CHESHIRE MEDICAL CENTER: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: CHESHIRE MEDICAL CENTER (EIN 02-0354549)
Tax period: 2020-07-01 to 2021-06-30
Filed: 2022-05-13
IRS object ID: 202221339349306522
Schema version: 2020v4.0
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-05-13T14:04:45-05:00	ReturnTs
Tax Period End	2021-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	350921680	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CROWE LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	9600 Brownsboro Road Suite 400	AddressLine1Txt
City	Louisville	CityNm
State Abbreviation	KY	StateAbbreviationCd
ZIP	402413902	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	020354549	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Cheshire Medical Center	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	CHES	BusinessNameControlTxt
Phone	6033545400	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	580 - 590 Court Street	AddressLine1Txt
City	Keene	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	034315400	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Daniel J Gross	PersonNm
Person Title	CFO	PersonTitleTxt
Signature	2022-05-13	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Daniel J	PersonFirstNm
Person Last	Gross	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Scifres	PreparerPersonNm
PTIN	P01316095	PTIN
Phone	5023263996	PhoneNum

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DON CARUSO	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	580 - 590 Court Street	AddressLine1Txt
City	Keene	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	034315400	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$247,401,480	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	https://www.cheshiremed.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1980	FormationYr
Legal Domicile State	NH	LegalDomicileStateCd
Activity Or Mission	TO LEAD OUR COMMUNITY TO OPTIMAL HEALTH AND WELLNESS THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME.	ActivityOrMissionDesc
Voting Members Governing Body	18	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	1252	TotalEmployeeCnt
Total Volunteers	119	TotalVolunteersCnt
Total Gross UBI	$294,820	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,188,452	PYContributionsGrantsAmt
CY Contributions Grants	$12,479,448	CYContributionsGrantsAmt
PY Program Service Revenue	$206,527,892	PYProgramServiceRevenueAmt
CY Program Service Revenue	$232,080,526	CYProgramServiceRevenueAmt
PY Investment Income	$1,397,005	PYInvestmentIncomeAmt
CY Investment Income	$264,042	CYInvestmentIncomeAmt
PY Other Revenue	$15,546,202	PYOtherRevenueAmt
CY Other Revenue	$2,574,788	CYOtherRevenueAmt
PY Total Revenue	$225,659,551	PYTotalRevenueAmt
CY Total Revenue	$247,398,804	CYTotalRevenueAmt
PY Grants And Similar Paid	$929,014	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$389,532	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$106,856,163	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$98,907,039	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$586,999	CYTotalFundraisingExpenseAmt
PY Other Expenses	$131,943,559	PYOtherExpensesAmt
CY Other Expenses	$141,498,493	CYOtherExpensesAmt
PY Total Expenses	$239,728,736	PYTotalExpensesAmt
CY Total Expenses	$240,795,064	CYTotalExpensesAmt
PY Revenues Less Expenses	-$14,069,185	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$6,603,740	CYRevenuesLessExpensesAmt
Total Assets BOY	$185,465,067	TotalAssetsBOYAmt
Total Assets EOY	$168,346,405	TotalAssetsEOYAmt
Total Liabilities BOY	$126,986,570	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$87,920,426	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$58,478,497	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$80,425,979	NetAssetsOrFundBalancesEOYAmt
Mission	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.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$223,307,898	ExpenseAmt
Grant	$389,532	GrantAmt
Revenue	$232,898,552	RevenueAmt
Desc	THE CHESHIRE MEDICAL CENTER (CMC) IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE. CMC IS A NOT-FOR-PROFIT ORGANIZATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS AFFILIATED WITH DARTMOUTH-HITCHCOCK HEALTH ("D-HH"), A NOT-FOR-PROFIT TAX-EXEMPT CORPORATION WITH A PRINCIPAL PLACE OF BUSINESS AT ONE MEDICAL CENTER DRIVE, LEBANON, NEW HAMPSHIRE. CONSISTENT WITH THE D-HH VISION AND STRATEGY TO CREATE A SUSTAINABLE HEALTH SYSTEM, CMC AND D-HH SHARE A COMMON COMMITMENT TO IMPROVING POPULATION HEALTH, VALUE-BASED CARE, AND CREATING NEW PAYMENT MODELS FOR THE BENEFIT OF THE CITIZENS OF NEW HAMPSHIRE AND VERMONT. CMC PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A COMMUNITY HOSPITAL. THESE INCLUDE A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, AND REHABILITATION. DURING FY21, CMC PROVIDED 227,803 PROVIDER VISITS AND HAD 4,115 HOSPITAL ADMISSIONS AND DISCHARGES, WHILE THE EMERGENCY DEPARTMENT WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 19,869 ER PATIENT VISITS. THERE ARE A TOTAL OF 207 PROVIDERS CONSISTING OF 130 PHYSICIANS AND 77 ASSOCIATE PROVIDERS. EACH YEAR CHESHIRE MEDICAL CENTER FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS CMC PROVIDES. THE MOST RECENT COMMUNITY BENEFIT REPORTS ARE AVAILABLE UPON REQUEST OR CAN BE FOUND ON CMC'S WEBSITE (https://www.cheshiremed.org/about/reports-community). THE COMMUNITY HEALTH ACTIVITIES INCLUDE THE COST OR VALUE OF SEVERAL DIFFERENT TYPES OF PROGRAMS INCLUDING THE COST OF COMMUNITY-BASED EDUCATION PROGRAMS INVOLVING A VARIETY OF CHRONIC DISEASE AND WELLNESS TOPICS SUCH AS STRESS MANAGEMENT AND RESILIENCY, NUTRITION, PHYSICAL EDUCATION AND EXERCISE, HIGH BLOOD PRESSURE PREVENTION AND MONITORING, DIABETES PREVENTION AND MONITORING, ADVANCED DIRECTIVE PLANNING, AND OTHERS. IN TOTAL, CMC PROVIDED ALMOST $18 MILLION IN COMMUNITY BENEFITS INCLUDING UNREIMBURSED CHARITY CARE, HEALTH SERVICES, HEALTH PROFESSION EDUCATION, SUBSIDIZED HEALTH SERVICES, AND COMMUNITY-BUILDING ACTIVITIES. THESE CONTRIBUTIONS ARE IN ADDITION TO THE OVER $16.6 MILLION DOLLARS IN UNREIMBURSED MEDICARE COSTS ABSORBED BY CMC.	Desc
Total Program Service Expenses	$223,307,898	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	false	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	Yes (true)	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	230	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	1252	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (true)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (true)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	false	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	18	GoverningBodyVotingMembersCnt
Independent Voting Member	10	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Daniel J Gross	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6033545400	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	580-590 COURT STREET	AddressLine1Txt
City	KEENE	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	034315400	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
CLAIRE FABIAN MD
Trustee/ Medical Staff President (eff. 11/1/20)	0.5	41.0	Yes (X)	Yes (X)	$0	$335,077	$53,467
DON CARUSO MD
TRUSTEE/CEO/PRESIDENT - CMC	1.0	41.0	Yes (X)	Yes (X)	$0	$529,046	$59,431
KATHERINE SNOW
TRUSTEE/SECRETARY (thru 12/31/20)	1.0	1.0	Yes (X)	Yes (X)	$0	$0	$0
MARK GAVIN
TRUSTEE/TREASURER	1.0	1.0	Yes (X)	Yes (X)	$0	$0	$0
Michael Ormont MD
TRUSTEE/EX-OFFICIO/Medical Staff Pres-CMC(thru 10/31/20)	0.5	40.5	Yes (X)	Yes (X)	$0	$416,175	$55,889
NATHALIE HOUDER
TRUSTEE/CHAIR	1.0	0.5	Yes (X)	Yes (X)	$0	$0	$0
ROBERT MITCHELL
TRUSTEE / Secretary (eff. 1/1/21)	0.5	0.5	Yes (X)	Yes (X)	$0	$0	$0
SUSAN ABERT
TRUSTEE/VICE CHAIR	1.0	0.5	Yes (X)	Yes (X)	$0	$0	$0
ANDREW TREMBLAY MD
TRUSTEE	1.0	40.0	Yes (X)		$0	$324,797	$56,841
ASHOK BAHL
TRUSTEE	0.5	0	Yes (X)		$0	$0	$0
Barbara Duckett
Trustee (Eff. 1/1/21)	0.5	0	Yes (X)		$0	$0	$0
BETSY COTTER
Trustee (Eff. 1/1/21)	0.5	0.5	Yes (X)		$0	$0	$0
Cherie Holmes MD
Trustee / Physician	1.0	40.0	Yes (X)		$0	$526,558	$45,791
GEOF MOLINA
TRUSTEE (thru 12/31/20)	1.0	0	Yes (X)		$0	$0	$0
GREGG TEWKSBURY CPA
TRUSTEE (thru 12/31/20)	1.0	0	Yes (X)		$0	$0	$0
H ROGER HANSEN
TRUSTEE	1.0	0.5	Yes (X)		$0	$0	$0
Maria Padin MD
TRUSTEE	1.0	41.0	Yes (X)		$0	$552,590	$70,033
Mark Bodin
Trustee (Eff. 1/1/21)	0.5	0	Yes (X)		$0	$0	$0
MICHAEL KAPILOFF
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
Michael Waters
Trustee (Eff. 7/1/20) / Treasurer	0.5	40.0	Yes (X)		$0	$258,147	$20,319
RACHEL LOVINS MD
TRUSTEE	0.5	40.0	Yes (X)		$0	$405,279	$47,003
Stephen Leblanc
Trustee (eff. 7/1/20)	0.5	42.5	Yes (X)		$0	$786,125	$60,997
AMY MATTHEWS
CHIEF NURSING OFFICER	40.0	0		Yes (X)	$222,665	$0	$21,034
Christine Schon MPA
COO (thru 12/31/20)	20.0	20.5		Yes (X)	$0	$373,374	$53,981
Daniel Gross
CFO (Hired 5/2021)	40.0	1.0		Yes (X)	$0	$0	$0
KATHRYN WILLBARGER
COO (Eff. 1/2021) / Sr. VP-Finance (thru 12/2020)	40.0	1.0		Yes (X)	$410,411	$0	$24,259
David Quigley
VP Clinical Operations - CMC	20.0	20.0			$0	$255,901	$27,975	Yes (X)
ERLI CHEN
PHYSICiST	40.0	0			$258,799	$0	$33,217		Yes (X)
LATASHA HEAPE
CHIEF CRNA	40.0	0			$215,867	$0	$24,219		Yes (X)
MICHAEL W FRANK
NURSE ANESTHETIST CRNA	40.0	0			$277,127	$0	$27,355		Yes (X)
Richard Crowe Jr
Pharmacy Manager	40.0	0			$172,187	$0	$28,747		Yes (X)
Shawn V Lafrance
VP Population Health	40.0	0			$200,266	$0	$33,799		Yes (X)
JENNIFER DINUBILA DO
Former President of Medical Staff	0.0	40.5			$0	$408,835	$58,316			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,757,322	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$5,171,904	TotReportableCompRltdOrgAmt
Total Other Compensation	$802,673	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	73	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
CONIFER REVENUE CYCLE SOLUTIONS
PO BOX 655025	DALLAS	TX	752655025	Revenue Management	$6,630,451
Mary Hitchcock Memorial Hospital
ONE MEDICAL CENTER DRIVE	LEBANON	NH	03756	Healthcare Services	$5,889,478
Dartmouth-Hitchcock Clinic
ONE MEDICAL CENTER DRIVE	Lebanon	NH	03756	Healthcare Services	$2,405,561
Cerner Health Services Inc
51 Valley Stream Parkway	Malvern	PA	19355	Healthcare Services	$1,005,346
Comprehensive Pharmacy Services
6409 No Quail Hollow Road	Memphis	TN	38120	Pharmacy Management	$989,723

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	22	CntrctRcvdGreaterThan100KCnt
Related Organizations	$9,337,428	RelatedOrganizationsAmt
Government Grants	$2,549,883	GovernmentGrantsAmt
All Other Contributions	$592,137	AllOtherContributionsAmt
Total Contributions	$12,479,448	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE	622110	$230,273,436	$230,273,436
PHARMACY REVENUE	446110	$1,619,770	$1,512,270	$107,500
Laboratory Services	621500	$187,320		$187,320

