CHESHIRE MEDICAL CENTER: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: CHESHIRE MEDICAL CENTER (EIN 02-0354549)
Tax period: 2018-07-01 to 2019-06-30
Filed: 2020-07-14
IRS object ID: 202001969349300540
Schema version: 2018v3.1
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 M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-07-14T08:31:06-05:00	ReturnTs
Tax Period End	2019-06-30	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	175 Powder Forest Drive	AddressLine1Txt
City	Simsbury	CityNm
State Abbreviation	CT	StateAbbreviationCd
ZIP	060897902	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	020354549	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	The 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	KATHRYN F WILLBARGER	PersonNm
Person Title	VP OF FINANCE	PersonTitleTxt
Signature	2020-07-14	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kristin Anderson	PreparerPersonNm
PTIN	P01231300	PTIN
Phone	8606789200	PhoneNum

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2021-01-29 14:40:06Z	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	$227,976,248	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.CHESHIRE-MED.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1980	FormationYr
Legal Domicile State	NH	LegalDomicileStateCd
Activity Or Mission	TO LEAD KEENE, NH TO BECOME THE NATION'S HEALTHIEST COMMUNITY THROUGH CLINICAL AND SERVICE EXCELLENCE, COLLABORATIONS, AND COMPASSION FOR EVERY PATIENT, EVERY TIME.	ActivityOrMissionDesc
Voting Members Governing Body	19	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	1417	TotalEmployeeCnt
Total Volunteers	135	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$152,629	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,195,644	PYContributionsGrantsAmt
CY Contributions Grants	$1,608,883	CYContributionsGrantsAmt
PY Program Service Revenue	$205,101,323	PYProgramServiceRevenueAmt
CY Program Service Revenue	$219,021,174	CYProgramServiceRevenueAmt
PY Investment Income	$1,096,844	PYInvestmentIncomeAmt
CY Investment Income	$2,693,828	CYInvestmentIncomeAmt
PY Other Revenue	$3,032,783	PYOtherRevenueAmt
CY Other Revenue	$4,652,363	CYOtherRevenueAmt
PY Total Revenue	$210,426,594	PYTotalRevenueAmt
CY Total Revenue	$227,976,248	CYTotalRevenueAmt
PY Grants And Similar Paid	$274,182	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$452,850	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$129,738,571	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$130,306,525	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$1,663,235	CYTotalFundraisingExpenseAmt
PY Other Expenses	$86,108,890	PYOtherExpensesAmt
CY Other Expenses	$87,482,331	CYOtherExpensesAmt
PY Total Expenses	$216,121,643	PYTotalExpensesAmt
CY Total Expenses	$218,241,706	CYTotalExpensesAmt
PY Revenues Less Expenses	-$5,695,049	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$9,734,542	CYRevenuesLessExpensesAmt
Total Assets BOY	$125,320,625	TotalAssetsBOYAmt
Total Assets EOY	$128,808,055	TotalAssetsEOYAmt
Total Liabilities BOY	$56,849,924	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$56,569,972	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$68,470,701	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$72,238,083	NetAssetsOrFundBalancesEOYAmt
Mission	THE CHESHIRE MEDICAL CENTER IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE WITH A MISSION TO LEAD OUR COMMUNITY TO BECOME THE NATION'S HEALTHIEST COMMUNITY 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	$186,770,925	ExpenseAmt
Grant	$452,850	GrantAmt
Revenue	$221,693,638	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. ON MARCH 2, 2014, CMC 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 FY19, CMC PROVIDED 21,322 DAYS OF INPATIENT CARE AND HAD 4,491 HOSPITAL DISCHARGES, WHILE THE EMERGENCY DEPARTMENT WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 23,358 ER PATIENT VISITS. 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 (HTTP://WWW CHESHIRE-MED.COM/ABOUT_US/COMMUNITYBEN_REPORT.HTML). 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 OVER $9 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 $26 MILLION DOLLARS IN UNREIMBURSED MEDICAID AND MEDICARE COSTS ABSORBED BY CMC.	Desc
