 false false 63288249 63288249 871862661 478045997 393816664 4111615 4048789 62826 737659443 606412882 131246561 43147504 43147504 631561804 PRIVATE EQUITIES 8857 F HEDGE FUNDS OTHER INVESTMENTS INVESTMENT IN POOLED FUNDS (MIP) 896659777 F 896668634 INVESTMENT IN CAPTIVE 31460523 CAPITAL LEASE RECEIVABLE 29122199 DUE FROM AFFILIATES 274504648 UNAMORTIZED BOND ISSUANCE COSTS 359604 OTHER INVESTMENT ASSETS 6437675 INVESTMENT IN MIP 457B PLAN ASSETS 3998545 OTHER RECEIVABLES 3116404 348999598 THIRD PARTY RESERVES 41022168 ACCRUED POST RETMNT PENS & MED 62840679 Payable to Dartmouth Hitchcock Health 784426980 888289827 Schedule D, Part V, Line 4 Intended uses of endowment funds THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROMOTE AND ADVANCE THE FOLLOWING MISSION-RELATED PROGRAMS: HEALTHCARE SERVICES, RESEARCH, CHARITY CARE, COMMUNITY OUTREACH AND ADVOCACY, EQUIPMENT PURCHASES, AND HEALTH EDUCATION. true Central America and the Caribbean 0 0 Investments 27237634 South Asia 0 4 Program Services DOCTORS HELPED TO LAUNCH LIFE-SAVING EMERGENCY MEDICAL EDUCATION TO BHUTAN. 21381 Sub-Saharan Africa 0 4 Program Services PROVIDERS WENT TO RWANDA TO HELP TRAIN AND DELIVER EMDOSCOPIC CARE ALONGSIDE RWANDAN PEERS. 21086 Sub-Saharan Africa 0 0 GRANTS TO RECIPIENTS LOCATED IN THE REGION 256180 Europe (Including Iceland and Greenland) 0 0 GRANTS TO RECIPIENTS LOCATED IN THE REGION 84137 North America (Canada & Mexico only) 0 0 GRANTS TO RECIPIENTS LOCATED IN THE REGION 13806 0 8 0 0 0 8 27634224 0 27634224 Sub-Saharan Africa PROGRAM SUPPORT 256180 CASH FMV Europe (Including Iceland and Greenland) PROGRAM SUPPORT 39950 CASH FMV Europe (Including Iceland and Greenland) PROGRAM SUPPORT 44187 CASH FMV North America (Canada & Mexico only) PROGRAM SUPPORT 13806 CASH FMV 4 0 true false true true true false Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements CENTRAL AMERICA AND THE CARIBBEAN-Accrual; EUROPE (INCLUDING ICELAND AND GREENLAND)-Accrual; NORTH AMERICA (CANADA & MEXICO ONLY)-Accrual; SOUTH ASIA-Accrual; SUB-SAHARAN AFRICA-Accrual Schedule F, Part II, Line 1 Method used to account for expenditures on org's financial statements EUROPE (INCLUDING ICELAND AND GREENLAND)-Accrual; NORTH AMERICA (CANADA & MEXICO ONLY)-Accrual; SUB-SAHARAN AFRICA-Accrual true true X true X 225 true X true true false true true 9689049 9689049 0.0044 317940633 179173694 138766939 0.0637 0 0.0 0 0 327629682 179173694 148455988 0.0682 6645888 303793 6342095 0.0029 62377385 20764987 41612398 0.0191 21437374 14418721 7018653 0.0032 73200141 44065069 29135072 0.0134 1654650 0 1654650 0.0008 0 0 165315438 79552570 85762868 0.0394 0 0 492945120 258726264 234218856 0.1076 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 96381 96381 0.0000 0 0.0 0 0.0 0 0.0 0 0 96381 0 96381 0.0000 true 0 0 356411249 381648660 -25237411 X true true 1 1 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 WWW.DARTMOUTH-HITCHCOCK.ORG 01799 X X X X X X PSYCHIATRIC UNIT AND TRANSPLANT UNIT CANCER CENTER 1 1 1 false false true X X X X X X X X X 21 true true true true X https://www.dartmouth-hitchcock.org/about/community-health X X true 23 true https://www.dartmouth-hitchcock.org/sites/default/files/2022-10/community-health-improvement-plan-20 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, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC, COLLECTIVELY KNOWN AS D-H) ARE ACTIVELY ENGAGED IN THE DEVELOPMENT OF THE UPPER VALLEY REGIONAL PUBLIC HEALTH ADVISORY COUNCIL AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL (WITH 60+ COMMUNITY REPRESENTATIVES). MEMBERS OF THESE TWO COMMUNITY HEALTH ADVISORY GROUPS HAVE HAD THE OPPORTUNITY TO REVIEW AND COMMENT ON DRAFTS OF D-H'S COMMUNITY HEALTH IMPROVEMENT PLAN. THE PLAN DOCUMENT HAS ALSO BEEN CIRCULATED TO PUBLIC HEALTH OFFICIALS IN NEW HAMPSHIRE AND VERMONT FOR THEIR COMMENT. IN ADDITION, D-H REPRESENTATIVES SERVE ON NUMEROUS BOARDS, TASK FORCES, MUNICIPAL HEALTH LEADERSHIP AND PLANNING TEAMS, AND OTHER COMMUNITY HEALTH LEADERSHIP ENTITIES IN ORDER TO ENSURE THAT BOTH ORGANIZATIONS PARTICIPATE IN AND BETTER-UNDERSTAND THE NEEDS OF OUR COMMUNITY. MHMH CONTRACTED WITH JOHN SNOW RESEARCH AND TRAINING INSTITUTE/COMMUNITY HEALTH INSTITUTE TO PROVIDE CONSULTATION AND TECHNICAL EXPERTISE TO OUR ASSESSMENT PROCESS. JOHN SNOW RESEARCH AND TRAINING INSTITUTE IS A PUBLIC HEALTH MANAGEMENT CONSULTING AND RESEARCH ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES THROUGHOUT THE WORLD. DURING THE PERIOD FEBRUARY THROUGH OCTOBER 2021, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY DARTMOUTH-HITCHCOCK AND ALICE PECK DAY MEMORIAL HOSPITAL IN PARTNERSHIP WITH NEW LONDON HOSPITAL, VALLEY REGIONAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH AND LAKE SUNAPEE VNA. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES, AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. WHILE DARTMOUTH-HITCHCOCK MEDICAL CENTER SERVES AS A TERTIARY REFERRAL MEDICAL CENTER FOR A LARGE, MULTI-STATE AREA, THE GEOGRAPHIC AREA OF INTEREST FOR THE PURPOSES OF THIS ASSESSMENT WAS THE PRIMARY SERVICE AREA OF MARY HITCHCOCK MEMORIAL HOSPITAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, VISITING NURSE & HOSPICE OF VT/NH, AND ALICE PECK DAY MEMORIAL HOSPITAL. THIS PRIMARY SERVICE AREA WAS DEFINED AS 19 MUNICIPALITIES COMPRISING THE UPPER VALLEY OF NEW HAMPSHIRE AND VERMONT WITH A TOTAL RESIDENT POPULATION OF APPROXIMATELY 70,000 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE PRIMARY SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), POPULATIONS EXPERIENCING HEALTH DISPARITIES OR VULNERABLE TO POOR HEALTH OUTCOMES ARE PRIMARILY DEFINED AS THOSE POPULATIONS FACING SIGNIFICANT INCOME AND SOCIAL DETERMINANTS CHALLENGES, WHICH IN THIS REGION ARE STRONGLY ASSOCIATED WITH NEGATIVE IMPACTS ON HEALTH. ENHANCED EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THESE POPULATIONS THROUGH TARGETED SURVEYS AND VIRTUAL COMMUNITY CONVERSATIONS, MULTIPLE REGIONAL FREE COVID VACCINATION CLINICS, HOMELESS PROGRAMS, AND OTHER COMMUNITY SETTINGS SERVING ECONOMICALLY-VULNERABLE RESIDENTS. FINDINGS OF THIS ASSESSMENT HAVE BEEN SHARED WITH PUBLIC HEALTH OFFICIALS IN NH AND VT, AS WELL AS WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY. DURING THIS ASSESSMENT, MARY HITCHCOCK MEMORIAL HOSPITAL USED SURVEYS FROM FEBRUARY 2021 THROUGH SEPTEMBER 2021 TO GENERATE INPUT FROM 1,642 RESIDENTS. SURVEYS WERE MADE AVAILABLE THROUGH PRIMARY CARE CLINICS, FREE CARE CLINICS, ANNUAL TOWN MEETINGS/ELECTIONS, AND NUMEROUS OTHER COMMUNITY LOCATIONS. VISITING NURSES AND OTHERS PROVIDED PRE-PAID MAILERS AND SURVEYS TO HOMEBOUND RESIDENTS. RESIDENTS COMPLETING SURVEYS INCLUDED MEMBERS OF