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$232,080,526	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$259,869	TotalRevenueColumnAmt
Exclusion	$259,869	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$19,161	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$19,161	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,161	TotalRevenueColumnAmt
Exclusion	$19,161	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$2,691	SecuritiesAmt
Other	$4,158	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$2,676	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$15	SecuritiesAmt
Other	$4,158	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,173	TotalRevenueColumnAmt
Exclusion	$4,173	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
FOOD SERVICES	722514	$863,240	$863,240
Childcare Income	624410	$579,541	$579,541
REBATES AND DISCOUNTS	622110	$707,401		$707,401

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$405,445	TotalRevenueColumnAmt
Related Or Exempt Func Income	$405,445	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$2,555,627	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$247,398,804	TotalRevenueColumnAmt
Related Or Exempt Func Income	$232,898,552	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$294,820	UnrelatedBusinessRevenueAmt
Exclusion	$1,725,984	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$334,531	TotalAmt
Program Services	$334,531	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$55,001	TotalAmt
Program Services	$55,001	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$709,742	TotalAmt
Program Services	$10,095	ProgramServicesAmt
Management And General	$699,647	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$137,183	TotalAmt
Program Services	$137,183	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$68,919,871	TotalAmt
Program Services	$62,158,210	ProgramServicesAmt
Management And General	$6,383,141	ManagementAndGeneralAmt
Fundraising	$378,520	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$3,252,568	TotalAmt
Program Services	$2,936,653	ProgramServicesAmt
Management And General	$298,230	ManagementAndGeneralAmt
Fundraising	$17,685	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$21,805,312	TotalAmt
Program Services	$19,672,777	ProgramServicesAmt
Management And General	$2,013,155	ManagementAndGeneralAmt
Fundraising	$119,380	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$4,082,363	TotalAmt
Program Services	$3,685,852	ProgramServicesAmt
Management And General	$374,314	ManagementAndGeneralAmt
Fundraising	$22,197	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$35,888	TotalAmt
Program Services	$8,874	ProgramServicesAmt
Management And General	$27,014	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$8,250	TotalAmt
Program Services	$8,250	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Fundraising	$0	FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$63,615,410	TotalAmt
Program Services	$62,942,896	ProgramServicesAmt
Management And General	$665,950	ManagementAndGeneralAmt
Fundraising	$6,564	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$212,032	TotalAmt
Program Services	$175,960	ProgramServicesAmt
Management And General	$35,245	ManagementAndGeneralAmt
Fundraising	$827	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,213,732	TotalAmt
Program Services	$928,562	ProgramServicesAmt
Management And General	$282,783	ManagementAndGeneralAmt
Fundraising	$2,387	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,752,607	TotalAmt
Program Services	$1,751,947	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$660	FundraisingAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$5,565,956	TotalAmt
Program Services	$4,250,164	ProgramServicesAmt
Management And General	$1,315,792	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$58,137	TotalAmt
Program Services	$46,919	ProgramServicesAmt
Management And General	$10,578	ManagementAndGeneralAmt
Fundraising	$640	FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$935,882	TotalAmt
Program Services	$935,882	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$8,498,730	TotalAmt
Program Services	$6,489,909	ProgramServicesAmt
Management And General	$2,008,821	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,621,076	TotalAmt
Program Services	$1,381,301	ProgramServicesAmt
Management And General	$239,775	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
MEDICAL SUPPLIES	$42,129,005	$42,129,005	$0	$0
MEDICAID ENHANCEMENT & PILOT TAXES	$8,315,940	$8,315,940	$0	$0
FOOD AND CAFETERIA EXPENSES	$831,177	$831,177	$0	$0
EQUIPMENT RENTAL AND MAINTENANCE	$5,047,657	$3,098,830	$1,942,216	$6,611

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,657,014	TotalAmt
Program Services	$1,021,980	ProgramServicesAmt
Management And General	$603,506	ManagementAndGeneralAmt
Fundraising	$31,528	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$240,795,064	TotalAmt
Program Services	$223,307,898	ProgramServicesAmt
Management And General	$16,900,167	ManagementAndGeneralAmt
Fundraising	$586,999	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$43,939,812	BOYAmt
EOY	$35,146,503	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$11,329,829	BOYAmt
EOY	$13,325,989	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$3,557,684	BOYAmt
EOY	$3,330,484	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,155,183	BOYAmt
EOY	$961,554	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$244,057,405	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$179,955,681	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$64,803,490	BOYAmt
EOY	$64,101,724	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$4,296,339	BOYAmt
EOY	$1,774,315	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$56,382,730	BOYAmt
EOY	$49,705,836	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$185,465,067	BOYAmt
EOY	$168,346,405	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$16,784,196	BOYAmt
EOY	$22,589,586	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$31,846,840	BOYAmt
EOY	$412,505	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$24,483,074	BOYAmt
EOY	$23,617,565	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$53,872,460	BOYAmt
EOY	$41,300,770	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$126,986,570	BOYAmt
EOY	$87,920,426	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$52,234,015	BOYAmt
EOY	$65,213,770	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,244,482	BOYAmt
EOY	$15,212,209	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$58,478,497	BOYAmt
EOY	$80,425,979	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$185,465,067	BOYAmt
EOY	$168,346,405	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$6,603,740	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$19,514,123	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$4,170,381	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$32,586	OtherActivitiesAmt
Total Lobbying Expenditures	$32,586	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

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

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$77,828,930	OtherCostOrOtherBasisAmt
Depreciation	$55,609,284	DepreciationAmt
Book Value	$22,219,646	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$27,429,792	OtherCostOrOtherBasisAmt
Depreciation	$10,177,107	DepreciationAmt
Book Value	$17,252,685	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$138,567,532	OtherCostOrOtherBasisAmt
Depreciation	$114,169,290	DepreciationAmt
Book Value	$24,398,242	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$64,101,724	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
Due from Affiliate	$46,043,401
Deferred 457(b) Plan Assets	$1,060,582
Other Assets	$2,601,853

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$49,705,836	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
PENSION LIABILITY	$5,285,868
DUE TO RELATED PARTY	$4,788,537
RESERVES FOR ESTIMATED 3RD PARTY SETTLEMENTS	$31,226,365