Total Program Service Expenses	$186,770,925	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
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
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	Yes (true)	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (true)	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	155	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	1417	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	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	Yes (true)	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	19	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	KATHRYN WILLBARGER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6033545454	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 (29 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
JENNIFER DINUBILA DO
TRUSTEE/Med Staff Pres. thru 11/30/18	1.0	40.5	Yes (X)	Yes (X)	$0	$323,567	$44,206
Michael Ormont MD
Trustee/Med Staff Pres., Starting 11/1/2018	40.0	1.0	Yes (X)	Yes (X)	$0	$393,324	$44,901
DON CARUSO MD
TRUSTEE/CEO/PRES	40.0	1.0	Yes (X)	Yes (X)	$0	$494,230	$44,511
H ROGER HANSEN
TRUSTEE/CHAIR	1.0	0.5	Yes (X)	Yes (X)	$0	$0	$0
MARTHA LANDRY
TRUSTEE/TREASURER	1.0	0.5	Yes (X)	Yes (X)	$0	$0	$0
NATHALIE HOULDER
TRUSTEE/VICE CHAIR	1.0	0.5	Yes (X)	Yes (X)	$0	$0	$0
Wendy Fielding MBA
TRUSTEE	1.0	40.0	Yes (X)		$0	$247,327	$49,988
Cherie Holmes MD
Trustee, Medical Director	1.0	40.0	Yes (X)		$0	$429,451	$54,176
Maria Padin MD
TRUSTEE	1.0	46.0	Yes (X)		$0	$405,936	$74,170
Steven A Paris MD
TRUSTEE	1.0	41.0	Yes (X)		$0	$431,163	$53,561
GEOF MOLINA
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
LESLIE PITTS MD
TRUSTEE	40.0	1.0	Yes (X)		$0	$321,507	$53,696
KATHERINE SNOW
TRUSTEE	1.0	1.0	Yes (X)		$0	$0	$0
GREGG TEWKSBURY CPA
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
JOHN ROUND
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
ANDREW TREMBLAY MD
TRUSTEE	1.0	40.0	Yes (X)		$0	$307,371	$44,099
MARK GAVIN
TRUSTEE	1.0	0.5	Yes (X)		$0	$0	$0
SUSAN ABERT
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
MICHAEL KAPILOFF
TRUSTEE	1.0	0	Yes (X)		$0	$0	$0
CINDI COUGHLIN
Chief Nursing Officer Thru 10/2018	40.0	0		Yes (X)	$264,552	$0	$24,194
AMY MATTHEWS
CHIEF NURSING OFFICER STARTING 10/2018	40.0	0		Yes (X)	$178,981	$0	$844
KATHRYN WILLBARGER
Senior VP FINANCE	40.0	1.0		Yes (X)	$204,291	$0	$2,764
PAUL PEZONE
VP FACILITIES & SUPPORT SRVCS	40.0	0			$194,128	$0	$25,067	Yes (X)
David Quigley
VP Clinical Operations	40.0	0			$0	$232,354	$24,816	Yes (X)
ERLI CHEN
PHYSICiST	40.0	0			$226,943	$0	$13,626		Yes (X)
LATASHA HEAPE
CHIEF CRNA	40.0	0			$223,991	$0	$27,933		Yes (X)
SANDRA PHIPPS
VP PHILANTHROPY/COMM RELATIONS	40.0	0			$157,030	$0	$24,962		Yes (X)
MICHAEL W FRANK
NURSE ANESTHETIST CRNA	40.0	0			$218,467	$0	$4,541		Yes (X)
Shawn V Lafrance
VP Population Health	40.0	0			$178,853	$0	$29,934		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,847,236	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$3,586,230	TotReportableCompRltdOrgAmt
Total Other Compensation	$641,989	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	48	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	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	$6,984,963
American Health Services Association
226 E Sixteenth St	Traverse City	MI	49684	Staffing	$1,375,029
Comprehensive Pharmacy Services
6409 North Quail Hollow Road	Memphis	TN	38120	Pharmacy Management	$622,802
Mayo Collaborative Services
3050 Superior Drive Northwest	Rochester	MN	55905	Laboratory	$596,631
Claro Healthcare LLC
6632 Telegraph Rd	Bloomfield Hills	MI	40301	Consulting	$216,373

