2021-05-12T11:32:18-05:00 2020-06-30 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402411122 990 2019-07-01 222519596 Dartmouth-Hitchcock Clinic DART 6036531155 One Medical Center Drive Lebanon NH 03756 Daniel P Jantzen CPA CFO 2021-05-12 true Kim Scifres P01316095 5023263996 2019 2022-09-23 18:48:47Z Joanne M Conroy MD One Medical Center Drive Lebanon NH 03756 498748711 false X www.dartmouth-hitchcock.org X 1983 NH Advancing health through research, education, clinical practice, and community partnerships; providing each person the best care in the right place, at the right time, every time. 21 14 5412 497 290304 0 8020230 24093904 391029523 348577612 1974910 94898 112531662 125967304 513556325 498733718 1697267 3969949 0 0 304820322 318246495 0 0 103043 188699423 207292227 495217012 529508671 18339313 -30774953 229963525 252063565 463672940 558937659 -233709415 -306874094 WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 394143835 3969949 471522859 Dartmouth-Hitchcock Clinic (DHC) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code (Code) and is exempt from federal income taxes on related income, pursuant to Section 501(a) of the Code. DHC and its subsidiaries form a multispecialty physician practice group which operates throughout New Hampshire and Vermont and provides both medical services to patients and medical education and research. Health care services provided during 2020 resulted in 1,470,854 office visits recorded by DHC personnel, with 356,626 unique patients served . The promotion of health through the medical practice activities of DHC provides the basis for the organization's tax-exempt status. DHC operates as an integral component of (and is fully owned by) Dartmouth-Hitchcock Health (D-HH), a New Hampshire not-for-profit corporation organized to support medical organizations like DHC. DHC provides the physician staff to a related affiliate, Mary Hitchcock Memorial Hospital (MHMH, also a fully-owned member of D-HH) and the related sophistication essential for the development and operations of the Hospital as the largest and only teaching hospital in New Hampshire and the designation by the federal government as a rural referral center for northern New England. The shared mission of DHC and MHMH is to advance health through research, education, clinical practice, and community partnerships, providing each person the best care, in the right place, at the right time, every time. Consistent with this mission, and in partnership with MHMH, DHC provides high-quality, cost-effective, comprehensive, and integrated health care to individuals, families, and the communities it serves regardless of a patient's ability to pay. DHC actively supports community-based health care, and promotes the coordination of services among health care providers and social services organizations within the regions it serves. DHC also seeks to work collaboratively with other area health care providers to improve the health status of residents in the region. DHC, MHMH, and Cheshire Medical Center (Cheshire) are playing key coordinating roles in the implementation of CMS'S Delivery System Reform Incentive Payment (DSRIP) Program, better known as a "1115 Waiver." This statewide initiative will integrate and improve behavioral and physical health care. The effort ties together mental health, substance use and disorder treatment, physical health, social needs, housing, transportation, and the criminal justice system to form a coordinated effort that provides care for New Hampshire's most vulnerable residents in the DSRIP. These activities are also an integral part of DHC's and MHMH's efforts at addressing the opioid abuse crisis, which impacts so many patients in DHC's service area. In addition to the alternative payment models and integrated care delivery relationships noted above, DHC has several shared risk contracts with the largest commercial insurance carriers in its market. DHC was responsible for managing the cost of care and health of approximately 100,000 members across these patient populations during fiscal year 2020. The Jack Byrne Center for Palliative & Hospice Care coordinates the clinical, education, and research efforts of DHC and Visiting Nurse alliances around the region. This effort provides much-needed end-of-life care for patients in a clinical setting that meets the needs of patients and their families. Due to increased patient demand in the southern part of New Hampshire, DHC has commenced a major construction project to expand the Manchester Clinic site to increase patient capacity. The 94,000 additional square feet will include a state-of-the-art, six-room, extended-stay (23 hour) ambulatory surgery center, expanded medical office space to support primary and specialty care outpatient clinics, and a fixed magnetic resonance imaging (MRI) unit, among other uses. DHC files an annual community benefits report with the State of New Hampshire which outlines the community and charitable benefits DHC provides. The complete and updated community benefits reports