AFRICAN-AMERICAN, HISPANIC, NATIVE AMERICAN, AND ASIAN POPULATIONS. SURVEYS WERE DISTRIBUTED THROUGH REGIONAL HEALTH CLINICS, THE REGION'S SHELTER FOR HOMELESS POPULATIONS; THE REGION'S LOW-INCOME HOUSING TRUST; SENIOR CENTERS; SUBSTANCE USE DISORDER TREATMENT PROGRAMS, DELIVERED DIRECTLY TO RESIDENT HOMES, AND OTHER LOCATIONS WHERE POPULATIONS MOST AFFECTED BY HEALTH DISPARITIES CONGREGATE. MARY HITCHCOCK MEMORIAL HOSPITAL DISSEMINATED THE SURVEY TOGETHER WITH MULTIPLE COMMUNITY ORGANIZATIONS THAT SERVE LOW-INCOME, FRAIL, AND HEALTH DISPARITY POPULATIONS. COMMUNITY PARTNERS PROVIDED ASSISTANCE DISSEMINATING THE SURVEY, INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHOSE MEMBERSHIP INCLUDES COMMUNITY MENTAL HEALTH SERVICES, SUBSTANCE USE SERVICES, MENTAL HEALTH PEER LEADERS, WIC PROVIDERS, SENIOR SERVICES ADVOCATES, SERVICES WORKING WITH PEOPLE WITH PHYSICAL AND DEVELOPMENTAL DISABILITIES, COMMUNITY NURSING, VISITING NURSES, AND OTHER CORE HUMAN SERVICES. IN ADDITION TO ASSISTING IN SURVEY DISSEMINATION, THESE PROVIDERS ADVOCATED FOR UNDERSERVED AND VULNERABLE POPULATIONS IN OUR REGION AS A PART OF THE CHNA PROCESS. DURING THIS CHNA PROCESS, WE MADE RESIDENT SURVEYS WIDELY AVAILABLE TO COMMUNITY RESIDENTS THROUGH PUBLIC LIST SERVES, DIRECT E-MAIL INVITATIONS TO PATIENTS OF OUR PRIMARY CARE CLINICS, SURVEY LINKS ON TOWN WEB SITES AND E-NEWS, EMPLOYEE E-NEWS IN MAJOR EMPLOYERS, AND THROUGH OTHER SYSTEMS THAT PROVIDED WIDESPREAD ACCESS TO OUR SURVEYS. WE PARTNERED CLOSELY WITH ORGANIZATIONS SERVING POPULATIONS AFFECTED BY POVERTY, LACK OF INSURANCE, HOMELESSNESS, BEHAVIORAL HEALTH CONDITIONS, AND SERIOUS AND CHRONIC ILLNESSES IN ORDER TO SURVEY THESE MEMBERS OF POPULATIONS IN OUR COMMUNITY, AND HOSTED MULTIPLE DISCUSSION GROUPS WITH PEOPLE AFFECTED BY POVERTY AND CHRONIC ILLNESS. WE RECOGNIZE THE LIMITATIONS OF OUR ENGAGEMENT OF RACIAL AND ETHNIC MINORITY MEMBERS OF OUR COMMUNITY AND ARE WORKING TO IMPROVE THIS PART OF OUR CHNA PROCESS. THIS POPULATION IS QUITE SMALL: 0.9% OF THE POPULATION OF GRAFTON COUNTY, NH IDENTIFIES AS AFRICAN AMERICAN, 0.4% AS NATIVE AMERICAN, 1.8% AS HISPANIC/LATINO, 3.0% AS ASIAN. 92.1% OF THE MHMH HOSPITAL SERVICE AREA'S RESIDENTS IDENTIFY AS CAUCASIAN. WIDE DISPERSAL OF THIS POPULATION ACROSS A LARGE GEOGRAPHY FURTHER COMPLICATES ENGAGEMENT EFFORTS. HOUSEHOLD MEDIAN INCOME, INSURANCE STATUS, AND OTHER INDICATORS OF POVERTY ARE SIGNIFICANT DRIVERS OF DISPARITY IN OUR REGION. POVERTY RATES RANGE WIDELY BY TOWN, WITH A RANGE BY TOWN OF 2% TO 16% OF HOUSEHOLDS LIVING ON INCOMES BELOW 100% OF FEDERAL POVERTY LEVEL. THESE POPULATIONS FACE NOTABLE HEALTH DISPARITY CONDITIONS ASSOCIATED WITH POVERTY AND OTHER SOCIAL DETERMINANTS OF HEALTH. (CONTINUED PART vi) Schedule H, Part V, Section B, Line 6a Facility 1, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING FEBRUARY 2021 - OCTOBER 2021, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO PARTNERED WITH NEIGHBORING HOSPITALS AND ORGANIZATIONS INCLUDING VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL, MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER, VISITING NURSE & HOSPICE OF VT/NH AND LAKE SUNAPEE VNA. WE USED SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION. Schedule H, Part V, Section B, Line 6b Facility 1, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING FEBRUARY 2021 - OCTOBER 2021, IN ADDITION TO WORKING WITH DARTMOUTH-HITCHCOCK CLINIC, MHMH WORKED CLOSELY WITH THE MEMBER ORGANIZATIONS OF THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY (60+ MEMBER ORGANIZATIONS) AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL TO DISSEMINATE SURVEYS, SERVE AS KEY INFORMANTS, AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT Schedule H, Part V, Section B, Line 7 Facility 1, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE CHNA WAS DISTRIBUTED TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE REGION INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHICH IS A MEMBERSHIP GROUP OF REGIONAL NON-PROFIT, MUNICIPAL, SAFETY, HUMAN SERVICE, AND PUBLIC HEALTH ORGANIZATIONS. IT IS ALSO AVAILABLE FROM THE ORGANIZATION UPON REQUEST AND IS POSTED ON THE MHMH WEB PAGE (HTTPS://WWW.DARTMOUTH-HEALTH.ORG/SITES/DEFAULT/FILES/2023-07/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF) Schedule H, Part V, Section B, Line 11 Facility 1, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH IS INCREASING COMMUNITY BENEFITS SPENDING TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE MOST RECENT CHNA IN AREAS OF TRAUMA AND VIOLENCE, SOCIAL DETERMINANTS OF HEALTH, IMPROVING ACCESS TO HEALTH CARE, AND NEEDS OF OLDER ADULTS, AS WELL AS MAINTAINING ONGOING INVESTMENTS IN BEHAVIORAL HEALTH AND SUBSTANCE USE NEEDS, STRENGTHENING FAMILIES AND CHILDREN, AND CANCER CARE AND TREATMENT. IN FY 2024, MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN OUR PREVIOUS COMMUNITY HEALTH IMPROVEMENT PLANS. AREAS WERE ANALYZED AND MHMH RESPONDED BY INCREASING INVESTMENTS, MAINTAINING SIMILAR LEVELS OF INVESTMENTS FOR SERVICES AND INITIATIVES, OR LIMITING INVESTMENT IN AREAS WHERE OTHER COMMUNITY ORGANIZATIONS ALREADY PROVIDE LEADERSHIP AND SERVICES TO ADDRESS THE NEED, AND/OR WHERE THE IDENTIFIED NEED IS SIGNIFICANTLY OUTSIDE THE MISSION/SERVICES/SCOPE OF MHMH. MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT PLAN IS A 3-YEAR DOCUMENT IDENTIFYING ANTICIPATED INVESTMENTS AND ACTIVITIES THAT IT WILL TAKE TO ADDRESS NEEDS IDENTIFIED IN THE MOST RECENT UPPER VALLEY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). Schedule H, Part V, Section B, Line 13 Facility 1, 1 Facility 1, 1 - MARY HTCHCOCK MEMORIAL HOSPITAL. 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 MHMH. Schedule H, Part V, Section B, Line 13 Facility 1, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH 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, 1 Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON MHMH'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. MHMH PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. MHMH CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, MHMH 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. MHMH SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, MHMH 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. 0 Schedule H, Part V, Section A FACILITY INFORMATION THE HOSPITAL HAS A SECOND CANCER TREATMENT CENTER LOCATED IN SAINT JOHNSBURY, VERMONT. THIS LOCATION IS REGISTERED UNDER THE SAME LICENSE AS THE ORGANIZATION'S MAIN CAMPUS LOCATED IN LEBANON, NEW HAMPSHIRE. Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG MHMH USES THE FPG GUIDELINES IN DETERMINING THE INITIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED. IN ADDITION, MHMH ALLOWS FOR CATASTROPHIC ASSISTANCE CONSIDERATION BASED ON A CALCULATION OF 10% OF TWO YEARS' INCOME PLUS 10% OF AMOUNT OVER SHELTERED ASSETS. IF THE PROJECTED OR CURRENT SELF-PAY BALANCE IS GREATER THAN THIS CALCULATION, THE SELF-PAY BALANCE IS REDUCED TO THE SUM OF 10% OF TWO YEARS' INCOME PLUS 10% OF ASSETS. EACH HOUSEHOLD IS ALLOWED CERTAIN SHELTERED ASSETS WHICH ARE NOT USED WHEN CALCULATING HOUSEHOLD INCOME OR ASSETS. SAVINGS IS SHELTERED UP TO 100% OF FPL BASED ON FAMILY SIZE, EQUITY IN PRIMARY RESIDENCE UP TO $200,000 UP TO AGE 55 AND $250,000 FOR PATIENTS AGED 55 AND OLDER, AND A RETIREMENT SHELTER OF UP TO $100,000 IN RETIREMENT ASSETS AS LONG AS THE FUNDS ARE EMPLOYER-BASED CONTRIBUTIONS (IF WORKING) OR IN AN IRA (IF SELF-EMPLOYED). IF A PATIENT IS RETIRED, PRIOR RETIREMENT ACCOUNTS WOULD BE INCLUDED AS A SHELTERED ASSET. Schedule H, Part I, Line 6a COMMUNITY BENEFITS REPORT MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND FILES A CONSOLIDATED COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW HAMPSHIRE. FOR PURPOSES OF IRS FORM 990, SCHEDULE H, ONLY MARY HITCHCOCK MEMORIAL HOSPITAL NUMBERS WERE USED. ALL AMOUNTS RELATING TO DHC WERE EXCLUDED. THE NEW HAMPSHIRE COMMUNITY BENEFITS REPORT FILED FOR FISCAL YEAR 2024 SHOWS THAT COMBINED, DHC AND MHMH PROVIDED BENEFIT TOTALING $326,680,381. Schedule H, Part V, Section B, Line 5 PERSONS WHO REPRESENT BROAD INTERESTS OF COMMUNITY SERVED CONT DURING OUR ASSESSMENT PROCESS, MHMH MADE SPECIFIC EFFORTS TO CONTACT AND RECEIVE INPUT FROM MEMBERS OF INCOME-VULNERABLE POPULATIONS, INCLUDING: *SURVEYS DISTRIBUTED AT A COVID VACCINATION CLINIC DESIGNATED FOR MEMBERS OF THE BIPOC COMMUNITY * VIRTUAL DISCUSSION GROUP WITH PEOPLE RECEIVING MEDICATION ASSISTED TREATMENT FOR OPIATE USE DISORDER (JANUARY 25, 2021). * VIRTUAL DISCUSSION GROUP WITH ADULTS WHO REGULARLY ACCESS FOOD VIA LOCAL FOOD SHELVES (1/26/2021). * VIRTUAL DISCUSSION GROUP WITH PEOPLE IDENTIFYING AS HAVING COMPLEX HEALTH CONDITIONS (1/26/2021.) * VIRTUAL DISCUSSION GROUP WITH COMMUNITY HEALTH WORKERS SERVING CHRONICALLY ILL, AND OTHERWISE VULNERABLE OLDER ADULTS IN REGIONAL TOWNS (1/26/2021.) * VIRTUAL DISCUSSION GROUP WITH RECOVERY COACHES SERVING PEOPLE WITH SUBSTANCE USE DISORDER (1/27/2021.) *VIRTUAL DISCUSSION GROUP WITH MEMBERS OF THE COMMUNITY AGES 65+ RECEIVING SERVICES FROM THE LAKE SUNAPEE VISITING NURSE ALLIANCE (1/28/2021). * WORKING WITH THE GOOD NEIGHBOR HEALTH CLINIC AND MASCOMA COMMUNITY HEALTH CENTER TO DISSEMINATE SURVEYS TO PATIENTS WHO ARE UNINSURED AND LOW-INCOME. DISSEMINATING SURVEYS AT THE UPPER VALLEY HAVEN (SHELTER); LISTEN COMMUNITY SERVICES (BASIC NEED SUPPORT, FOOD SHELF, AND COMMUNITY DINNERS); TO PARENTS OF CHILDREN IN DARTMOUTH-HITCHCOCK AND ALICE PECK DAY'S PEDIATRICS CLINICS; VIA WOMEN, INFANTS, AND CHILDREN'S CLINICS; THROUGH GRAFTON COUNTY SENIOR CITIZENS COUNCIL (HOME-DELIVERED MEALS AND CONGREGATE MEALS); THROUGH VISITING NURSE AND HOSPICE OF VT AND NH (HOME-VISITING PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FOR SENIORS WITH COMPLEX HEALTH NEEDS); AND THROUGH OTHER COMMUNITY ORGANIZATIONS SERVING PEOPLE AFFECTED BY POVERTY AND POOR HEALTH. IN FY21 MHMH STAFF WORKED CLOSELY WITH UPPER VALLEY STRONG AND GREATER SULLIVAN STRONG, RAPID-FORMING COMMUNITY RESPONSE COALITIONS EACH WITH 50+ COMMUNITY ORGANIZATION MEMBERS, TO SHARE INFORMATION AND ASSESS COMMUNITY NEEDS ABOUT REAL-TIME IMPACTS OF COVID-19, INCLUDING SHARING INFORMATION ABOUT PREVENTION, RISK REDUCTION, VACCINATIONS, AND IMPACT OF COVID-19 ON COMMUNITY SOCIAL SAFETY ORGANIZATIONS, HELPING TO COORDINATE COMMUNITY RESPONSE AND KEEP CRITICAL COMMUNITY SERVICES OPEN AND FUNCTIONING DESPITE COVID-19 RELATED COMMUNITY DISRUPTIONS. Schedule H, Part I, Line 7g Subsidized Health Services THE ORGANIZATION DID NOT INCLUDE ANY SUBSIDIZED HEALTH SERVICE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC ON PART I, LINE 7G. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 41336812 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. Schedule H, Part II Community Building Activities COMMUNITY BUILDING ACTIVITIES INCLUDE CONTINUING EXPENSES RELATED TO COALITIONS SUCH AS ONES THAT ADDRESS REGIONAL PUBLIC HEALTH NETWORKS, IMPROVEMENT IN SYSTEMS OF CARE FOR SUBSTANCE USE AND MENTAL HEALTH DISORDERS, PREVENTION OF SUBSTANCE ABUSE, FALLS REDUCTION FOR OLDER ADULTS, AND PRESCRIPTION DRUG MISUSE. IT ALSO INCLUDES SUPPORTING INVESTMENTS IN REGIONAL PUBLIC TRANSPORTATION AND AFFORDABLE HOUSING INITIATIVES AND WORKFORCE TRAINING INITIATIVES THAT ENABLE UNEMPLOYED AND MARGINALLY EMPLOYED PERSONS TO ACCESS CAREERS IN OUR HOSPITAL, OTHER HEALTH CARE SETTINGS, AND OTHER REGIONAL EMPLOYERS. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount BASED ON ACCOUNTING GUIDANCE, BAD DEBT IS RECORDED AS A REDUCTION TO NET PATIENT REVENUE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The hospital is unable to estimate accurately the amount of bad debt expense attributable to patients eligible for financial assistance. Although a portion of bad debt expense may be related to patients who would qualify for charity care, a reportable figure cannot be reasonably estimated. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote MHMH 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 used to calculate the amounts reported as Medicare shortfalls was derived from the Internal Revenue Service's Worksheet B as provided for Part III calculations. MHMH had revenues of $199,647,423 and costs of $287,978,621 for services not included on the Medicare Cost Report (Ambulance Services, Laboratory and other fee screens, and Medicare Part C & D services). MHMH incurred a net loss of $88,331,196 on the provision of these services. Because of the central role of the organization in serving the healthcare needs of its community and the demographic characteristics of the community served, it is likely that a portion of the Medicare shortfall should be considered community benefit expenditure. MHMH has not identified a specific amount of Medicare shortfall that should be reported as such. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance MHMH 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 D-H CREDIT AND COLLECTIONS POLICY. Schedule H, Part V, Section B, Line 16a FAP website 1 - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16a URL: https://www.dartmouth-hitchcock.org/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website 1 - MARY HITCHCOCK MEMORIAL HOSPITAL: 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 1 - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16c URL: https://www.dartmouth-hitchcock.org/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY NEEDS ASSESSMENT AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT. DARTMOUTH-HITCHCOCK PARTICIPATES WITH OTHER HEALTH CARE CHARITABLE TRUSTS AND COMMUNITY PARTNERS IN EACH OF OUR SERVICE AREAS TO COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENTS. DURING FY2022, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL, TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO WORKED TOGETHER WITH NEIGHBORING HOSPITALS, INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CLINIC, VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL, AND VISITING NURSE & HOSPICE OF VT & NH TO USE SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENTS TOOLS AND APPROACHES, TO ALLOW COMPARABILITY OF HEALTH DATA ACROSS A WIDER GEOGRAPHIC REGION. COLLECTIVELY D-H AND PARTNERED HOSPITALS HIRED COMMUNITY HEALTH INSTITUTE/JOHN SNOW RESEARCH AND TRAINING INSTITUTE, A PUBLIC HEALTH CONSULTING FIRM, TO PROVIDE TECHNICAL ASSISTANCE AND ANALYSIS RELATED TO OUR COMMUNITY HEALTH NEEDS ASSESSMENTS. THE NEEDS ASSESSMENT INCLUDED REVIEWING SELECTED SERVICE AREA DEMOGRAPHICS; PUBLIC HEALTH DATA AVAILABLE THROUGH NH AND VT HEALTH DEPARTMENTS, HOSPITAL DISCHARGE DATA, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND YOUTH RISK BEHAVIOR SURVEYS; FOCUS GROUPS WITH EMPLOYERS AND WITH COMMUNITY MEMBERS RECEIVING SERVICES AT REGIONAL SAFETY NET SERVICE ORGANIZATIONS; ELECTRONIC SURVEYS OF PROFESSIONAL HEALTH AND SOCIAL SERVICE PROVIDERS; AS WELL AS PAPER AND ELECTRONIC CONVENIENCE SURVEYS OF COMMUNITY RESIDENTS. FINDINGS OF THE FY2022 COMMUNITY HEALTH NEEDS ASSESSMENT WERE REVIEWED AT 2 LARGE VIRTUAL COMMUNITY MEETINGS (80+ TOTAL STAKEHOLDERS) HOSTED IN CONCERT WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY AND OTHERS FOR FURTHER COMMENTS AND FEEDBACK. THE FINDINGS WERE ALSO REVIEWED IN 16 DEPARTMENT MEETINGS WITHIN MHMH INCLUDING MORE THAN 50 STAFF. ADDITIONALLY, MHMH COMMUNITY HEALTH STAFF PARTICIPATE IN OR LEAD MULTIPLE COMMUNITY COALITIONS AND PROJECTS CONNECTING US TO 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 ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PROACTIVELY 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 OUR REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTIONS 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 ORGANIZATION DEFINES ITS SERVICE REGION AS NEW HAMPSHIRE AND EASTERN VERMONT, WITH THE LARGEST PRESENCE IN A 19-TOWN HOSPITAL SERVICE AREA REGION ADJOINING LEBANON, NEW HAMPSHIRE, SITE OF DARTMOUTH-HITCHCOCK MEDICAL CENTER WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC'S MAIN NORTHERN CLINIC. THE 19-TOWN HOSPITAL SERVICE AREA REGION HAS A POPULATION OF 70,000 PEOPLE, WITH TOWNS RANGING IN POPULATION FROM 200-14,000 PEOPLE. THESE TOWNS ARE GENERALLY CONSIDERED RURAL, THOUGH THE HANOVER, LEBANON, NH AND HARTFORD, VT COMMUNITIES ARE CONSIDERED TO BE A MICROPOLITAN AREA. AMONG THE REGION'S 19 TOWNS, MEDIAN HOUSEHOLD INCOME VARIES WIDELY, FROM $50K-$120K ANNUALLY. 17.5% OF THE POPULATION IS OVER THE AGE OF 65; 11% OF CHILDREN LIVE IN HOUSEHOLDS WHOSE MEDIAN HOUSEHOLD INCOME IS LESS THAN 100% OF FEDERAL POVERTY LEVEL, 26.8% OF CHILDREN LIVE IN HOUSEHOLDS WITH INCOME LESS THAN 200% OF FEDERAL POVERTY LEVEL; 1.5% OF THE REGION'S RESIDENTS HAVE LIMITED ENGLISH PROFICIENCY; AND 7.1% LACKED HEALTH INSURANCE. 11.8% OF NH RESIDENTS AND 24.9% OF VERMONT RESIDENTS ARE MEDICAID BENEFICIARIES. THE REGION IS SERVED BY MHMH AND BY ALICE PECK DAY MEMORIAL HOSPITALS. THERE ARE NO FEDERALLY QUALIFIED HEALTH CENTERS OPERATING WITHIN THE REGION, THOUGH ONE REGIONAL COMMUNITY HEALTH CLINIC IS PURSUING THIS STATUS. THE GOOD NEIGHBOR HEALTH CLINIC, IN HARTFORD, VT, OFFERS CARE TO UNINSURED COMMUNITY MEMBERS. TWO MINOR CIVIL DIVISIONS IN OUR REGION, DORCHESTER NH AND PIERMONT NH, ARE CONSIDERED MEDICALLY UNDERSERVED AREAS. MHMH SERVES THE GENERAL POPULATION WITH A WIDE RANGE OF SERVICES. IN ADDITION TO GENERAL HOSPITAL POPULATIONS, THE ORGANIZATION PROVIDES SERVICES TO PATIENTS WITH HIGHLY-SPECIALIZED NEEDS THAT ARE NOT AVAILABLE ELSEWHERE IN NEW HAMPSHIRE. MHMH IS THE STATE'S ONLY TERTIARY REFERRAL CENTER, PROVIDES THE STATE'S ONLY COMPREHENSIVE CANCER CENTER (NORRIS COTTON CANCER CENTER ~ NCCC), OPERATES THE ONLY LEVEL I TRAUMA CENTER IN NEW HAMPSHIRE, OPERATES THE ONLY COMPREHENSIVE CHILDREN'S HOSPITAL AND ACCREDITED PEDIATRIC TRAUMA CENTER IN NEW HAMPSHIRE (CHILDREN'S HOSPITAL AT DARTMOUTH - CHAD), HOSTS THE ONLY LEVEL IV NEONATAL INTENSIVE CARE NURSERY, HAS ONE OF TWO PEDIATRIC INTENSIVE CARE UNITS IN NEW HAMPSHIRE, AND OPERATES THE ONLY HELICOPTER TRANSPORT SERVICE IN THE STATE. AS SUCH, THE SERVICE POPULATION IS BOTH THE GENERAL PUBLIC SEEKING PRIMARY HEALTH CARE SERVICES AS WELL AS RESIDENTS WITH UNIQUE AND HIGHLY-SPECIALIZED HEALTH CARE NEEDS. Schedule H, Part VI, Line 5 Promotion of community health MHMH supports organizations and initiatives that further health by strengthening and developing key community capacities to address identified community health needs. This includes hosting or leading community partnerships to address substance misuse and treatment and to improve public health; providing funding for child and adult oral health initiatives, and participation of our staff in other partnerships including the outpatient falls prevention task force, the transportation management association, and the Upper Valley Housing Coalition. In addition, MHMH operates health education and support services such as a women's health resource center, the aging resource center, and a health education center. MHMH uses cash contributions, contracted services, and in-kind contributions of staff time and expertise to support these strategies which improve community health. At MHMH's Lebanon, NH campus, the hospital 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 the Geisel School of Medicine at Dartmouth College. MHMH's trustees annually set strategic priorities for the institution and approve operating and capital budgets which support improvements, patient care, medical education, and research. Examples of these investments include the development of MHMH's patient safety and training center; ongoing quality and patient safety initiatives; purchases of new and emerging medical technologies; support for translational research, and medical education. Of the 16 voting members of the Mary Hitchcock board of trustees at the end of FY24, 10 are neither contractors nor employees of MHMH. Schedule H, Part VI, Line 6 Affiliated health care system COMMUNITY BENEFITS ARE PROVIDED BY THE DARTMOUTH HEALTH SYSTEM, WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, AND OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IN LEBANON