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	11	CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIII	Yes (X)	InfoInScheduleOPartVIIIInd
Related Organizations	$120,000	RelatedOrganizationsAmt
Government Grants	$930,726	GovernmentGrantsAmt
All Other Contributions	$558,157	AllOtherContributionsAmt
Noncash Contributions	$40,683	NoncashContributionsAmt
Total Contributions	$1,608,883	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
NET PATIENT SERVICE REVENUE	621300	$218,571,739	$218,571,739
PHARMACY AND DRUGS	446110	$213,145	$213,145
LAB SERVICES	621500	$236,290		$236,290

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	$219,021,174	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,688,478	TotalRevenueColumnAmt
Exclusion	$2,688,478	ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$5,350	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$5,350	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$5,350	TotalRevenueColumnAmt
Exclusion	$5,350	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
FOOD SERVICES	722210	$1,108,018	$1,108,018
CHILDCARE INCOME	624410	$635,591	$635,591
REBATES AND DISCOUNTS	900099	$788,259		$788,259

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,120,495	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,120,495	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$4,652,363	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$227,976,248	TotalRevenueColumnAmt
Related Or Exempt Func Income	$221,693,638	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$4,673,727	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$404,870	TotalAmt
Program Services	$404,870	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$47,980	TotalAmt
Program Services	$47,980	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,330,512	TotalAmt
Program Services	$133,813	ProgramServicesAmt
Management And General	$1,196,699	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$105,125,455	TotalAmt
Program Services	$85,992,622	ProgramServicesAmt
Management And General	$18,081,578	ManagementAndGeneralAmt
Fundraising	$1,051,255	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,298,537	TotalAmt
Program Services	$1,062,204	ProgramServicesAmt
Management And General	$223,348	ManagementAndGeneralAmt
Fundraising	$12,985	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$18,779,947	TotalAmt
Program Services	$15,361,997	ProgramServicesAmt
Management And General	$3,230,151	ManagementAndGeneralAmt
Fundraising	$187,799	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,772,074	TotalAmt
Program Services	$3,085,556	ProgramServicesAmt
Management And General	$648,797	ManagementAndGeneralAmt
Fundraising	$37,721	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$12,363	TotalAmt
Program Services	$10,113	ProgramServicesAmt
Management And General	$2,250	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$5,133	TotalAmt
Program Services	$4,199	ProgramServicesAmt
Management And General	$934	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$17,876	TotalAmt
Program Services	$17,876	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$17,093,975	TotalAmt
Program Services	$14,199,938	ProgramServicesAmt
Management And General	$2,735,024	ManagementAndGeneralAmt
Fundraising	$159,013	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$209,684	TotalAmt
Program Services	$171,521	ProgramServicesAmt
Management And General	$36,066	ManagementAndGeneralAmt
Fundraising	$2,097	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$922,494	TotalAmt
Program Services	$754,600	ProgramServicesAmt
Management And General	$158,669	ManagementAndGeneralAmt
Fundraising	$9,225	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$7,398,211	TotalAmt
Program Services	$6,051,737	ProgramServicesAmt
Management And General	$1,272,492	ManagementAndGeneralAmt
Fundraising	$73,982	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$202,420	TotalAmt
Program Services	$165,580	ProgramServicesAmt
Management And General	$34,816	ManagementAndGeneralAmt
Fundraising	$2,024	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,052,533	TotalAmt
Program Services	$860,972	ProgramServicesAmt
Management And General	$181,036	ManagementAndGeneralAmt
Fundraising	$10,525	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$7,989,211	TotalAmt
Program Services	$6,535,175	ProgramServicesAmt
Management And General	$1,374,144	ManagementAndGeneralAmt
Fundraising	$79,892	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,210,438	TotalAmt
Program Services	$990,139	ProgramServicesAmt
Management And General	$208,195	ManagementAndGeneralAmt
Fundraising	$12,104	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt
MEDICAL SUPPLIES	$34,204,233	$34,204,233
MEDICAID ENHANCEMENT & PILOT TAXES	$8,355,729	$8,355,729
FOOD AND CAFETERIA EXPENSES	$951,355	$951,355
EQUIPMENT RENTAL AND MAINTENANCE	$5,395,359	$5,395,359