Field	Value	IRS element (for citing)
Total Liability	$41,300,770	TotalLiabilityAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	225	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	false	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,796,260	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,796,260	NetCommunityBenefitExpnsAmt
Total Expense	0.0075	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$29,264,737	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$17,679,140	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$11,585,597	NetCommunityBenefitExpnsAmt
Total Expense	0.0481	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$31,060,997	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$17,679,140	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$13,381,857	NetCommunityBenefitExpnsAmt
Total Expense	0.0556	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,025,859	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,025,859	NetCommunityBenefitExpnsAmt
Total Expense	0.0084	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,489,725	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,489,725	NetCommunityBenefitExpnsAmt
Total Expense	0.0062	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,427,627	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$811,960	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$615,667	NetCommunityBenefitExpnsAmt
Total Expense	0.0026	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,963	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$15,963	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$512,323	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$73,300	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$439,023	NetCommunityBenefitExpnsAmt
Total Expense	0.0018	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$5,471,497	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$885,260	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,586,237	NetCommunityBenefitExpnsAmt
Total Expense	0.0190	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$36,532,494	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$18,564,400	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,968,094	NetCommunityBenefitExpnsAmt
Total Expense	0.0746	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$327,501	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$255,063	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$72,438	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,528,924	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,528,924	NetCommunityBenefitExpnsAmt
Total Expense	0.0063	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$1,856,425	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$255,063	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,601,362	NetCommunityBenefitExpnsAmt
Total Expense	0.0067	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$0	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$98,506,247	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$115,083,259	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$16,577,012	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CHESHIRE MEDICAL CENTER	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	580 COURT STREET	AddressLine1Txt
City	KEENE	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03431	ZIPCd

Field	Value	IRS element (for citing)
Website Address	https://www.cheshiremed.org	WebsiteAddressTxt
State License	00014	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	IN-PATIENT REHAB	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	CHESHIRE MEDICAL CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	https://www.cheshiremed.org/about/reports-community	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	19	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	https://www.cheshiremed.org/about/reports-community	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	225.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.0	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://www.cheshiremed.org/patients-visitors/billing-charges	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://www.cheshiremed.org/patients-visitors/billing-charges	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://www.cheshiremed.org/patients-visitors/billing-charges	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 BOTH COMMUNITY BENEFITS SPENDING AND PARTNERSHIPS TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE MOST RECENT CHNA. THESE NEEDS ARE IN THE AREAS OF BEHAVIORAL HEALTH, SUBSTANCE AND ALCOHOL MISUSE, TOBACCO USE, OBESITY, AND EMERGENCY PREPAREDNESS. WITH THE ONSET OF COVID-19 IN FEBRUARY-MARCH 2020, MHMH HAS ADDED AND PRIORITIZED COVID-19 DRIVEN COMMUNITY NEEDS TO OUR OTHER CHNA PRIORITIES. THIS HAS INCLUDED PROVIDING SIGNIFICANT FUNDING AND STAFF SUPPORT TO HELP COMMUNITY FOOD SUPPORT PROGRAMS, BEHAVIORAL HEALTH PROVIDERS, NURSING HOMES, AND OTHER COMMUNITY ORGANIZATIONS ADAPT TO AND MAINTAIN BASIC SOCIAL SERVICES SAFELY DURING THE PANDEMIC. IN FY 2019, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN THE FY2019 COMMUNITY HEALTH IMPROVEMENT PLANS. AREAS WERE ANALYZED AND THE HOSPITAL 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 HOSPITAL'S MISSION/SERVICES/SCOPE. 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 DARTHMOUTH-HITCHCOCK HEALTH HAS ALSO PROVIDED SUPPORT FOR THE IDENTIFIED COMMUNITY-BASED NEEDS. THE CHESHIRE MEDICAL CENTER'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 CENTRAL NEW HAMPSHIRE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).
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.

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CHESHIRE MEDICAL CENTER COLLECTING STATION	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	580-590 COURT STREET	AddressLine1Txt
City	KEENE	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03431	ZIPCd