IS NEW HAMPSHIRE'S LARGEST HOSPITAL. IN FISCAL YEAR 2024 MHMH HAD 460 LICENSED INPATIENT BEDS. THE DARTMOUTH-HITCHCOCK CLINIC (DHC) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE WITH A NETWORK OF PROVIDERS ACROSS NEW HAMPSHIRE AND VERMONT. WHILE DHC'S MAIN OFFICES ARE LOCATED IN LEBANON, THE CLINIC ALSO HAS MULTI-SPECIALTY PRACTICES IN MANCHESTER, NASHUA, CONCORD, AND KEENE, NH AREAS AS WELL AS BENNINGTON, VT. IN ADDITION, THE CLINIC PROVIDES PRIMARY CARE IN RURAL COMMUNITIES IN VERMONT AND NORTHERN NEW HAMPSHIRE. THE HOSPITAL AND CLINIC OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING AND MANAGEMENT AND THEY SHARE IDENTICAL MISSIONS. THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH COLLEGE, WHICH WORKS CLOSELY WITH THE HOSPITAL AND CLINIC, IS FOCUSED ON MEDICAL EDUCATION AND RESEARCH. Schedule H, Part VI, Line 7 State filing of community benefit report NH true American Cancer Society 2 Commerce Drive Suite 110 BEDFORD NH 03110 131788491 501(c)3 28000 FMV PROGRAM SUPPORT Amoskeag Health 145 Hollis Street MANCHESTER NH 03101 020458174 501(c)3 28000 FMV PROGRAM SUPPORT Baby Steps Family Assistance 169 Main St Suite 211 CLAREMONT NH 03743 821200566 501(c)3 10500 FMV PROGRAM SUPPORT BAYLOR COLLEGE OF MEDICINE PO BOX 301207 DALLAS TX 753031207 741613878 501(c)3 31117 FMV CHARITABLE RESEARCH BOARD OF REGENTS OF UNIV OF NEBRASKA UNIV OF NEBRASKA MEDICAL CENTER 985045 NEBRASKA MED CTR OMAHA NE 681985045 470049123 STATE OF NE 21111 FMV EDUCATIONAL SERVICES BOSTON MEDICAL CENTER ATTN ELTA ETIENNE 660 HARRISON AVE GAMBRO 2 BOSTON MA 02118 043314093 501(c)3 18743 FMV CHARITABLE RESEARCH BOSTON UNIVERSITY PO BOX 28763 NEW YORK NY 100878763 042103547 501(c)3 27769 FMV CHARITABLE RESEARCH CENTERSTONE RESEARCH INSTITUTE INC 44 VANTAGE WAY NASHVILLE TN 372197520 262505456 501(c)3 123487 FMV CHARITABLE RESEARCH CHILDREN'S HOSPITAL VICTORIA CUNNIGHAM 300 LONGWOOD AVENUE BOSTON MA 02115 042774441 501(c)3 34935 FMV CHARITABLE RESEARCH CHILDREN'S HOSPITAL LOS ANGELES 4650 SUNSET BOULEVARD LOS ANGELES CA 90027 195612191 501(c)3 28564 FMV CHARITABLE RESEARCH CHILDREN'S HOSPITAL OF PHILADELPHIA LOCKBOX 7932 PHILADELPHIA PA 191787932 231352166 501(c)3 44485 FMV CHARITABLE RESEARCH City of Lebanon City Hall 51 Park Street LEBANON NH 03766 026000473 Lebanon, NH 247280 FMV PROGRAM SUPPORT Claremont Learning Partnership 169 Main Street CLAREMONT NH 03743 820901496 501(c)3 10500 FMV PROGRAM SUPPORT Claremont Soup Kitchen Inc 51 Central Street CLAREMONT NH 03743 020367045 501(c)3 7000 FMV PROGRAM SUPPORT COLBY-SAWYER COLLEGE FINANCIAL SERVICES 541 MAIN STREET NEW LONDON NH 03257 020222120 STATE OF NH 69008 FMV EDUCATIONAL SERVICES COMMUNITY ACTION PROGRAM BELKNAP 2 INDUSTRIAL PARK DR CONCORD NH 03301 020270376 501(c)3 10500 FMV CHARITABLE PROGRAM SUPPORT COMMUNITY COLLEGE SYSTEM NEW HAMPSHIRE C/O RIVER VALLEY COMM COLLEGE ONE COLLEGE DRIVE CLAREMONT NH 037439707 900531902 STATE OF NH 112588 FMV EDUCATIONAL SERVICES Community Nurse Connection PO Box 1302 LEBANON NH 03766 831224873 501(c)3 30100 FMV CHARITABLE PROGRAM SUPPORT Early Care and Education Association Po Box 5428 WEST LEBANON NH 03784 853076751 501(c)3 17500 FMV PROGRAM SUPPORT Families Flourish Northeast 235 Whitford Street MANCHESTER NH 03104 844591232 501(c)3 21000 FMV PROGRAM SUPPORT FAMILY PLACE INC 319 US ROUTE 5 SOUTH NORWICH VT 05055 030305264 501(c)4 49928 FMV CHARITABLE EDUCATIONAL SERVICES Foundation for Healthy Communities (NHHA) 125 Airport Road CONCORD NH 03301 020275078 501(c)3 605323 FMV PROGRAM SUPPORT Girls Incorporated of New Hampshire 1711 South Willow Street Unit 5 MANCHESTER NH 03103 237416090 501(c)3 7000 FMV PROGRAM SUPPORT Good Neighbor Health Clinic POBox 1250 WHITE RIVER JUNCTION VT 05001 030346949 501(c)3 56000 FMV PROGRAM SUPPORT Grafton County Senior Citizens Council 10 Campbell St LEBANON NH 03766 237248316 501(c)3 16100 FMV PROGRAM SUPPORT GRANITE UNITED WAY 22 CONCORD STREET MANCHESTER NH 03101 026006033 501(c)3 48327 FMV EDUCATIONAL SERVICES Hartford Community Coalition POBox 4343 WHITE RIVER JUNCTION VT 05001 824272638 501(c)3 24515 FMV PROGRAM SUPPORT HIVHCV Resource Center 2 Blacksmith Street LEBANON NH 03766 223104237 501(c)3 14000 FMV PROGRAM SUPPORT JOHNS HOPKINS UNIVERSITY 3910 KESWICK ROAD N4327-B BALTIMORE MD 21211 520595110 501(c)3 22089 FMV EDUCATIONAL SERVICES JSI RESEARCH &TRAINING INSTITUTE INC 501 South Street 2nd Floor BOW NH 03304 042679824 501(c)3 17500 FMV PROGRAM SUPPORT KAISER FOUNDATION RESEARCH INSTITUTE KAISER FOUNDATION HOSPITAL P O BOX 748165 LOS ANGELES CA 900748165 941105628 501(c)3 662369 FMV CHARITABLE RESEARCH LISTEN COMMUNITY SERVICES 60 HANOVER ST LEBANON NH 03766 237225952 501(c)3 50058 FMV CHARITABLE PROGRAM SUPPORT MAGEE-WOMENS RESEARCH INSTITUTE AND FDN 3240 CRAFT PLACE PITTSBURGH PA 15213 251462312 501(c)3 6037 FMV CHARITABLE RESEARCH MAINE COUNCIL ON AGING PO BOX 988 BRUNSWICK ME 04011 461549012 501(c)3 24666 FMV CHARITABLE PROGRAM SUPPORT MASSACHUSETTS GENERAL HOSPITAL 100 CHARLES RIVER PLAZA STE 600 BOSTON MA 021142792 042697983 501(c)3 43636 FMV CHARITABLE PROGRAM SUPPORT MAYO CLINIC PO BOX 4003 ROCHESTER MN 55905 416011702 501(c)3 12414 FMV CHARITABLE RESEARCH MAYO CLINIC ARIZONA PO BOX 860334 MINNEAPOLIS MN 554860334 860800150 501(c)3 7746 FMV CHARITABLE RESEARCH MEMORIAL SLOAN-KETTERING CANCER CENTER PO BOX 27084 NEW YORK NY 100876352 131924236 501(c)3 47755 FMV CHARITABLE RESEARCH Millennium Running LLC 138 Bedford Ct Road BEDFORD NH 03110 352410359 12600 FMV PROGRAM SUPPORT MONADNOCK UNITED WAY 23 CENTER STREET KEENE NH 03431 020236885 501(c)3 14000 FMV CHARITABLE PROGRAM SUPPORT MT ASCUTNEY HOSPITAL AND HEALTH CENTER 289 COUNTY RD WINDSOR VT 05089 030183721 501(c)3 21000 FMV CHARITABLE RESEARCH MY CNA NOW LLC DBA LNA HEALTH CAREERS 22 CONCORD ST 3RD FLOOR MANCHESTER NH 03101 850569951 For Profit 15820 FMV CHARITABLE RESEARCH NAVAL HEALTH RESEARCH CENTER 140 SYLVESTER ROAD SAN DIEGO CA 92106 800520146 501(c)3 76699 FMV CHARITABLE RESEARCH New Hampshire Hunger Solutions Inc POBox 3477 CONCORD NH 03301 222936618 501(c)3 17500 FMV PROGRAM SUPPORT NEW HAMPSHIRE LEGAL ASSISTANCE 117 NORTH STATE STREET CONCORD NH 03301 020300897 501(c)3 107810 FMV CHARITABLE PROGRAM SUPPORT NH Children's Trust Inc 10 Ferry Street Suite 315 CONCORD NH 03301 272458454 501(c)3 10500 FMV PROGRAM SUPPORT NORTH COUNTRY HEALTH CONSORTIUM INC 262 COTTAGE STREET LITTLETON NH 03561 020503184 501(c)3 28162 FMV CHARITABLE PROGRAM SUPPORT OREGON CLINIC PC 847 NE 19TH AVENUE PORTLAND OR 97232 931127856 501(c)3 195499 FMV CHARITABLE RESEARCH OREGON HEALTH & SCIENCE UNIVERSITY PO BOX 575 PORTLAND OR 97207 931176109 501(c)3 130583 FMV CHARITABLE EDUCATIONAL SERVICES PRONTO