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,461,317	TotalAmt
Program Services	$2,013,357	ProgramServicesAmt
Management And General	$423,347	ManagementAndGeneralAmt
Fundraising	$24,613	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$218,241,706	TotalAmt
Program Services	$186,770,925	ProgramServicesAmt
Management And General	$29,807,546	ManagementAndGeneralAmt
Fundraising	$1,663,235	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$6,687,629	BOYAmt
EOY	$9,411,695	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$16,862,239	BOYAmt
EOY	$12,440,780	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)
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$3,205,530	BOYAmt
EOY	$3,444,158	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,011,991	BOYAmt
EOY	$1,027,424	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$231,681,950	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$164,535,433	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$66,758,838	BOYAmt
EOY	$67,146,517	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$26,029,147	BOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

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

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$192,141	BOYAmt
EOY	$2,920,513	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$71,667	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$3,501,443	BOYAmt
EOY	$32,416,968	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$125,320,625	BOYAmt
EOY	$128,808,055	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$6,262,231	BOYAmt
EOY	$15,140,408	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$103,896	BOYAmt
EOY	$49,521	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$26,164,093	BOYAmt
EOY	$25,333,583	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$24,319,704	BOYAmt
EOY	$16,046,460	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$56,849,924	BOYAmt
EOY	$56,569,972	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$63,506,628	BOYAmt
EOY	$65,993,601	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,964,073	BOYAmt
EOY	$6,244,222	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
EOY	$260	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$68,470,701	BOYAmt
EOY	$72,238,083	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$125,320,625	BOYAmt
EOY	$128,808,055	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$9,734,542	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$2,037,175	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$3,929,985	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	false	FederalGrantAuditRequiredInd

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	$17,876	OtherActivitiesAmt
Total Lobbying Expenditures	$17,876	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. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1i REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS.	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	$77,681,840	OtherCostOrOtherBasisAmt
Depreciation	$51,972,721	DepreciationAmt
Book Value	$25,709,119	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$21,237,067	OtherCostOrOtherBasisAmt
Depreciation	$7,160,113	DepreciationAmt
Book Value	$14,076,954	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$132,531,892	OtherCostOrOtherBasisAmt
Depreciation	$105,402,599	DepreciationAmt
Book Value	$27,129,293	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$67,146,517	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
Due from Affiliate	$24,181,189
Temp restricted Specific Purpose Fund	$6,969,840
457(b) Plan Assets	$1,073,798
Other	$192,141

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$32,416,968	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
PENSION LIABILITY	$10,261,933
DUE TO RELATED PARTY	$5,681,153
RESERVES FOR INSURANCE RELATED ESTIMATED 3RD PARTY SETTLEMENT	$103,374
ACCRUED EARNED TIME

Field	Value	IRS element (for citing)
Total Liability	$16,046,460	TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule D, Part V, Line 1e	While the endowment funds have been given and are being maintained for the benefit of Cheshire Medical Center, the funds are being held by the Cheshire Health Foundation (CHF). CHF is a supporting organization of Cheshire Medical Center. This entry is being made to move the reporting of the endowment funds from the Medical Center to the Health Foundation.
Schedule D, Part V, Line 4 Intended uses of endowment funds	THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROMOTE AND ADVANCE MISSION-RELATED PROGRAMS OF THE CHESHIRE MEDICAL CENTER.