Field	Value	IRS element (for citing)
Facility	COLLECTING STATION	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (20 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 22 MAX CHARGES TO FAP ELIGIBLE INDIVIDUALS	THE STATE OF NEW HAMPSHIRE MANDATES A DISCOUNT FOR ALL UNINSURED PATIENTS. THIS DISCOUNT IS EQUAL TO THE AVERAGE DISCOUNT NEGOTIATED BY THE LARGEST (BY DOLLAR) THREE COMMERCIAL INSURERS. THE CHESHIRE MEDICAL CENTER HAS ALWAYS BEEN IN FULL COMPLIANCE WITH THE LAWS OF THE STATE NEW HAMPSHIRE, AND A COMMITTEE IS IN PLACE TO ENSURE THE HOSPITAL IS IN FULL COMPLIANCE WITH FINAL 501(R) REGULATIONS IN AREAS WHERE FEDERAL REGULATIONS DIFFER FROM OR ARE MORE STRINGENT THAN THOSE ISSUED BY THE STATE.
Schedule H, Part V, Section C MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY	THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: https://www.cheshiremed.org/patients-visitors/billing-charges. CMC HAS PLAIN LANGUAGE SUMMARY BROCHURES AVAILABLE AT ALL ADMISSION SITES AS WELL AS PLAIN LANGUAGE SUMMARY POSTERS AT ALL PHYSICAL LOCATIONS.
Schedule H, Part I, Line 7g Subsidized Health Services	The organization did not include as subsidize health services any costs attributable to a physician clinic on line 7g.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	0
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	CHESHIRE MEDICAL CENTER IS PARTNERING WITH THE GREATER MONADNOCK PUBLIC HEALTH NETWORK (GMPHN), A COMMUNITY HEALTH AND SAFETY COLLABORATIVE, WHICH WORKS TO ENHANCE AND IMPROVE PUBLIC HEALTH-RELATED SERVICES. THE GMPHN IS ONE OF 13 PUBLIC HEALTH NETWORKS IN THE STATE OF NEW HAMPSHIRE. THE GMPHN IS HOUSED BY CMC AND, IN COLLABORATION WITH CHESHIRE COUNTY, IS FINANCED WITH FUNDS PROVIDED BY THE US CENTERS FOR DISEASE CONTROL AND PREVENTION, UNDER AN AGREEMENT WITH THE STATE OF NH DEPARTMENT OF HEALTH AND HUMAN SERVICES/DIVISION OF PUBLIC HEALTH SERVICES AND A MIX OF STATE FUNDING VIA THE GENERAL FUNDS. THE GMPHN SERVES ALL OF CHESHIRE COUNTY AND THE 10 WESTERN-MOST TOWNS IN HILLSBOROUGH COUNTY. THE GMPHN STRIVES TO INCREASE COLLABORATION AND PLANNING ACROSS MUNICIPAL BOUNDARIES AND THE HEALTH AND SAFETY SECTORS BY THE DEVELOPMENT OF A PUBLIC HEALTH ADVISORY COUNCIL, ADDRESSING EMERGENCY PREPAREDNESS, AND THROUGH A REGIONAL NETWORK, SUBSTANCE MISUSE PREVENTION, REDUCING SUBSTANCE ABUSE IN THE REGION. AS OF JUNE 2020 THERE ARE 80 INDIVIDUALS AND/OR ORGANIZATIONS ENGAGED IN ACTIVITIES RELATED TO THE PUBLIC HEALTH ADVISORY COUNCIL, 122 MEMBER INDIVIDUALS/ORGANIZATIONS ADDRESSING EMERGENCY PREPAREDNESS AND OVER 300 INDIVIDUALS SUPPORTING REGIONAL SUBSTANCE MISUSE PREVENTION AND RECOVERY EFFORTS. INCLUDED WITHIN THE GMPHN IS THE GREATER MONADNOCK MEDICAL RESERVE CORPS. DEVELOPED INITIALLY TO BUILD LOCAL CAPACITY TO ADDRESS PUBLIC HEALTH EMERGENCY RESPONSE NEEDS, THE GMMRC ALSO SUPPORTS LOCAL INITIATIVES TO ADDRESS PRESSING PUBLIC HEALTH ACTIVITIES. THESE ACTIVITIES INCLUDE ANYTIME CPR CLINICS, RECRUITING AND PLANNING HEPATITIS A CLINICS, AND EDUCATING THE PUBLIC ON PREPAREDNESS RESOURCES. MEMBERSHIP INCLUDES DOCTORS, NURSES, EMT/PARAMEDICS, PHARMACISTS, VETERINARIANS, OTHER PUBLIC HEALTH PROFESSIONALS, AND NONMEDICAL/PUBLIC HEALTH MEMBERS. The GMPHN has been pivotal to the COVID-19 response efforts in the region, working in concert with Cheshire Medical Center and other agencies to disseminate information and supplies. Further, the GMPHN stood up an Alternate Care Site at Keene State College, as well as secured a fixed COVID-19 community testing location.
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 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. 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.cheshiremed.org/patients-visitors/billing-charges;
Schedule H, Part V, Section B, Line 16b FAP Application website	- CHESHIRE MEDICAL CENTER: Line 16b URL: https://www.cheshiremed.org/patients-visitors/billing-charges;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- CHESHIRE MEDICAL CENTER: Line 16c URL: https://www.cheshiremed.org/patients-visitors/billing-charges;
Schedule H, Part VI, Line 2 Needs assessment	IN ADDITON TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL USES REGULAR FEEDBACK FROM THE COMMUNITY, PROVIDED THROUGHOUT THE YEAR, TO ASSESS ITS HEALTH NEEDS. THE HEALTH STAFF PARTICPATES IN OR LEADS MULTIPLE COMMUNITY COALITIONS AND PROJECTS COLLABORATING AND CONNECTING WITH A WIDE ARRAY OF COMMUNITY-BASED HEALTH, MUNICIPAL, SCHOOL, SERVICE ORGANIZATION, REGIONAL PLANNING AND STATE PUBLIC HEALTH STAKEHOLDERS. WE REGULARLY REVIEW EMERGING NH & VT STATE HEALTH DATA; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS), AND CONVERSATIONS WITH COMMUNITY PARTNERS TO IDENTIFY CONCERNS THAT ARE EMERGING, INTENSIFYING, OR ARE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST CHNA WAS CONDUCTED.