are available upon request; these reports can also be found on the organization's website. The broad categories used in the community benefit report to summarize the benefits mentioned here include: "financial assistance" (formerly called "charity care"), which represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended June 30, 2020, DHC provided financial assistance to 23,363 patients in the amount of $16,102,221 as measured by gross charges . The estimated cost of providing this care for the year ended June 30, 2019, was $4,344,664 . DHC also routinely provides services to Medicaid patients at reimbursement levels that are well below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the year ended June 30, 2019 was $31,102,839 . Community health activities include the cost or value of several different types of programs, including the cost of community-based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include Granite State Fit Kids Health Program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, and Smoking Prevention and Cessation programs. This category also includes financial contributions and the contribution of time and services to community programs, hospitals, and agencies. DHC also provides a significant amount of uncompensated care to its patients that is reported as "provision for bad debts," which is not included in the amounts reported above. For the fiscal year ended June 30, 2020, DHC reported a provision for bad debts of approximately $26,448,136 . 35792252 0 1419965 As a component of an integrated academic medical center, Dartmouth-Hitchcock Clinic (DHC) provides significant support for academic and research programs through its support of the Geisel School of Medicine at Dartmouth College (GSM). DHC provides support for physicians' unpaid teaching time as part of its community benefit initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, DHC provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to Mary Hitchcock Memorial Hospital (MHMH) and GSM. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across New Hampshire, Vermont, and beyond as well as uncompensated costs of academic and medical research activities. During fiscal year 2020, DHC continued the transition of research activities and management from GSM to DHC, under the leadership of the Vice President for Research. 429936087 true true false true false false false false true true true false true true false false true false true true true false false false false false true true true false false false true false false true false false false false false true true true true false false true 0 0 5412 true true true false false false false false false false false false true false X 21 14 false false false false true true true true true false false true true true true true true true true false NH X Daniel P Jantzen 6036505634 One Medical Center Drive Lebanon NH 03756 Charles G Plimpton MBA Trustee/Secretary/Treasurer 1.5 2.5 X X 0 0 0 Edward H Stansfield III MA Trustee/ Chair (effective 1/1/20) 0.8 2.3 X X 0 0 0 Joanne M Conroy MD Trustee, Ex-Officio, CEO 16.2 39.9 X X 1356521 0 53900 Vincent S Conti MHA Trustee/Board Chair (Through 12/31/19) 0.8 1.8 X X 0 0 0 Cherie Holmes MD Trustee 12.0 29.0 X 485345 0 55299 David P Paul Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Duane A Compton PHD Trustee / Ex-Officio 0.8 1.7 X 0 0 0 Elof Eriksson MD PhD Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Jennifer L Moyer MBA Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Jocelyn Chertoff MD VP SRVC LN/DPT CHCR DGNSTC RAD 12.0 28.0 X 702848 0 42604 Jon Wahrenberger MDFAHAFAC Trustee 12.0 28.0 X 355485 0 65268 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (EFFECTIVE 1/1/20) 40.0 0.5 X 417979 0 57113 Kari M Rosenkranz MD Trustee (through 12/2019) / Physician 12.0 28.0 X 522969 0 36344 KURT K RHYNHART MD TRUSTEE 12.0 28.0 X 491637 0 42285 Laura K Landy MBA Trustee 0.8 1.3 X 0 0 0 Marc B Wolpow JDMBA Trustee 0.8 1.3 X 0 0 0 Mark W Begor MBA Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 Pamela Thompson MSRNCENP Trustee 0.8 1.3 X 0 0 0 Paul P Danos PHD Trustee 0.8 1.3 X 0 0 0 Robert A Oden Jr PHD Trustee 1.5 2.5 X 0 0 0 ROBERTA L HINES MD TRUSTEE 1.5 1.5 X 0 0 0 Senator Judd A Greg Trustee (through 6/2020) 0.8 0.8 X 0 0 0 Thomas Raffio Trustee (effective 1/1/20) 0.8 0.8 X 0 0 0 William J Conaty Trustee 0.8 1.3 X 0 0 0 Aimee M Claiborne Chief HR Officer 12.0 28.0 X 0 452838 48214 DANIEL P JANTZEN CPA CFO 15.0 42.0 X 0 821761 56733 EDWARD MERRENS Chief Clinical Officer 12.0 29.0 X 794781 0 43222 JOHN KACAVAS Chief Legal Officer 12.0 31.0 X 0 714988 57857 Maria Padin MD Chief Medical Officer 12.0 30.0 X 430924 0 64642 Martin Purcell MBA Chief Information Officer 12.0 28.0 X 0 411454 53030 Matthew Haag VP Development 12.0 28.0 X 0 371795 35780 Patrick F Jordan III MBA Chief Operating Officer 15.0 42.0 X 0 770233 64134 Stephen Leblanc Chief Strategy Officer 12.0 30.5 X 828259 0 52333 Susan A Reeves EDDRN Chief Nursing Executive 12.0 28.5 X 0 577922 56445 GEORGE T BLIKE