INTERNATIONAL 5419 Greenwood Ave N SEATTLE WA 98103 461318242 501(c)3 17500 FMV PROGRAM SUPPORT PUBLIC HEALTH COUNC OF THE UPPER VALLEY ONE COURT STREET LEBANON NH 03766 752991608 501(c)3 57645 FMV CHARITABLE PROGRAM SUPPORT RECTOR & VISITORS OF UNIV OF VIRGINIA JOHN W STEINKE PO BOX 801355 CHARLOTTESVILLE VI 229081355 546001796 STATE OF VA 45243 FMV EDUCATIONAL SERVICES RESEARCH INSTITUTE AT NATIONWIDE CHILDRE PO BOX 781653 DETROIT MI 482781653 316055230 501(c)3 33803 FMV CHARITABLE RESEARCH RHODE ISLAND HOSPITAL PO BOX 373 PROVIDENCE RI 02901 050258954 501(c)3 13152 FMV CHARITABLE RESEARCH RIVER VALLEY COMMUNITY COLLEGE RVCC BOOKSTORE 967 CLAREMONT NH 03743 540903278 STATE OF NH 99173 FMV EDUCATIONAL SERVICES RUTGERS THE STATE UNIVERSITY OF NJ 33 KNIGHTSBRIDGE ROAD PISCATAWAY NJ 08854 226001086 501(c)3 28428 FMV EDUCATIONAL SERVICES Safeline Inc POBox 368 CHELSEA VT 05038 030332395 501(c)3 7000 FMV PROGRAM SUPPORT SEVEN COUNTIES SERVICES INC ATTN ACCTS RECEIVABLE 10401 LINN STATION RD LOUISVILLE KY 40223 310939757 501(c)3 190986 FMV CHARITABLE RESEARCH SINAI HOSPITAL OF BALTIMORE INC 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 520486540 501(c)3 9785 FMV CHARITABLE RESEARCH Southeast Vermont Transit Inc 706 Rockingham Road ROCKINGHAM VT 05101 030353976 501(c)3 21000 FMV PROGRAM SUPPORT Southwestern Community Services PO Box 603 / 63 Community Way KEENE NH 03431 026013808 501(c)3 14000 FMV CHARITABLE PROGRAM SUPPORT STANFORD UNIVERSITY ADMINISTRATION PO BOX 884253 LOS ANGELES CA 900884253 941156365 501(c)3 24917 FMV CHARITABLE PROGRAM SUPPORT STATE OF NEW HAMPSHIRE 25 Capitol St CONCORD NH 03301 026000618 501(c)3 14000 FMV PROGRAM SUPPORT THE BRIGHAM AND WOMEN'S HOSPITAL INC 75 FRANCIS ST BOSTON MA 02115 042312909 501(c)3 56911 FMV CHARITABLE RESEARCH The Hitchcock Foundation One Medical Center Drive LEBANON NH 03756 020222139 501(c)3 474772 FMV PROGRAM SUPPORT The Second Wind Foundation 200 Olcott Drive WHITE RIVER JUNCTION VT 05001 020451558 501(c)3 10500 FMV PROGRAM SUPPORT THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO 7703 FLOYD CURL DRIVE SAN ANTONIO TX 782293900 741586031 STATE OF TX 58978 FMV EDUCATIONAL SERVICES TLC FAMILY RESOURCE CENTER 62 PLEASANT ST CLAREMONT NH 03743 522439830 501(c)3 42262 FMV CHARITABLE PROGRAM SUPPORT Town of Hartford School District 37 Highland Ave WHITE RIVER JUNCTION VT 05001 036000504 501(c)3 9800 FMV PROGRAM SUPPORT Tri-Valley Transit 279 Creek Road MIDDLEBURY VT 05753 030335768 501(c)3 44111 FMV PROGRAM SUPPORT TRUSTEES OF DARTMOUTH COLLEGE CASHIERS OFFICE / AR 6132 MCNUTT RM 103 HANOVER NH 03755 020222111 501(c)3 2423077 FMV CHARITABLE EDUCATIONAL SERVICES TRUSTEES OF THE UNIV OF PENNSYLVANIA THE WHARTON SCHOOL LOCKBOX 9726 PHILADELPHIA PA 191789726 231352685 STATE OF PA 36528 FMV EDUCATIONAL SERVICES Twin Pines Housing Trust 226 Holiday Drive Suite 20 WHITE RIVER JUNCTION VT 05001 222809527 501(c)3 28000 FMV PROGRAM SUPPORT UMASS MEDICAL SCHOOL 222 MAPLE AVENUE SHREWSBURY MA 01545 042911067 STATE OF MA 9091 FMV EDUCATIONAL SERVICES UNIVERSITY OF ALABAMA AT BIRMINGHAM GRANTS CONTRACTS ACCOUNTING 1720 2ND AVE SOUTH BIRMINGHAM AL 352940109 636005396 STATE OF AL 140281 FMV EDUCATIONAL SERVICES UNIVERSITY OF CALIFORNIA SAN FRANCISCO SUNDRY DEBTOR - BOX 0815 SAN FRANCISCO CA 94143 946036493 STATE OF CA 9748 FMV EDUCATIONAL SERVICES UNIVERSITY OF CALIFORNIA SAN DIEGO BIOCHEMICAL GENETICS LABORATORY 9500 GILMAN DRIVE BOX 0830 LA JOLLA CA 920930830 956006144 STATE OF CA 39519 FMV EDUCATIONAL SERVICES UNIVERSITY OF COLORADO ANSCHUTZ UNIVERSITY OF COLORADO 12801 E 17th AVE L18-10101 MAIL AURORA CO 80045 846000555 STATE OF CO 98502 FMV EDUCATIONAL SERVICES UNIVERSITY OF FLORIDA 123 GRINTER HALL GAINESVILLE FL 32611 596002052 STATE OF FL 66881 FMV EDUCATIONAL SERVICES UNIVERSITY OF MARYLAND PO BOX 41428 BALTIMORE MD 212036428 526002033 STATE OF MD 125225 FMV EDUCATIONAL SERVICES UNIVERSITY OF PITTSBURGH PO BOX 640458 PITTSBURGH PA 152640458 250965591 STATE OF PA 79436 FMV EDUCATIONAL SERVICES UNIVERSITY OF TEXAS SOUTHWESTERN MED CTR 5323 HARRY HINES BLVD DALLAS TX 752359029 756002868 STATE OF TX 55637 FMV EDUCATIONAL SERVICES UNIVERSITY OF UTAH GRANTS CONTRACTS ACCOUNTING 201 S PRESIDENTS CIR RM 406 SALT LAKE CITY UT 841129020 876000525 STATE OF UT 8881 FMV EDUCATIONAL SERVICES UNIVERSITY OF VERMONT MEDICAL CENTER PO BOX 1902 BURLINGTON VT 05402 030179440 STATE OF VT 42955 FMV EDUCATIONAL SERVICES UNIVERSITY OF WASHINGTON GRANT CONTRACT ACCOUNTING 12455 COLLECTIONS DRIVE CHICAGO IL 60693 916001537 STATE OF WA 38605 FMV EDUCATIONAL SERVICES UNIVERSITY SYSTEM OF NEW HAMPSHIRE 5 CHANELL DRIVE CONCORD NH 03301 026000937 STATE OF NH 26434 FMV EDUCATIONAL SERVICES Upper Valley Haven 713 Hartford Ave WHITE RIVER JUNCTION VT 05001 030277908 501(c)3 76329 FMV PROGRAM SUPPORT Upper Valley Lake Sunapee Regional Planning Foundation 10 Water Street Ste 225 LEBANON NH 037661604 834074101 501(c)3 31500 FMV PROGRAM SUPPORT VIRGINIA COMMONWEALTH UNIVERSITY BOX 843035 RICHMOND VA 23219 546001758 STATE OF VA 35058 FMV EDUCATIONAL SERVICES WEILL MEDICAL COLLEGE OF CORNELL ATTN CORNELL ECHO 2001 NEW YORK NY 10021 131623978 STATE OF VA 26719 FMV EDUCATIONAL SERVICES WEST VIRGINIA UNIVERSITY RESEARCH CORPOR ONE WATERFRONT PLACE MORGANTOWN WV 265066001 550665758 STATE OF WV 9986 FMV EDUCATIONAL SERVICES WESTAT INC PO BOX 1004 ATTN ACCOUNTS RECEIVA ROCKVILLE MD 20850 840529566 For Profit 45277 FMV CHARITABLE RESEARCH White River Council on Aging 262 North Main St WHITE RIVER JUNCTION VT 05001 030261891 501(c)3 7000 FMV PROGRAM SUPPORT WILLING HANDS 198 CHURCH STREET NORWICH VT 05055 202204811 501(c)3 25043 FMV CHARITABLE PROGRAM SUPPORT Women's Information Service of the Upper Valley 38 Bank Street LEBANON NH 03766 020346512 501(c)3 14000 FMV PROGRAM SUPPORT 91 4 Awards and Educational Assistance 66 462288 FMV Patient Assistance 3011 159431 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) HAS WRITTEN GUIDELINES AND PROCEDURES. AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE DARTMOUTH INSTITUTE SCHOLARSHIPS (TDI) ARE PAID DIRECTLY TO DARTMOUTH COLLEGE ON BEHALF OF THE INDIVIDUALS RECEIVING THE AWARDS. THE COORDINATORS OF THE PROGRAM ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. X X true true false true false false false false false false false Joanne M Conroy MD Trustee, Ex-Officio, CEO 0 1470830 0 420000 0 187662 0 31590 0 19059 0 2129141 0 0 Sandra L Wong MD Trustee (through 12/31/23)/SVP Svc Ln & Dept Chair 0 724829 0 0 0 68000 0 24990 0 15204 0 833023 0 0 Carl W Dobson MD Trustee/ Medical Director (through 12/31/23) 407482 0 25000 0 23065 0 16500 0 43266 0 515313 0 0 0 Gary L Freed MD Trustee / Physician (through 12/31/23) 0 