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	THE CHESHIRE MEDICAL CENTER IS COMMITTED TO PROVIDING MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PRO-ACTIVELY SCREENED USING PAPER AND/OR AN AUTOMATED TOOL TO IDENTIFY POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. IN ADDITION, SPECIFIC OUTPATIENT ACTIVITIES DEEMED TO HAVE A HIGHER RATE OF NEED ARE SCREENED AS PART OF REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTION REGARDING HOW TO COMPLETE THE QUALIFICATION PROCESS. IN SOME CASES A FINANCIAL COUNSELOR WILL ACT ON BEHALF OF THE PATIENT, AT THEIR SIGNED CONSENT, IN ORDER TO COMPLETE THE APPLICATION PROCESS (FOR EXAMPLE, IN NEW HAMPSHIRE A PATIENT MUST BE PHYSICALLY PRESENT AT THE DISTRICT OFFICE). IF A PATIENT DOESN'T QUALIFY FOR SPECIFIC PROGRAMS, THEY ARE ALSO CONSIDERED FOR FINANCIAL ASSISTANCE AS PART OF THEIR SCREENING. FOR OUTPATIENT SERVICES THAT ARE NOT ROUTINELY SCREENED, STAFF INTERACTING WITH PATIENTS ARE INSTRUCTED TO PROVIDE EITHER A FINANCIAL ASSISTANCE APPLICATION OR CONTACT INFORMATION FOR A FINANCIAL COUNSELOR WHEN A PATIENT EXPRESSES THEIR INABILITY TO MAKE PAYMENT. EVERY APPLICATION IS SCREENED FOR COMPLETED INCOME AND ASSET DOCUMENTATION. APPLICATIONS ARE ALSO SCREENED TO ASSURE THERE ARE NO OTHER POTENTIAL OPTIONS OF FEDERAL, STATE, OR LOCAL PROGRAMS. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY.
Schedule H, Part VI, Line 4 Community information	THE MEDICAL CENTER IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA ("PSA"). MANAGEMENT DEFINES ITS PSA AS THE CITY OF KEENE AND 19 GEOGRAPHICALLY PROXIMATE COMMUNITIES. TOWNS AND CITIES INCLUDED IN THE PSA INCLUDE ALSTEAD, CHESTERFIELD, FITZWILLIAM, GILSUM, HARRISVILLE/CHESHAM, KEENE, MARLBOROUGH, MARLOW, MUNSON/MUNSONVILLE, RICHMOND, ROXBURY, STODDARD, SULLIVAN, SURRY, SWANZEY, TROY, WALPOLE, WESTMORELAND AND WINCHESTER, ALL LOCATED IN CHESHIRE COUNTY. BASED ON THE US CENSUS BUREAU'S POPULATION ESTIMATES FROM 2012 TO 2016: MEDICAL CENTER'S PSA REPRESENTED APPROXIMATELY 4.52% OF NEW HAMPSHIRE'S POPULATION. THE PSA'S TOTAL POPULATION IS 59,612 WITH 23,409 RESIDING IN KEENE, THE LARGEST COMMUNITY IN THE SERVICE AREA. CHESHIRE COUNTY POPULATION IS 75,950 . THE MEDIAN AGE OF RESIDENTS IN CHESHIRE COUNTY IS 42.2 WITH: - 14,886 OR 19.6% LESS THAN 18 YEARS OF AGE, - 49,899 OR 65.7% BETWEEN THE AGES OF 18-64, AND - 11,164 OR 14.7% OVER THE AGE OF 64, IN 2020 THE POVERTY RATE FOR CHESHIRE COUNTY WAS 10.2%. THE MEDIAN HOUSEHOLD INCOME IS $64,751. ACCORDING TO THE JUNE 2021 NEW HAMPSHIRE EMPLOYMENT SECURITY, ECONOMIC & LABOR MARKET INFORMATION BUREAU REPORT, THE STATE AND CHESHIRE COUNTY HAD AN UNEMPLOYMENT RATES OF 3.1% AND 3.6%, RESPECTIVELY (NOT SEASONALLY-ADJUSTED).
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-HITCHCOCK HEALTH (D-HH)) OFFERS A VARIETY OF HEALTH PROMOTION, EDUCATION 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. IN ADDITION, CMC OFFERS 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 COALITON FOR TOBACCO-FREE COMMUNITIES. IN ADDITION, THE HOSPITAL OPERATES HEALTH EDUCATION AND OTHER SUPPORT SERVICES SUCH AS ADVANCE CARE PLANNNG, 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. 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	CHESHIRE MEDICAL CENTER IS OWNED BY DARTMOUTH-HICHCOCK HEALTH. THIS RELATIONSHIP ALLOWS THE STREAMLINING OF PATIENT CARE BETWEEN THE TWO HEALTHCARE SYSTEMS AND STRENGTHENS THE CENTER AS A REGIONAL RESOURCE FOR SOUTHWESTERN NEW HAMPSHIRE AND SOUTHEASTERN VERMONT. THE AFFILIATION ALLOWS MORE PATIENTS TO RECEIVE CARE CLOSER TO HOME, FREES UP BED CAPACITY FOR TERTIARY CARE PATIENTS AT DARTMOUTH-HITCHCOCK MEDICAL CENTER IN LEBANON, AND ALLOWS THE CHESHIRE MEDICAL CENTER TO CONTINUE ITS LEADERSHIP ROLE IN POPULATION HEALTH AND THE HEALTHY MONADNOCK 2020 INITIATIVE. CHESHIRE MEDICAL HAS A MULTI-SPECIALTY GROUP PRACTICE THAT COMPRISES THE MAJORITY OF CHESHIRE MEDICAL CENTER'S MEDICAL STAFF AND WITH THE AFFILIATION, IT ENABLES BOTH ORGANIZATIONS TO MORE EFFECTIVELY PURSUE A COMMON VISION OF THE FUTURE OF HEALTH CARE THAT IS BASED ON CREATING A SUSTAINABLE HEALTH SYSTEM, FOCUSING ON POPULATION HEALTH, DELIVERING VALUE-BASED CARE, AND EMBRACING THE OPPORTUNITIES PROVIDED BY NEW PAYMENT MODELS. IN ADDITION TO THE CHESHIRE MEDICAL CENTER AND THE DARTMOUTH-HITCHCOCK HEALTH, THE AFFILIATED HEALTH CARE SYSTEM INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, THE NEW LONDON HOSPITAL ASSOCIATION, WINDSOR HOSPITAL CORPORATION, ALICE PECK DAY MEMORIAL HOSPITAL, VISITING NURSE ASSOCIATION AND HOSPICE OF NEW HAMPSHIRE AND VERMONT, AND A NUMBER OF OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE IN THE REGION. THE CHESHIRE MEDICAL CENTER AND OTHER MEMBERS OF THE AFFILIATED HEALTH CARE SYSTEM OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING, MANAGEMENT, AND SHARE IDENTICAL MISSIONS.
Schedule H, Part VI, Line 7 State filing of community benefit report	NH