MD Chief Quality & Value Officer 12.0 29.5 X 474747 0 64154 Jeffrey Obrien MHA KEY EMP/ VP CLINICAL OPS 12.0 28.0 X 0 370955 59933 Karen Clements RNBSNMSB Chief Nursing Officer 12.0 28.0 X 0 360969 33521 Peter D Solberg MD Chief Medical Information Officer 12.0 28.0 X 390772 0 60729 Simon Hillier Dept Chair ANESTHESIOLOGY 12.0 28.0 X 565423 0 57356 Staci Hermann PHARMDMS CHIEF PHARMACY OFFICER 12.0 28.0 X 0 285277 27090 Daniel Stewart MD Physician 12.0 28.0 X 1212148 0 57872 John Nigriny Staff Physician 40.0 0 X 973872 0 58042 Lixia Ellis MD Physician 12.0 28.0 X 933061 0 49489 Nathan Simmons MD Physician 12.0 28.0 X 929952 0 53695 Timothy Ryken Staff Physician 12.0 28.0 X 1063854 0 58379 Christine Schon MPA FMR KEY EMP/ VP Ambulatory Care 40.0 0.5 X 294491 0 56219 Kimberly Troland JD FMR INTRM GC/DEPUTY GEN CNSL 12.0 28.0 X 0 397737 42204 Richard I Rothstein MD Former Dept Chair/Srvc LN LDR - MED 12.0 28.0 X 681373 0 57240 Sandra Wong MD SVP SVC LN & Chair of Surgery 12.0 28.0 X 720339 0 33203 Tina E Naimie CPA FMR KEY EMP/ VP CORP FINANCE 12.0 30.0 X 0 284775 23176 Wendy Fielding MBA FMR KEY EMP/ VP FINANCE PLANNING 12.0 29.0 X 0 282795 54116 Wendy Wells MD FMR KEY EMP/DEPT CHR PATHOLOGY 12.0 28.0 X 596868 0 50558 15223648 6103499 1782179 1530 true true false 0 9152721 14941183 24093904 NET PATIENT SERVICE REVENUE 621300 348577612 348577612 0 0 0 0 348577612 85477 -312 85789 841103 63392 10154 4839 830949 58553 889502 889502 9421 0 9421 9421 9421 CONTRACTED REVENUE 621300 105137200 104846584 290616 CAFETERIA INCOME 722212 421974 421974 STIMULUS PAYMENTS 621300 4812814 4812814 14705814 14705814 0 0 125077802 498733718 472942824 290304 1406686 3203243 3203243 710083 710083 56623 56623 0 0 4250992 1174234 2999568 77190 893362 289731 583704 19927 251976962 219365616 32611346 16613171 14453459 2159712 28823640 18139913 10683727 15688368 8246213 7436229 5926 693479 13907 679572 282297 282297 15400 15400 39678609 32307628 7370981 0 1043829 25686 1018143 6866583 4930207 1936376 6669052 600216 6068836 7007482 507447 6500035 1608913 809592 799321 63544 63544 6551031 589593 5961438 3532030 1060542 2471488 7666224 2787341 4878883 MEDICAL SUPPLIES 112326112 111488726 837386 EQUIP REPAIR & MAINTENANCE 6192647 4202471 1990176 ACADEMIC, GME, TEACHING & SUPPORT 3091047 2492332 598715 RECRUITMENT COSTS 1055209 80431 974778 2948739 2337309 611430 0 529508671 429936087 99469541 103043 0 6158147 57629020 45372368 155947 161724 0 0 2097728 2047228 586067 679143 126405153 107529790 20326348 18875363 666552 1224488 57742694 58812630 152738 1435821 90606431 117296653 229963525 252063565 203815575 241810363 13401173 0 0 6660425 7047317 253196940 296678806 463672940 558937659 X -235130437 -308302368 1421022 1428274 -233709415 -306874094 229963525 252063565 X -30774953 -1071449 -41318277 X false true X true true true X 0 0 0 8020230 24093904 32114134 419623067 437313420 454429030 501802116 472942824 2286110457 0 0 0 419623067 437313420 454429030 509822346 497036728 2318224591 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2318224591 1411061 735442 770344 1008778 989972 4915597 0 1411061 735442 770344 1008778 989972 4915597 230170 -172489 150042 3882 4453 216058 61525638 83083146 90978791 111631549 125261413 472480537 482789936 520959519 546328207 622466555 623292566 2795836783 0.8292 0.8376 0.0018 0.0025 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - OTHER INCOME, COLUMN A - 61525638.0, COLUMN B - 83083146.0, COLUMN C - 90978791.0, COLUMN D - XXX-XX-XXXX.0, COLUMN E - XXX-XX-XXXX.0, COLUMN F - XXX-XX-XXXX.0; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 15400 false true 40848 56248 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINES IB & 1G DARTMOUTH-HITCHCOCK CLINIC THROUGH THE USE OF CONSULTANTS, CONTACTS GOVERNMENT OFFICIALS AND LEGISLATORS. THIS CONTACT IS FOR THE PURPOSE OF PROPOSING LEGISLATION OR EXPRESSING AN OPINION ON CHANGES IN LEGISLATION THAT AFFECT DHC AND ITS ABILITY TO CARRY OUT ITS MISSION. THE TYPICAL ACTIVITIES MAY INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. FOR THE FISCAL YEAR ENDED JUNE 30, 2020, DARTMOUTH HITCHCOCK CLINIC INCURRED $15,400 OF EXPENSES IN CONJUNCTION WITH THESE ACTIVITIES. LINE 1I DHC PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1I REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS. 1345817 28397 14120 1360094 1340985 61035 56203 1345817 1284444 1105 55436 1340985 1214414 72236 2206 1284444 1128967 102466 -10712 6307 1214414 0.0 0.7341 0.2659 false false 2505032 7215859 9720891 72493046 63369823 9123223 27567760 27548115 19645 16623456 16611852 11604 18875363 Public Equities Funds Private Equities Funds 145375 F Hedge Funds 61528 F Other Secuities 119442 F INVESTMENT IN CAPTIVE - HAMDEN 58486285 F 58812630 DHC 457(B) PLAN ASSETS 88232195 DUE FROM AFFILIATE 29064458 117296653 ACCRUED POST RETIREMENT PENSION 214396684 RESERVES FOR INSURANCE RELATED LOSS 78858824 ESTIMATED THIRD PARTY SETTLEMENT 3423298 296678806 Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH HITCHCOCK CLINIC true East Asia and the Pacific 0 