643417 0 1548 0 60533 0 24990 0 3720 0 734208 0 0 Nancy M Dunbar MD Trustee / Physician 0 366278 0 0 0 31871 0 24990 0 44225 0 467364 0 0 Laura Chiang Trustee 0 335314 0 0 0 26586 0 14994 0 40060 0 416954 0 0 Marcus Coe MD Trustee (as of 1/1/24) 0 777216 0 0 0 48673 0 24990 0 40636 0 891515 0 0 Keith Loud MD Trustee (as of 3/21/24) 0 396242 0 0 0 38604 0 31590 0 35939 0 502375 0 0 Jonathan B Thyng MD Trustee/Medical Director (as of 1/1/24) 0 348927 0 0 0 16947 0 31590 0 44450 0 441914 0 0 DANIEL P JANTZEN Former Chief Financial Officer 812887 0 148750 0 144010 0 31590 0 35375 0 1172612 0 0 0 Maria Padin MD Chief Medical Officer, CGP 0 484606 0 35700 0 40541 0 31590 0 36263 0 628700 0 0 Wendy Fielding Chief Financial Officer 363306 0 28000 0 51906 0 31590 0 16059 0 490861 0 0 0 Aimee M Claiborne Chief Human Resource Officer 486033 0 85825 0 20008 0 24990 0 19923 0 636779 0 0 0 Patrick F Jordan III MBA Chief Operating Officer 777017 0 140000 0 62855 0 31590 0 39676 0 1051138 0 0 0 Stephen Leblanc Chief Strategy Officer 0 686348 0 122500 0 109513 0 31590 0 34425 0 984376 0 0 EDWARD J MERRENS MD Chief Clinical Officer 0 723268 0 131250 0 76674 0 31590 0 19284 0 982066 0 0 Susan A Reeves EDD RN Executive VP (medical center) 674530 0 113800 0 129620 0 31590 0 11128 0 960668 0 0 0 Kimberly Troland JD Deputy Gen Counsel / Interim Chief Legal Officer (through 1/7/24) 481706 0 90995 0 59558 0 0 0 13885 0 646144 0 0 0 Matthew Haag Chief Development Officer 365972 0 69125 0 47304 0 24990 0 17725 0 525116 0 0 0 GEORGE T BLIKE MD MHCDS Former/ Chief Quality & Value Officer (DHC) 0 106407 0 0 0 0 0 7449 0 22 0 113878 0 0 Peter D Solberg MD Chief Health Information Officer 0 461656 0 35000 0 46674 0 31590 0 18889 0 593809 0 0 Staci Hermann PHARMD MS Chief Pharmacy Officer (Through March 2024) 323611 0 33500 0 15788 0 24990 0 17383 0 415272 0 0 0 Simon C Hillier Dept. Chair - Anesthesiology 0 595395 0 1299 0 40190 0 31590 0 36901 0 705375 0 0 Jeffrey Obrien MHA Chief Operating Officer - DHMC 349987 0 0 0 24788 0 31590 0 33092 0 439457 0 0 0 Martin Purcell MBA Chief Information Officer 460630 0 35075 0 70877 0 31590 0 37669 0 635841 0 0 0 David F Duncan System VP - Facilities Mgmt 303767 0 30980 0 5065 0 19800 0 26776 0 386388 0 0 0 Samuel Shields System VP - Strtgy & Rgnl Ops 313919 0 37800 0 6472 0 24990 0 2605 0 385786 0 0 0 Tracy Galvin Chief Nursing Officer 203677 0 20000 0 1067 0 12891 0 8356 0 245991 0 0 0 Brenda L Blair System VP HR Ops 327150 0 16800 0 6894 0 31590 0 28872 0 411306 0 0 0 Martin T Manion President/CEO NLH 317497 0 40800 0 25244 0 19800 0 1250 0 404591 0 0 0 Barbara Vance VP-Research Ops 337472 0 17219 0 6593 0 19800 0 12103 0 393187 0 0 0 Christopher L Hubble MD VP Patient Safety 383440 0 20000 0 1936 0 19800 0 43789 0 468965 0 0 0 Kenneth Kelliher System VP Supply Chain 298739 0 31000 0 23491 0 19800 0 2731 0 375761 0 0 0 Schedule J, Part I, Line 1a Discretionary spending account THE ORGANIZATION HAS IN PLACE A MANAGEMENT SELF DEVELOPMENT PLAN (MSDP) DESIGNED TO PROMOTE PROFESSIONAL AND PERSONAL DEVELOPMENT. THE MSDP IS CAPPED AT 2% OF GROSS PAY AND MAY BE UTILIZED FOR EXPENSES SUCH AS PROFESSIONAL DUES, MEETINGS AND SEMINARS, TUITION REIMBURSEMENT, AND OTHER MISCELLANEOUS ITEMS THAT PROMOTE PROFESSIONAL KNOWLEDGE. ALL EXPENSES ARE SUBMITTED FOR APPROVAL BEFORE REIMBURSEMENT. Schedule J, Part I, Line 1a Health or social club dues or initiation fees THE ORGANIZATION HAS IN PLACE A MANAGEMENT SELF DEVELOPMENT PLAN (MSDP) DESIGNED TO PROMOTE PROFESSIONAL AND PERSONAL DEVELOPMENT. THE MSDP IS CAPPED AT 2% OF GROSS PAY AND MAY BE UTILIZED FOR EXPENSES SUCH AS PROFESSIONAL DUES, MEETINGS AND SEMINARS, TUITION REIMBURSEMENT, AND OTHER MISCELLANEOUS ITEMS THAT PROMOTE PROFESSIONAL KNOWLEDGE. ALL EXPENSES ARE SUBMITTED FOR APPROVAL BEFORE REIMBURSEMENT. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC (DHC), A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, 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) and Mary Hitchcock Memorial Hospital (MHMH) sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC and MHMH 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 number of participants and dollar value continues to dwindle as individuals retire/leave the organization. THE FOLLOWING INDIVIDUALS HAVE A SPLIT DOLLAR LIFE PLAN ARRANGEMENT AND RESPECTIVE EMPLOYER PREMIUMS: DANIEL JANTZEN $148,478 STEPHEN LEBLANC $68,044 RICHARD ROTHSTEIN $105,014 Schedule J, Part II NOTE REGARDING COMPENSATION FORM 990, SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY MHMH AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY D-H ON BEHALF OF ITS EMPLOYEES. A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 6446142B4 2014-08-13 41242990 REFUNDING false false false B NH HEALTH AND ED FACILITIES AUTHORITY 020279866 000000000 2016-07-01 35575000 REFUNDING AND CONSTRUCTION false false false A 26960000 0 41242990 0 0 0 352990 0 0 0 40890000 0 2014 true false true true B 24605000 0 35575000 0 0 0 408058 0 0 15936616 19230326 0 2017 true false true true A false false false false 0.0 0.0 0.0 false false true B false true false true true 0.0 0.0 0.0 false false true A false false false true false false false false true B false false false true true false false false true A true B true Schedule K, Part I, Column (f) Bond B THE PURPOSE OF THE ISSUE IS TO CURRENTLY REFUND THE SERIES 2013A AND SERIES 2013B DATED 10/24/2013; TO FINANCE ROUTINE CAPTIAL EXPENDITURES AND REIMBURSE EXPENDITURES IN CONNECTION WITH THE WILLIAMSON TRANSLATIONAL RESEARCH BUILDING. Schedule K, Part I, Column (a) Bonds A & B THE ISSUER NAME IS NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY. Schedule K, Part IV, Line 2c Bond B FINAL REBATE CALCULATION PERFORMED ON 08/31/2021. Schedule K, Part I, Column (f) Bond A THE PURPOSE OF THE ISSUE IS TO CURRENTLY REFUND THE SERIES 2009 DATED 08/19/2009. Schedule K, Part IV, Line 2c Bond A FORM 8038-T FILED ON 09/18/2019. THE LATEST ARBITRAGE CALCULATION PERFORMED ON 09/18/2019. Schedule K, Part II, Line 11 Bonds A & B The Other Spent Proceeds are the refunding proceeds of the issue no longer in escrow. Schedule K, Part IV, Line 2c COLUMN A Issuer name: NH HEALTH AND ED. FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 09/18/2019 Schedule K, Part IV, Line 2c COLUMN B Issuer name: NH HEALTH AND ED. FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 08/31/2021 DANIEL JANTZEN OFFICER SPLIT DOLLAR LIFE X 0 148478 false true true DEBORAH JANTZEN FAMILY MEMBER SPLIT DOLLAR LIFE X 0 74611 false true true 223089 X 2 213258 Market value 0 false true true Schedule M, Part I, Line 32b Third parties used to solicit, process, or sell noncash contributions THE