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Valuation Method UsedValuationMethodUsedDesc	Purpose Of GrantPurposeOfGrantTxt
FOUNDATION FOR HEALTHY COMMUNITIES
125 AIRPORT ROAD	Concord	NH	03301	020275078	501(c)(3)	$330,784	FMV	Program Support
MONADNOCK FAMILY SERVICES
17 93RD ST	kEENE	NH	03431	026012230	501(C)(3)	$204,711	FMV	PROGRAM SUPPORT
SOUTHWEST REGION PLANNING COMMISSION STATE OF NH
37 ASHUELOT STREET	KEENE	NH	03431	020359624	GOVERNMENT	$55,250	FMV	PROGRAM SUPPORT
KEENE STATE COLLEGE
229 MAIN STREET	KEENE	NH	03431	026000937	GOVERNMENT	$10,815	FMV	PROGRAM SUPPORT
DENTAL HEALTH WORKS
69V ISLAND STREET	KEENE	NH	03431	300275867	501(C)(3)	$10,000	FMV	PROGRAM SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	5	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	NURSING & HEALTHCARE SCHOLARSIHPS	GrantTypeTxt
Recipient	27	RecipientCnt
Cash Grant	$55,001	CashGrantAmt
Valuation Method Used	FMV	ValuationMethodUsedDesc