1 Program Services Medical program 2294 Central America and the Caribbean 0 1 Program Services Medical Services 487 Sub-Saharan Africa 0 6 Program Services Medical Services 13393 Europe (Including Iceland and Greenland) 0 0 Program Services Program Support 21724 Central America and the Caribbean 0 0 Program Services Program Support 34899 Central America and the Caribbean 0 0 Investments Captive Investments 58486285 0 8 0 0 0 8 58559082 0 58559082 Europe (Including Iceland and Greenland) Program Support 8400 Cash Central America and the Caribbean Program Support 34899 Cash Europe (Including Iceland and Greenland) Program Support 13324 Cash 3 0 true false true true true false Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. Schedule F, Part I, Line 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. true Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 501(c)(3) 35562 FMV PROGRAM SUPPORT American Cancer Society 2 Commerce Drive Suite 110 Bedford NH 03110 131788491 501(c)(3) 11060 FMV PROGRAM SUPPORT American Heart Association PO Box 4002012 Des Moines IA 503402012 135613797 501(c)(3) 9660 FMV PROGRAM SUPPORT Amoskeag Health 145 Hollis Street Manchester NH 03101 020458174 501(c)(3) 15400 FMV PROGRAM SUPPORT APPLIED GEOSOLUTIONS LLC 15 NEWMARKET ROAD DURHAM NH 03824 020518753 8770 FMV PROGRAM SUPPORT ATRIUM HEALTH CAROLINAS HEALTHCARE SYSTEM CHARLOTTE NH 282601979 560529945 501(c)(3) 12110 FMV CHARITABLE RESEARCH Bipartisan Policy Center Inc 1225 I Street NW Washington DC 02005 731628382 501(c)(3) 7000 FMV PROGRAM SUPPORT BOSTON MEDICAL CENTER 52 RATTLESNAKE HILL RD ANDOVER MA 01810 043314093 501(c)(3) 7806 FMV CHARITABLE RESEARCH BOSTON UNIVERSITY PO BOX 28763 NEW YORK NY 100878763 042103547 501(c)(3) 67613 FMV CHARITABLE RESEARCH Boys & Girls Club of Central New Hampshire 55 Bradley Street Concord NH 03301 020259874 501(c)(3) 6000 FMV PROGRAM SUPPORT BRD OF REGENTS UNIV OF OK HLTH SCIENCE ROOM 2B02 TULSA OK 741352512 731563627 St. of OK 15896 FMV EDUCATIONAL SERVICES BRIGHAM AND WOMEN'S HOSPITAL INC NURSING PROF DEVELOPMENT BOSTON MA 02115 042312909 501(c)(3) 54798 FMV CHARITABLE RESEARCH CEDARS-SINAI MEDICAL CENTER 6500 WILSHIRE BLVD SUITE 1150 LOS ANGELES CA 90048 951644600 501(c)(3) 79396 FMV CHARITABLE RESEARCH CENTERSTONE OF KENTUCKY INC 10101 LINN STATION RD LOUISVILLE KY 40223 310939757 501(c)(3) 16844 FMV CHARITABLE RESEARCH CENTERSTONE RESEARCH INSTITUTE 44 VANTAGE WAY SUITE 280 NASHVILLE TN 37228 262505456 501(c)(3) 59852 FMV CHARITABLE RESEARCH Cheshire Medical Center 580 Court St 590 Keene NH 03431 020354549 501(c)(3) 149237 FMV PROGRAM SUPPORT City of Manchester PO Box 9598 Manchester NH 03108 026000517 City of Manchester 20000 FMV PROGRAM SUPPORT CLEVELAND CLINIC FOUNDATION ATTN STACIE PALLOTTA CLEVELAND OH 44195 340714585 501(c)(3) 32254 FMV CHARITABLE RESEARCH COMMONWEALTH OF MASSACHUSETTS DEPT OF REVENUE BOSTON MA 022055140 046002284 St. of MA 86674 FMV EDUCATIONAL SERVICES COMMUNITY MENTAL HEALTH AFFILIATES INC 270 JOHN DOWNEY DR NEW BRITAIN CT 06051 060934544 501(c)(3) 11228 FMV CHARITABLE PROGRAM SUPPORT Counseling Assoc of New London LLC 35 Newport Road New London NH 03257 201917474 501(c)(3) 43506 FMV PROGRAM SUPPORT Crotched Mountain 1 Verney Drive Greenfield NH 03047 222541478 501(c)(3) 5544 FMV PROGRAM SUPPORT Easter Seals of NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 14454 FMV PROGRAM SUPPORT Families Flourish Northeast 235 Whitford Street Manchester NH 03104 844591232 501(c)(3) 14000 FMV PROGRAM SUPPORT Families in Transition 122 Market St Manchester NH 03101 020475414 501(c)(3) 24815 FMV PROGRAM SUPPORT FAMILY PLACE INC 319 US ROUTE 5 SOUTH NORWICH VT 05055 030305264 501(c)(3) 16536 FMV CHARITABLE PROGRAM SUPPORT Family Promise of Greater Nashua 180 Lowell Road Hudson NH 03051 020528837 501(c)(3) 5625 FMV PROGRAM SUPPORT FEINSTEIN INSTITUTES FOR MEDICAL RESEARC 350 COMMUNITY DRIVE MANHASSET NY 11030 112673595 501(c)(3) 9246 FMV CHARITABLE RESEARCH Foundation for Healthy Communities (NHHA) 125 Airport Road Concord NH 03301 020275078 501(c)(3) 390579 FMV PROGRAM SUPPORT Good Neighbor Health Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 18200 FMV PROGRAM SUPPORT Grafton County Senior Citizens Council 10 Campbell St Lebanon NH 03766 237248316 501(c)(3) 5040 FMV PROGRAM SUPPORT Granite United Way 22 Concord Street Floor 2 Manchester NH 03101 026006033 501(c)(3) 5600 FMV PROGRAM SUPPORT Greater Manchester Chamber of Commerce 54 Hanover Street Manchester NH 03101 020161920 501(c)(3) 8270 FMV PROGRAM SUPPORT Greater Nashua Chamber of Commerce 142 Main Street Nashua NH 03060 020116973 501(c)(3) 7500 FMV PROGRAM SUPPORT GREATER NASHUA MENTAL HEALTH CENTER 100 WEST PEARL STREET NASHUA NH 03060 020222121 501(c)(3) 14679 FMV CHARITABLE PROGRAM SUPPORT Headrest Inc 141 Mascoma St Lebanon NH 03766 237256865 501(c)(3) 13114 FMV PROGRAM SUPPORT John Hopkins University Rubenstein Building Baltimore MD 21287 520595110 501(c)(3) 17456 FMV PROGRAM SUPPORT Keene Serenity Center 34 Mechanic Street Keene NH 03431 463123664 501(c)(3) 9517 FMV