ORGANIZATION USES DARTMOUTH-HITCHCOCK HEALTH, MHMH'S PARENT ORGANIZATION, FOR SOLICITATION OF CONTRIBUTIONS AND ANNUAL FUND ACTIVITIES. Schedule M, Part I Explanations of reporting method for number of contributions Securities - Publicly traded - MHMH is reporting the number of contributors of stock. Form 990, Part VI, Line 15a OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR UNDERTAKEN ALTHOUGH PAID BY A RELATED ORGANIZATION, DARTMOUTH-HITCHCOCK CLINIC, THE COMPENSATION FOR THE CEO 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 The Mary Hitchcock Memorial Hospital (MHMH) board has a Governance Committee who has the authority/responsibility of the MHMH Board to ensure that MHMH continues to fulfill its central mission and vision. This committee has authority to act on behalf of the full Board when the need arises. Members are all members of the governing board. Form 990, Part VI, Line 4 Significant changes to organizational documents MHMH'S FORMER BYLAWS CALLED FOR A BOARD OF GOVERNORS (BOG), WHICH FULFILLED TWO FUNCTIONS: PROVIDING A MEANS FOR PROVIDERS/MEDICAL STAFF TO COMMENT AND PROVIDE INPUT ON GOVERNING DECISIONS, AND TO OVERSEE MEDICAL DECISION-MAKING WITHIN THE ORGANIZATION. DURING FY '24, THE BYLAWS WERE AMENDED TO EFFECTIVELY SPLIT THESE TWO FUNCTIONS, ESTABLISHING BOTH A: * GROUP PRACTICE COUNCIL THAT IS CHARGED WITH PROVIDING A COLLECTIVE VOICE FOR MHMH MEDICAL STAFF, AND A * MEDICAL EXECUTIVE COMMITTEE THAT HAS RESPONSIBILITY FOR OVERSEEING THE MEDICAL SERVICES MHMH PROVIDES. ADDITIONALLY, THE UPDATED BYLAWS AMENDED: * THE SELECTION/ELIGIBILITY CRITERIA FOR THE MHMH PRESIDENT/CEO BY REMOVING THE REQUIREMENT THAT THE INDIVIDUAL BE A LICENSED PHYSICIAN AND REMOVING THE PREFERENCE FOR AN INTERNAL CANDIDATE. * THE BYLAWS AMENDMENT PROCESS BY REMOVING THE REQUIREMENT THAT MHMH MEDICAL STAFF VOTE ON AN ADVISORY RECOMMENDATION RELATIVE TO ANY BYLAWS AMENDMENTS. Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF MHMH'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL, AND OPERATIONAL DECISIONS OF MHMH'S TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders IN ADDITION TO RESERVED POWERS, DARTMOUTH-HITCHCOCK HEALTH (D-HH) SHALL HAVE THE AUTHORITY TO TAKE ACTIONS TO ESTABLISH, MANAGE, AND GOVERN MHMH TO CREATE AND MAINTAIN AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF THE MISSION OF MHMH AND OTHER ORGANIZATIONS WITHIN THE SYSTEM. THESE POWERS INCLUDE BUT ARE NOT LIMITED TO ITEMS SUCH AS THE ABILITY TO APPROVE, DISAPPROVE, OR MODIFY ALL MATERIAL GOVERNANCE, PROGRAMMATIC, AND FINANCIAL DECISIONS OF MHMH'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF MHMH'S BOARD OF TRUSTEES, ASSESS MHMH A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE MHMH'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY MHMH, APPROVE KEY STRATEGIC RELATIONSHIPS, APPROVE THE ELIMINATION OR ADDITION OF ANY MATERIAL HEALTH CARE SERVICE OR PROGRAM, AND OTHER AUTHORITY TO TAKE ACTION ON BEHALF OF MHMH. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS REVIEWED BY THE DIRECTOR OF FINANCIAL COMPLIANCE, THE VICE PRESIDENT OF CORPORATE FINANCE, THE CHIEF FINANCIAL OFFICER, AND EXTERNAL TAX ADVISORS BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL FORM 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING. Form 990, Part VI, Line 12c Conflict of interest policy THE MARY HITCHCOCK MEMORIAL HOSPITAL BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES 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 TRUSTEES 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 CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA (ALONG WITH ONGOING EVALUATIONS AND APPROVAL BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS). THE LAST FORMAL PROCESS WAS COMPLETED IN 2024 AND CONTEMPORANEOUSLY DOCUMENTED. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. THE PROCESS DESCRIBED ABOVE TO ESTABLISH COMPENSATION WAS USED FOR THE FOLLOWING POSITIONS: Chief Financial Officer, Chief Strategy Officer, Chief Clinical Officer, Chief Legal Officer, Chief Human Resources Officer, Chief Operating Officer, Chief Nursing - Executive, Chief Nursing Officer, Chief Pharmacy Officer, Chief Quality & Value Officer, Department Chair - Anesthesia, Department Chair - Radiology, Department Chair - Pathology and similar positions. Form 990, Part VI, Line 19 Required documents available to the public MHMH'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST EITHER IN ELECTRONIC OR HARD COPY FORM. Form 990, Part VII, Section A, Line 1a, Column (B) AVERAGE HOURS PER WEEK AS PART OF DARTMOUTH-HITCHCOCK CLINIC AND MARY HITCHCOCK MEMORIAL HOSPITAL'S AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS' FORMS 990 EVEN THOUGH COMPENSATION REPORTED IN PART VII IS BASED ON THE ENTITY ISSUING THE W-2. IN ADDITION, CERTAIN OFFICERS SPEND TIME ON DARTMOUTH-HITCHCOCK HEALTH (THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC), AND/OR DARTMOUTH-HITCHCOCK CLINIC ALONG WITH OTHER AFFILIATED ORGANIZATIONS: DARTMOUTH-HITCHCOCK MEDICAL CENTER, HAMDEN RISK RETENTION GROUP (AND RELATED ENTITIES), ALICE PECK DAY MEMORIAL HOSPITAL, WINDSOR HOSPITAL CORPORATION (DBA MT ASCUTNEY HOSPITAL AND HEALTH CENTER), MT. ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER, CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION, VNA & HOSPICE OF VT AND NH, THE HITCHCOCK FOUNDATION, AND SOUTHWESTERN VERMONT HEALTH CARE CORPORATION. Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSET TRANSFER FROM AFFILIATES - 19573300; PENSION-RELATED AND OTHER CHANGES - -22445536; NET ASSET RELEASED FROM RESTRICTION - -16128473; NEW ENGLAND ALLIANCE FOR HEALTH LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264232401 HEALTH IMPROVEMENT NH 60023 2057058 MHMH D-H SPECIALTY SERVICES LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 460876427 SHARED SAVINGS PROGRAM NH 0 0 MHMH 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 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 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 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 Juction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false DARTMOUTH -HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTING ORGANIZATION NH 501(c)(3) Type I NA false SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 HOSPITAL VT 501(c)(3) 3 DHH false DARTMOUTH-HITCHCOCK MASTER INVESTMENT PROGRAM OF POOLED INVESTMENT ACCOUNTS 1 MED CTR DR LEBANON NH 03756 020205863 POOLED INVESTMENTS NH MHMH Excluded 58206102 986813329 false 2080449 true 0.7478 false true false false true false false false false true true true true true true true true true true Dartmouth-Hitchcock Master Investment S 10500000