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	FormAndLineReferenceDesc
Explanation	ALL GRANTS AND ASSISTANCE ARE PAID TO 501(C)(3) ORGANIZATIONS OR GOVERNMENTAL ENTITIES.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JENNIFER DINUBILA DO
Former President of Medical Staff	$0	$383,055	$0	$0	$0	$25,780	$0	$21,615	$0	$36,701	$0	$467,151	$0	$0
DON CARUSO MD
TRUSTEE/CEO/PRESIDENT - CMC	$0	$457,446	$0	$37,420	$0	$34,180	$0	$27,315	$0	$32,116	$0	$588,477	$0	$0
CLAIRE FABIAN MD
Trustee/ Medical Staff President (eff. 11/1/20)	$0	$330,063	$0	$0	$0	$5,014	$0	$27,315	$0	$26,152	$0	$388,544	$0	$0
Michael Ormont MD
TRUSTEE/EX-OFFICIO/Medical Staff Pres-CMC(thru 10/31/20)	$0	$381,411	$0	$13,687	$0	$21,077	$0	$27,315	$0	$28,574	$0	$472,064	$0	$0
Cherie Holmes MD
Trustee / Physician	$0	$482,870	$0	$0	$0	$43,688	$0	$27,315	$0	$18,476	$0	$572,349	$0	$0
Stephen Leblanc
Trustee (eff. 7/1/20)	$0	$683,250	$0	$0	$0	$102,875	$0	$27,315	$0	$33,682	$0	$847,122	$0	$0
Maria Padin MD
TRUSTEE	$0	$467,964	$0	$45,000	$0	$39,626	$0	$27,315	$0	$42,718	$0	$622,623	$0	$0
ANDREW TREMBLAY MD
TRUSTEE	$0	$321,716	$0	$0	$0	$3,081	$0	$21,615	$0	$35,226	$0	$381,638	$0	$0
RACHEL LOVINS MD
TRUSTEE	$0	$392,810	$0	$0	$0	$12,469	$0	$11,400	$0	$35,603	$0	$452,282	$0	$0
Michael Waters
Trustee (Eff. 7/1/20) / Treasurer	$0	$257,597	$0	$0	$0	$550	$0	$18,875	$0	$1,444	$0	$278,466	$0	$0
Christine Schon MPA
COO (thru 12/31/20)	$0	$341,947	$0	$0	$0	$31,427	$0	$27,315	$0	$26,666	$0	$427,355	$0	$0
KATHRYN WILLBARGER
COO (Eff. 1/2021) / Sr. VP-Finance (thru 12/2020)	$358,894	$0	$0	$0	$51,517	$0	$21,615	$0	$2,644	$0	$434,670	$0	$0	$0
AMY MATTHEWS
CHIEF NURSING OFFICER	$221,892	$0	$0	$0	$773	$0	$19,742	$0	$1,292	$0	$243,699	$0	$0	$0
David Quigley
VP Clinical Operations - CMC	$0	$253,372	$0	$0	$0	$2,529	$0	$23,844	$0	$4,131	$0	$283,876	$0	$0
ERLI CHEN
PHYSICiST	$239,807	$0	$0	$0	$18,992	$0	$24,779	$0	$8,438	$0	$292,016	$0	$0	$0
LATASHA HEAPE
CHIEF CRNA	$215,867	$0	$0	$0	$0	$0	$9,116	$0	$15,103	$0	$240,086	$0	$0	$0
MICHAEL W FRANK
NURSE ANESTHETIST CRNA	$268,575	$0	$0	$0	$8,552	$0	$25,706	$0	$1,649	$0	$304,482	$0	$0	$0
Shawn V Lafrance
VP Population Health	$197,977	$0	$0	$0	$2,289	$0	$18,337	$0	$15,462	$0	$234,065	$0	$0	$0
Richard Crowe Jr
Pharmacy Manager	$160,721	$0	$0	$0	$11,466	$0	$14,842	$0	$13,905	$0	$200,934	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 1a Tax indemnification and gross-up payments	Kathryn Willbarger received a gross-up payment that was treated as taxable compensation.
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 $61,630

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	NH HEALTH AND ED FACILITIES AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	020279866	BondIssuerEIN
CUSIP	644614V48	CUSIPNum
Bond Issued	2012-11-15	BondIssuedDt
Issue Price	$30,360,529	IssuePriceAmt
Purpose	REFUND OF EXISTING DEBT; ACQUISITION	PurposeDesc
Defeased	false	DefeasedInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Pool Financing	false	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$6,180,000	RetiredAmt
Total Proceeds	$30,360,529	TotalProceedsAmt
Issuance Costs From Proceeds	$379,754	IssuanceCostsFromProceedsAmt
Working Capital Expenditures	$554,125	WorkingCapitalExpendituresAmt
Capital Expenditures	$4,777,102	CapitalExpendituresAmt
Other Spent Proceeds	$24,649,548	OtherSpentProceedsAmt
Substantial Completion	2013	SubstantialCompletionYr
Refunding Tax Exempt Bonds	Yes (true)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	false	RefundingTaxableBondsInd
Final Allocation Made	Yes (true)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (true)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (true)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	false	MgmtContractBondFincdPropInd
Any Research Agreements	false	AnyResearchAgreementsInd
Private Bus Use By Others	0.0	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.0126	PrivateBusConcerningUBIPct
Total Private Business Use	0.0126	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	false	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (true)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiledInd
Rebate Not Due Yet	false	RebateNotDueYetInd
Exception To Rebate	Yes (true)	ExceptionToRebateInd
No Rebate Due	false	NoRebateDueInd
Variable Rate Issue	false	VariableRateIssueInd
Hedge Identified In Bks And Rec	false	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	false	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (true)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (true)	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
ASHLEY COPELAND
FAMILY MEMBER of TRUSTEE H. ROGER HANSON	$79,067	Employment Compensation	false
ELIZABETH LEHR
FAMILY MEMBER OF TRUSTEE H. ROGER HANSON	$58,116	Employment Compensation	false