PROGRAM SUPPORT MAINE MEDICAL CENTER 22 BRAMHALL STREET PORTLAND ME 04102 010238552 501(c)(3) 33969 FMV CHARITABLE RESEARCH MASSACHUSETTS GENERAL HOSPITAL 100 CHARLES RIVER PLAZA STE 600 BOSTON MA 021142792 042697983 501(c)(3) 33006 FMV CHARITABLE RESEARCH MAYFLOWER MEDICAL OUTREACH INC PO BOX 75449 OKLAHOMA CITY OK 73147 271245528 501(c)(3) 7701 FMV CHARITABLE RESEARCH MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 501(c)(3) 41814 FMV CHARITABLE RESEARCH MEDICAL UNIVERSITY OF SO CAROLINA 1 SOUTH PARK CIRCLE CHARLESTON SC 29407 576000722 St. of SC 53199 FMV EDUCATIONAL SERVICES Mental Health Center of Greater Manchester ATTN JOANN BATTY STAFF DEV MANCHESTER NH 03101 020258994 501(c)(3) 5743 FMV CHARITABLE PROGRAM SUPPORT MICHIGAN STATE UNIVERSITY 426 AUDITORIUM ROAD EAST LANSING MI 48824 386005984 St. of MI 9958 FMV EDUCATIONAL SERVICES Monadnock Area Peer Support Agency 64 Beaver Street Keene NH 03431 020484723 501(c)(3) 10385 FMV PROGRAM SUPPORT Monadnock Community Hospital 452 Old Street Rd Peterborough NH 03458 020222157 501(c)(3) 46266 FMV PROGRAM SUPPORT Monadnock Family Services 17 93rd Street Keene NH 03431 026012230 501(c)(3) 77329 FMV PROGRAM SUPPORT Monadnock United Way 23 Center Street Keene NH 03431 020236885 501(c)(3) 5600 FMV PROGRAM SUPPORT Mt Ascutney Hospital and Health Center 289 County Rd Windsor VT 05089 030183721 501(c)(3) 6300 FMV PROGRAM SUPPORT National Alliance on Mental Illness NH (NAMI) 85 No State Street Concord NH 03301 222760743 501(c)(3) 31862 FMV PROGRAM SUPPORT NEUROLOGY ASSOCIATES PA 331 N MAITLAND AVE MAITLAND FL 32751 591931548 9600 FMV CHARITABLE RESEARCH New Hampshire Charitable Foundation 37 Pleasant Street Concord NH 03301 026005625 501(c)(3) 16800 FMV PROGRAM SUPPORT New Hampshire Coalition Against Domestic Violence PO Box 353 Concord NH 03302 020360151 501(c)(3) 7000 FMV PROGRAM SUPPORT New Hampshire Public Broadcast 268 Mast Road Durham NH 03824 943443883 501(c)(3) 5600 FMV PROGRAM SUPPORT New London Hospital 273 Country Rd New London NH 03257 020222171 501(c)(3) 51804 FMV PROGRAM SUPPORT OREGON CLINIC PC 847 NE 19TH AVENUE PORTLAND OR 97232 931127856 23038 FMV PROGRAM SUPPORT OREGON HEALTH & SCIENCE UNIVERSITY PO BOX 575 PORTLAND OR 97207 931176109 St. of OR 10292 FMV EDUCATIONAL SERVICES PENNSYLVANIA STATE UNIVERSITY 500 UNIVERSITY DRIVE HERSHEY PA 170330850 246000376 St. of PA 10012 FMV EDUCATIONAL SERVICES PROVIDENCE CENTER 528 NORTH MAIN STREET PROVIDENCE RI 02860 050316969 501(c)(3) 24096 FMV CHARITABLE RESEARCH Public Health Council of the Upper Valley ONE COURT STREET LEBANON NH 03766 752991608 501(c)(3) 11224 FMV CHARITABLE PROGRAM SUPPORT Reality Check Inc 17 Turnpike Road Jaffrey NH 03452 263344553 501(c)(3) 12047 FMV PROGRAM SUPPORT RECTOR & VISITORS OF UNIV OF VIRGINIA JOHN W STEINKE CHARLOTTESVILLE VA 229081355 546001796 St. of VA 14060 FMV EDUCATIONAL SERVICES REGENTS OF THE UNIVERSITY OF CALIFORNIA UNIVERSITY OF CALIFORNIA SAN DIEGO LA JOLLA CA 920930009 943067788 St. of CA 13933 FMV EDUCATIONAL SERVICES REGENTS OF UNIV OF MICHIGAN DEPT OF PATHOLOGY BILLING ANN ARBOR MI 48109 386006309 St. of MI 45657 FMV EDUCATIONAL SERVICES RESEARCH INSTITUTE AT NATIONWIDE CHILDRENS HOSPITAL PO BOX 781653 DETROIT MI 48278 316056230 501(c)(3) 20799 FMV CHARITABLE RESEARCH SEATTLE CHILDREN'S HOSPITAL PO BOX 24728 SEATTLE WA 981240728 910564748 501(c)(3) 17880 FMV CHARITABLE RESEARCH SECOND GROWTH INC PO BOX 206 HANOVER NH 03755 020519093 501(c)(3) 8055 FMV CHARITABLE PROGRAM SUPPORT SINAI HOSPITAL OF BALTIMORE INC 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 520486540 501(c)(3) 8957 FMV CHARITABLE RESEARCH Southwestern Community Services PO Box 603 / 63 Community Way Keene NH 03431 026013808 501(c)(3) 16465 FMV PROGRAM SUPPORT STANFORD UNIVERSITY 3145 PORTER DRIVE PALO ALTO CA 94305 941156365 501(c)(3) 11667 FMV CHARITABLE EDUCATIONAL SERVICES Sullivan County 14 Main Street Newport NH 03773 026000870 501(c)(3) 33600 FMV PROGRAM SUPPORT THOMAS JEFFERSON UNIVERSITY 901 WALNUT ST PHILADELPHIA PA 19107 231352651 501(c)(3) 21358 FMV CHARITABLE EDUCATIONAL SERVICES TLC Family Resource Center PO Box 1098 Claremont NH 03743 522439830 501(c)(3) 20960 FMV PROGRAM SUPPORT Tri-Valley Transit 279 Creek Road Middlebury VT 05753 030335768 501(c)(3) 11900 FMV PROGRAM SUPPORT TRUSTEES OF DARTMOUTH COLLEGE 7 LEBANON STREET HANOVER NH 03755 020222111 501(c)(3) 442391 FMV CHARITABLE EDUCATIONAL SERVICES TRUSTEES OF THE UNIV OF PENNSYLVANIA THE WHARTON SCHOOL PHILADELPHIA PA 191789726 231352685 St. of PA 9438 FMV EDUCATIONAL SERVICES Turning Points Network 11 School Street Claremont NH 03743 020350899 501(c)(3) 27292 FMV PROGRAM SUPPORT Twin Pines Housing Trust 226 Holiday Drive Suite 20 White River Junction VT 05001 222809527 501(c)(3) 11200 FMV PROGRAM SUPPORT United Way of Greater Nashua 20 Broad Street Nashua NH 03064 026015642 501(c)(3) 20000 FMV PROGRAM SUPPORT UNIVERSITY OF ALABAMA AT BIRMINGHAM UAB SCHOOL OF NURSING BIRMINGHAM AL 352941210 636005396 St. of AL 22779 FMV EDUCATIONAL SERVICES UNIVERSITY OF ARIZONA PROJECTS CONTRACTING SERVICES TUCSON AZ 857190521 742652689 St. of AZ 5405 FMV EDUCATIONAL SERVICES UNIVERSITY OF COLORADO UCHSC DNA DIAGNOSTIC LAB AURORA CO 80045 846000555 St. of CO 11462 FMV EDUCATIONAL SERVICES UNIVERSITY OF MARYLAND BALTIMORE 220 ARCH STREET BALTIMORE MD 212011531 526002033 St. of MA 22999 FMV EDUCATIONAL SERVICES UNIVERSITY OF MIAMI DEPARTMENT OF PATHOLOGY ATLANTA GA 303845776 592695890 St. of FL 8569 FMV EDUCATIONAL SERVICES UNIVERSITY OF NEBRASKA MEDICAL CTR 985045 NEBRASKA MED CTR OMAHA NE 681985045 470491233 St. of NE 8174 FMV EDUCATIONAL SERVICES UNIVERSITY OF NEW HAMPSHIRE 51 COLLEGE ROAD DURHAM NH 03824 026000937 St. of NH 10544 FMV EDUCATIONAL SERVICES UNIVERSITY OF TEXAS AT AUSTIN VALUE INSTITUTE ATTN ROBERT CROSS AUSTIN TX 78712 746002003 St. of TX 19781 FMV EDUCATIONAL SERVICES UNIVERSITY OF VERMONT DEPT OF PEDIATRICS BURLINGTON VT 054050068 030179440 St. of VT 67238 FMV EDUCATIONAL SERVICES UNIVERSITY OF WASHINGTON GRANT CONTRACT ACCOUNTING CHICAGO IL 60693 916001537 St. of WA 20627 FMV EDUCATIONAL SERVICES Upper Valley Habitat for Humanity PO Box 1038 White River Junction VT 05001 030306081 501(c)(3) 5991 FMV PROGRAM SUPPORT Upper Valley Haven 713 Hartford Ave White River Junction VT 05001 030277908 501(c)(3) 22575 FMV PROGRAM SUPPORT Valley Regional Hospital 243 Elm Street Claremont NH 03743 020222118 501(c)(3) 93154 FMV PROGRAM SUPPORT VINFEN CORPORATION 950 CAMBRIDGE ST CAMBRIDGE MA 02141 042632219 501(c)(3) 23810 FMV CHARITABLE PROGRAM SUPPORT VIRGINIA COMMONWEALTH UNIVERSITY 800 E LEIGH STREET RICHMOND VA 23219 546001758 St. of VA 9558 FMV EDUCATIONAL SERVICES Vital Communities 195 North Main Street White River Junction VT 05001 030355283 501(c)(3) 9660 FMV PROGRAM SUPPORT West Central Behavioral Health 9 Hanover Street Lebanon NH 03766 222645978 501(c)(3) 90127 FMV PROGRAM SUPPORT WEST VIRGINIA UNIVERSITY RESEARCH CORPOR ONE WATERFRONT PLACE MORGANTOWN WV 265066001 550665758 St. of WV 6391 FMV EDUCATIONAL SERVICES Willing Hands Enterprises PO Box 172 Lebanon NH 03766 202204811 501(c)(3) 16940 FMV PROGRAM SUPPORT Women's Information Service of the Upper Valley 38 Bank Street Lebanon NH 03766 020346512 501(c)(3) 19600 FMV PROGRAM SUPPORT Woodstock Area Council on Aging 99 Senior Lane Woodstock VT 05091 030295419 501(c)(3) 5600 FMV PROGRAM SUPPORT YMCA of Greater Nashua 6 Henry Clay Drive Merrimack NH 03054 020222250 501(c)(3) 19750 FMV PROGRAM SUPPORT Visiting Nurse Association and Hospice of Vermont and New Hampshire Inc 88 Prospect St White River Junction VT 05001 036006494 501(c)3 51411 FMV Program Support 100 3 Awards and Educational Assistance 31 348737 D-H Tuition Reimbursement Program 155 324278 Patient Assistance 308 16616 Charitable Research 1 20452 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY DARTMOUTH-HITCHCOCK CLINIC (DHC) HAS WRITTEN GUIDELINES AND PROCEDURES. AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE DARTMOUTH INSTITUTE SCHOLARSHIPS (TDI) ARE PAID DIRECTLY TO DARTMOUTH COLLEGE ON BEHALF OF THE INDIVIDUALS RECEIVING THE AWARD. THE COORDINATORS OF THE PROGRAMS ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. X X X X false true false false false false false false false Joanne M Conroy MD Trustee, Ex-Officio, CEO 1030023 0 184500 0 141998 0 26955 0 26945 0 1410421 0 0 0 Jocelyn Chertoff MD VP SRVC LN/DPT CHCR DGNSTC RAD 644951 0 0 0 57897 0 26955 0 15649 0 745452 0 0 0 Cherie Holmes MD Trustee 446943 0 1000 0 37402 0 26955 0 28344 0 540644 0 0 0 Kari M Rosenkranz MD Trustee (through 12/2019) / Physician 500097 0 0 0 22872 0 21355 0 14989 0 559313 0 0 0 Jon Wahrenberger MDFAHAFAC Trustee 336765 0 0 0 18720 0 26955 0 38313 0 420753 0 0 0 KURT K RHYNHART MD TRUSTEE 453257 0 0 0 38380 0 21355 0 20930 0 533922 0 0 0 JONATHAN HUNTINGTON MD PhD MPH TRUSTEE (EFFECTIVE 1/1/20) 384586 0 0 0 33393 0 21355 0 35758 0 475092 0 0 0 Richard I Rothstein MD Former Dept Chair/Srvc LN LDR - MED 593894 0 0 0 87479 0 26955 0 30285 0 738613 0 0 0 Kimberly Troland JD FMR INTRM GC/DEPUTY GEN CNSL 0 365343 0 0 0 32394 0 21355 0 20849 0 439941 0 0 Aimee M Claiborne Chief HR Officer 0 371431 0 45600 0 35807 0 12813 0 35401 0 501052 0 0 DANIEL P JANTZEN CPA CFO 0 643403 0 80400 0 97958 0 26955 0 29778 0 878494 0 0 Patrick F Jordan III MBA Chief Operating Officer 0 654825 0 80400 0 35008 0 21355 0 42779 0 834367 0 0 JOHN KACAVAS Chief Legal Officer 0 586982 0 74400 0 53606 0 23617 0 34240 0 772845 0 0 Stephen Leblanc Chief Strategy Officer 662188 0 80400 0 85671 0 26955 0 25378 0 880592 0 0 0 EDWARD MERRENS Chief Clinical Officer 648460 0 80400 0 65921 0 26955 0 16267 0 838003 0 0 0 Maria Padin MD Chief Medical Officer 394016 0 0 0 36908 0 26955 0 37687 0 495566 0 0 0 Susan A Reeves EDDRN Chief Nursing Executive 0 493481 0 60350 0 24091 0 26955 0 29490 0 634367 0 0 Martin Purcell MBA Chief Information Officer 0 385271 0 0 0 26183 0 26955 0 26075 0 464484 0 0 Matthew Haag VP Development 0 352781 0 0 0 19014 0 21355 0 14425 0 407575 0 0 Wendy Fielding MBA FMR KEY EMP/ VP FINANCE PLANNING 0 263381 0 0 0 19414 0 21355 0 32761 0 336911 0 0 Tina E Naimie