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule L, Part III Tuition Assistance	FormAndLineReferenceDesc
Explanation	A related organization remitted $15,144 to an educational institution for the tuition of Kathryn Willbarger.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH CEO COMPENSATION	THE CEO IS PAID BY A RELATED ORGANIZATION. TO ASSIST WITH COMPENSATION DECISIONS, THE ORGANIZATION RETAINED YAFFE & COMPANY, INC. TO PROVIDE CONSULTATION TO THE EXECUTIVE COMMITTEE OF THE CMC BOARD OF TRUSTEES REGARDING EXECUTIVE COMPENSATION, BENEFITS, AND PREREQUISITES. THE EXECUTIVE COMMITTEE HAS A COMPENSATION REVIEW PROCESS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE COMPENSATION DECISIONS. ANNUALLY, THE COMMITTEE USES A MULTI-TIERED APPROACH THAT INCLUDES INDEPENDENT COMPARABILITY DATA TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOWS FROM THE ORGANIZATION'S STRATEGIC PLAN. BY WAY OF QUESTIONNAIRE, BOARD MEMBERS PARTICIPATE IN THE PERFORMANCE REVIEW PROCESS AND A SUMMARY REPORT IS SHARED WITH THE CEO. VARIABLE PAY IS AWARDED BASED ON ACHIEVEMENT OF SPECIFIC QUALITATIVE AND QUANTITATIVE GOALS. IN CONJUNCTION WITH THE EXECUTIVE COMMITTEE, CHALLENGING AND MEASURABLE GOALS ARE ESTABLISHED, WHICH PROVIDE ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC INITIATIVES.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	As described in the organization's bylaws, the Executive Committee shall consist of the officers of the Board of Trustees of the Corporation and an additional trustee recommended by the Chairperson of the Board and approved by the Board. The Chairperson of the Board of Trustees shall be the Chairperson of the Executive Committee, which shall work at the direction of (and report to) the Board of Trustees, undertaking specific activities assigned to it by the full Board. The Executive Committee shall serve as a resource in the following areas: policy formulation, preparation of background material and analysis for Board deliberations, evaluation of the CEO's performance and recommendations on compensation, and other areas in which the Board requires the deliberation of the officers. The Executive Committee shall have the power to transact all regular business of the Corporation between meetings of the Board. The Executive Committee shall also perform functions of the "Executive Compensation Committee."
Form 990, Part VI, Line 6 Classes of members or stockholders	DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER. D-HH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF THE CHESHIRE MEDICAL CENTER'S BOARD OF TRUSTEES.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	THE SOLE MEMBER HAS THE RIGHT TO RATIFY THE CHESHIRE MEDICAL CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD, APPROVE THE DISSOLUTION OR LIQUIDATION OF THE CHESHIRE MEDICAL CENTER; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS AND THE CFO BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO THE OFFICIAL FILING OF OF THE FORMS.
Form 990, Part VI, Line 12c Conflict of interest policy	CHESHIRE MEDICAL CENTER'S BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS AND TRUSTEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CURCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	TO ASSIST WITH COMPENSATION DECISIONS, THE ORGANIZATION RETAINED YAFFE & COMPANY, INC. TO PROVIDE CONSULTATION TO THE EXECUTIVE COMMITTEE OF THE CMC BOARD OF TRUSTEES REGARDING EXECUTIVE COMPENSATION, BENEFITS, AND PREREQUISITES. THE EXECUTIVE COMMITTEE HAS A COMPENSATION REVIEW PROCESS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE COMPENSATION DECISIONS. ANNUALLY, THE COMMITTEE USES A MULTI-TIERED APPROACH THAT INCLUDES INDEPENDENT COMPARABILITY DATA TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOWS FROM THE ORGANIZATION'S STRATEGIC PLAN. BY WAY OF QUESTIONNAIRE, BOARD MEMBERS PARTICIPATE IN THE PERFORMANCE REVIEW PROCESS AND A SUMMARY REPORT IS SHARED WITH THE CEO. VARIABLE PAY IS AWARDED BASED ON ACHIEVEMENT OF SPECIFIC QUALITATIVE AND QUANTITATIVE GOALS. IN CONJUNCTION WITH THE EXECUTIVE COMMITTEE, CHALLENGING AND MEASURABLE GOALS ARE ESTABLISHED, WHICH PROVIDE ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC INITIATIVES. DURING FY21, 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 Income - Total Revenue: 405445, Related or Exempt Function Revenue: 405445, 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: 48595885, Program Service Expense: 48595885, Management and General Expenses: , Fundraising Expenses: ; Lab and Radiology Services - Total Expense: 2346072, Program Service Expense: 2346072, Management and General Expenses: , Fundraising Expenses: ; Consulting and Other Services - Total Expense: 12217386, Program Service Expense: 11544872, Management and General Expenses: 665950, Fundraising Expenses: 6564; Pharmacy Management Services - Total Expense: 456067, Program Service Expense: 456067, Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	NET ASSET TRANSFERS - 680017; Transfer to related organization - -4850398;
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 2021, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FEDERAL FUNDING WHICH MET THE MINIMUM THRESHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 . DUE TO THE NATURE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE AUDIT WAS PERFORMED ON THE FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING CHESHIRE MEDICAL CENTER.
Form 990, Part XII, Line 2c Change of oversight process or selection process	CHESHIRE MEDICAL CENTER DELEGATES OVERSIGHT OF THE AUDIT TO THE FINANCE & AUDIT SUBCOMMITTEE. THE FULL BOARD REVIEWS AND APPROVES THE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS ALSO INCLUDED IN THE AUDIT AND CONSOLIDATED FINANCIAL STATEMENTS OF ITS PARENT ORGANIZATION, DARTMOUTH-HITCHCOCK HEALTH.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
CHESHIRE HEALTH FOUNDATION
580 COURT STREET	KEENE	NH	03431	020202220	SUPPORTING ORGANIZATION	NH	501(c)(3)	Type I	CMC	Yes (true)
CHESHIRE HEALTH SERVICES
580-590 COURT STREET	KEENE	NH	03431	473379283	HEALTHCARE	NH	501(c)(3)	3	CMC	Yes (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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
KEENE HEALTH ENTERPRISES
580 COURT STREET	KEENE	NH	03431	020374999	REAL ESTATE HOLDING	NH	CMC	C Corporation	$0	$0	1	Yes (true)
KEENE HEALTH REALTY
580 COURT STREET	KEENE	NH	03431	020374998	REAL ESTATE HOLDING	NH	CMC	C Corporation	-$45,911	$505,810	1	Yes (true)
KEENE HEALTH SERVICES
580 COURT STREET	KEENE	NH	03431	020374997	REAL ESTATE HOLDING	NH	CMC	C Corporation	$19,352	$1,306,192	1	Yes (true)

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (true)	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Cheshire Health Foundation
C	$8,623,795	FMV
Cheshire Health Foundation
Q	$176,960	FMV
Cheshire Health Foundation
K	$72,000	FMV
Cheshire Health Services
Q	$165,887	FMV
Cheshire Health Services
O	$1,443,134	FMV
Cheshire Health Services
R	$4,850,398	FMV