CPA FMR KEY EMP/ VP CORP FINANCE 0 273632 0 0 0 11143 0 21355 0 1821 0 307951 0 0 Christine Schon MPA FMR KEY EMP/ VP Ambulatory Care 262978 0 2000 0 29513 0 26955 0 29264 0 350710 0 0 0 Wendy Wells MD FMR KEY EMP/DEPT CHR PATHOLOGY 548491 0 0 0 48377 0 26955 0 23603 0 647426 0 0 0 Sandra Wong MD SVP SVC LN & Chair of Surgery 653814 0 0 0 66525 0 21355 0 11848 0 753542 0 0 0 GEORGE T BLIKE MD Chief Quality & Value Officer 433049 0 0 0 41698 0 26955 0 37199 0 538901 0 0 0 Karen Clements RNBSNMSB Chief Nursing Officer 0 333940 0 250 0 26779 0 21355 0 12166 0 394490 0 0 Staci Hermann PHARMDMS CHIEF PHARMACY OFFICER 0 260616 0 0 0 24661 0 12813 0 14277 0 312367 0 0 Simon Hillier Dept Chair ANESTHESIOLOGY 516806 0 0 0 48617 0 26955 0 30401 0 622779 0 0 0 Jeffrey Obrien MHA KEY EMP/ VP CLINICAL OPS 0 343917 0 0 0 27038 0 26955 0 32978 0 430888 0 0 Peter D Solberg MD Chief Medical Information Officer 369462 0 0 0 21310 0 25455 0 35274 0 451501 0 0 0 Lixia Ellis MD Physician 913881 0 0 0 19180 0 13286 0 36203 0 982550 0 0 0 Nathan Simmons MD Physician 840404 0 0 0 89548 0 21355 0 32340 0 983647 0 0 0 Daniel Stewart MD Physician 1102691 0 0 0 109457 0 21355 0 36517 0 1270020 0 0 0 John Nigriny Staff Physician 894894 0 0 0 78978 0 21355 0 36687 0 1031914 0 0 0 Timothy Ryken Staff Physician 978573 0 0 0 85281 0 21355 0 37024 0 1122233 0 0 0 Schedule J, Part II NOTE REGARDING COMPENSATION SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY DHC AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY D-H ON BEHALF OF ITS EMPLOYEES. Schedule J, Part I, Line 3 ESTABLISHING COMPENSATION CEO The process for determining compensation of the CEO is the responsibility of the Compensation Committee of Dartmouth Hitchcock Health (DHH). The compensation committee consists of the Chairperson of the Board and three or more members of the board who are elected by the board, acting upon the recommendation of the chairperson and are not employees of DHH, a related organization or a subsidiary organization of a related organization. The compensation committee determines the compensation of the CEO of the DHH within ranges established by the board. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Dartmouth Hitchcock Clinic (DHC) and Mary Hitchcock Memorial Hospital (MHMH) sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC and MHMH to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen to new participants in 1998. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization.THE FOLLOWING INDIVIDUALS HAVE A SPLIT DOLLAR LIFE PLAN ARRANGEMENT: DANIEL JANTZEN $130,828 STEPHEN LEBLANC $59,434 RICHARD ROTHSTEIN $102,290 Stephen Leblanc Officer Split Dollar Life X 0 59434 false true true Richard Rothstein Former Officer Split Dollar Life X 0 102290 false true true 161724 Amy Stansfield Family member of Trustee Ed Stansfield 233957 Employment Compensation false Form 990, Part VI, Line 1a Delegate broad authority to a committee The DARTMOUTH-HITCHCOCK CLINIC (DHC) board has a Governance Committee who has the authority/responsibility of the DHC Board to ensure that DHC continues to fulfill its central mission and vision. This committee has authority to act on behalf of the full Board when the need arises. Members include the following who are all members of the governing board: Edward H. Stansfield, III, MA (Board Chair and Chair of Governance Committee) William J. Conaty (Chair - Talent Development and Compensation Committee) Roberta L. Hines, MD (Chair - Research and Education Committee) Charles G. Plimpton, MBA (Chair- Finance Committee) Pamela A. Thompson, MS, RN, CENP, FAAN (Chair - Value Committee) Ex Officio member: Dr. Joanne Conroy (CEO) Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D- HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders IN ADDITION TO RESERVED POWERS, DARTMOUTH-HITCHCOCK HEALTH (D-HH) SHALL HAVE THE AUTHORITY TO TAKE ACTIONS TO ESTABLISH, MANAGE, AND GOVERN THE SYSTEM AS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF DHC'S MISSION. THESE POWERS INCLUDE BUT ARE NOT LIMITED TO ITEMS SUCH AS THE ABILITY TO APPROVE, DISAPPROVE, OR MODIFY ALL MATERIAL GOVERNANCE, PROGRAMMATIC, AND FINANCIAL DECISIONS OF DHC'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF DHC'S BOARD OF TRUSTEES, ASSESS DHC A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE DHC'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY DHC, APPROVE KEY STRATEGIC RELATIONSHIPS, APPROVE THE ELIMINATION OR ADDITION OF ANY MATERIAL HEALTH CARE SERVICE OR PROGRAM, AND OTHER AUTHORITY TO TAKE ACTION ON BEHALF OF DHC. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORMS 990 AND 990-T ARE REVIEWED BY THE DIRECTOR OF CORPORATE FINANCE, VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 AND 990-T IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING OF THE FORMS. Form 990, Part VI, Line 12c Conflict of interest policy THE DARTMOUTH-HITCHCOCK CLINIC (DHC) BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. DARTMOUTH-HITCHCOCK HEALTH'S COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL INVOLVED 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 UNDER THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION FOR THE CEO IS EVALUATED BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSULTATION WITH THE INDEPENDENT THIRD PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2020. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES ARE EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA, ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS, WITH THE LAST FORMAL PROCESS IN 2020. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. THE PROCESS DESCRIBED ABOVE TO ESTABLISH COMPENSATION WAS USED FOR THE FOLLOWING POSITIONS: Chief Financial Officer, Chief Strategy Officer, Chief Clinical Officer, Chief Legal Officer, Chief Human Resources Officer, Chief Operating Officer, Chief Nursing - Executive, Chief Nursing Officer, Chief Pharmacy Officer, Chief Quality & Value Officer, Department Chair - Anesthesia, Department Chair - Pathology, and similar positions. Form 990, Part VI, Line 19 Required documents available to the public DHC'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. CERTAIN FINANCIAL INFORMATION IS DISCLOSED THROUGH THE COMMUNITY BENEFITS ANNUAL REPORT. THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST EITHER IN ELECTRONIC OR HARD COPY FORM. Form 990, Part VII, Section A, Line 1a, Column (B) AVERAGE HOURS PER WEEK AS PART OF DARTMOUTH-HITCHCOCK CLINIC'S (DHC) AND MARY HITCHCOCK MEMORIAL HOSPITAL'S (MHMH) AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS ON THEIR FORM 990'S EVEN THOUGH COMPENSATION REPORTED IN PART VII IS BASED ON THE ENTITY ISSUING THE W-2. IN ADDITION, CERTAIN OFFICERS SPEND TIME ON DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC, ALONG WITH TWO SUPPORTING ORGANIZATIONS: DARTMOUTH-HITCHCOCK MEDICAL CENTER (DHMC) AND HAMDEN RISK RETENTION GROUP (HAMDEN). CERTAIN OFFICERS ALSO SPEND TIME ON RELATED ENTITIES, INCLUDING ALICE PECK DAY MEMORIAL HOSPITAL (APD), WINDSOR HOSPITAL CORPORATION (DBA MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER) (MAHHC), MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER (CHESHIRE), CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION (NLH), VISITING NURSE ASSOCIATION & HOSPICE OF VT AND NH (VNA), AND THE HITCHCOCK FOUNDATION (THC). Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS DARTMOUTH-HITCHCOCK CLINIC (DHC) IS PART OF THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) SYSTEM, WHICH INCLUDES DHC, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH), AND ITS SUBSIDIARIES. MHMH RECEIVED AUTHORITY FROM THE INTERNAL REVENUE SERVICE TO ACT AS DHC'S PAY AGENT AND IMPLEMENTED THIS PROCESS AT THE BEGINNING OF FISCAL YEAR 2010. ALL EXPENSES ARE PAID DIRECTLY BY MHMH AND REIMBURSED BY DHC. MHMH MANAGES ALL REQUIRED IRS REPORTING RELATED TO THESE DISBURSEMENTS. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER REVENUE - Total Revenue: 14705814, Related or Exempt Function Revenue: 14705814, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Column (A) STATEMENT OF FUNCTIONAL EXPENSES MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC) OPERATE UNDER AN AFFILIATION AGREEMENT AS DIRECTED BY DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH ENTITIES. DUE TO THE INTEGRATED OPERATING STRUCTURE, RELATED MISSION, AND CLOSE RELATIONSHIP OF DHC AND MHMH, EXPENSES ARE SHARED BETWEEN THE TWO ENTITIES. ALL EXPENSES REPORTED WITHIN THIS FORM 990 ARE DHC'S SHARE OF EXPENSES AS DESIGNATED BY THE AFFILIATION AGREEMENT. Form 990, Part XI, Line 9 Other changes in net assets or fund balances PENSION AND OTHER CHARGES - -41318277; RENAISSANCE PSYCHIATRY OF NEW ENGLAND ONE MEDICAL CENTER DRIVE LEBANON NH 03756 813076466 PSYCH SERVICES NH -285182 753203 D-HC MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(c)(3) 3 D-HH false THE HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 HeaLTH CaRE ReSeaRCH NH 501(c)(3) 7 DHC true HAMDEN RISK RETENTION GROUP 30 MAIN STREET STE 330 BURLINGTON VT 05401 208530788 SELF INSURANCE VT 501(c)(3) Type I DHC true DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORG NH 501(c)(3) 7 NA false THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(c)(3) 3 D-HH false WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(c)(3) 3 D-HH false CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 501(c)(3) 3 D-HH false ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(c)(3) 3 D-HH false Visiting Nurse Association & HOSPICE OF VT AND NH INC 88 Prospect Street White River Junction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false POMPANOOSUC INVESTMENT CORPoration ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020352330 REAL ESTate HoLDinG NH DHC C Corporation -127 75632 1 true HAMDEN ASSURANCE CO LTD 980121409 Liability INSURANCE BD DHC C Corporation 0 65767503 0.702 true false true false false true false true false false true true true true true true true true true true Hamden Risk Retention Group M 3206530 FMV The Hitchcock Foundation P 446872 FMV The Hitchcock Foundation S 246039 FMV