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	$1,012,294	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,012,294	NetCommunityBenefitExpnsAmt
Total Expense	0.0046	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,082,177	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,276,238	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,805,939	NetCommunityBenefitExpnsAmt
Total Expense	0.0129	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
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	$17,094,471	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,276,238	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,818,233	NetCommunityBenefitExpnsAmt
Total Expense	0.0175	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,451,695	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$207,402	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,244,293	NetCommunityBenefitExpnsAmt
Total Expense	0.0103	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,691,855	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$78,896	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,612,959	NetCommunityBenefitExpnsAmt
Total Expense	0.0074	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$470,978	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$880,428	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$70,866	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$70,866	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$566,843	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$566,843	NetCommunityBenefitExpnsAmt
Total Expense	0.0026	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$5,252,237	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,166,726	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,494,961	NetCommunityBenefitExpnsAmt
Total Expense	0.0206	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$22,346,708	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,442,964	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,313,194	NetCommunityBenefitExpnsAmt
Total Expense	0.0381	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	17012	PersonsServedCnt
Total Community Benefit Expns	$286,696	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$217,150	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$69,546	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	3122	PersonsServedCnt
Total Community Benefit Expns	$285,258	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$167,187	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$118,071	NetCommunityBenefitExpnsAmt
Total Expense	0.0005	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$220,296	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$220,296	NetCommunityBenefitExpnsAmt
Total Expense	0.0010	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$760,624	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$40,814	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$719,810	NetCommunityBenefitExpnsAmt
Total Expense	0.0033	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Persons Served	20134	PersonsServedCnt
Total Community Benefit Expns	$1,552,874	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$425,151	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,127,723	NetCommunityBenefitExpnsAmt
Total Expense	0.0052	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,400,320	BadDebtExpenseAmt
Reimbursed By Medicare	$95,654,036	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$108,494,790	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$12,840,754	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	WWW.CHESHIRE-MED.COM	WebsiteAddressTxt
State License	00014	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

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	19	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://cheshire-med.co/documents/pdf/2019_chna.pdfm	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	19	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	https://www.cheshire-med.com/documents/pdf/2019_chna_implementation_plan.pdf	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
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
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
Other Method	Yes (X)	OtherMethodInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://www.cheshire-med.com	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://www.cheshire-med.com	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://www.cheshire-med.com	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
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 (6 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.
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.
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. 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 15 Facility , 1	Facility , 1 - CHESHIRE MEDICAL CENTER. THE CONTACT INFORMATION FOR HOSPITAL FACILITY STAFF AVAILABLE ON THE WEBSITE (WWW.CHESHIRE-MED.COM/PATIENTS___VISITORS/FINANCIAL_ASSISTANCE.HTML), IN THE SUPPLEMENTAL FAP BROCHURE, AND AT ALL REGISTRATION STATIONS WITHIN THE MEDICAL CENTER.

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
CHESHIRE MED CENTER COLLECTING STATION
580-590 COURT STREET	KEENE	NH	03431	COLLECTING STATION
CHESHIRE HEALTH SERVICES INC
580-590 COURT STREET	KEENE	NH	03431	NON-EMERGENCY WALK IN CLINIC

Supplemental Information Detail SupplementalInformationDetail (17 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 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 called Monadnock Voices for Prevention to reduce substance abuse. As of June 30, 2019 there are 62 individuals and/or organizations addressing development of the public health advisory council, 122 member individuals/organizations addressing emergency preparedness and over 600 individuals reached through the efforts of Monadnock Voices for Prevention. 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 non-medical/public health members. As of June 30, 2019 the GMMRC had 54 members.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	IF THE PATIENT DOES NOT RESPOND TO THE HOSPITAL'S ATTEMPTS TO COMPLETE THE FINANCIAL ASSISTANCE PACKAGE, OUTSTANDING BALANCES FOR THESE PATIENTS MAY BE WRITTEN OFF TO BAD DEBT. The organization USES A PRESUMPTIVE CHARITY REVIEW FOR BAD DEBT PATIENTS. THIS REVIEW IS THE LAST STEP PRIOR TO TRANSFERRING UNPAID BALANCES TO BAD DEBT expense.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The hospital is unable to estimate accurately the amount of bad debt expense attributable to patients eligible for financial assistance. Although a portion of bad debt expense may be related to patients who would qualify for charity care, a reportable figure cannot be reasonably estimated.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	FOOTNOTE 2: CHARITY CARE AND PROVISION FOR BAD DEBTS: THE HEALTH SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR FINANCIAL ASSISTANCE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE THE HEALTH SYSTEM DOES NOT ANTICIPATE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE HEALTH SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS. MOST ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY ARRANGEMENTS. ADDITIONS TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR BAD DEBTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOOTNOTE 3: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR ESTIMATED UNCOLLECTIBLES. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES PAST COLLECTION HISTORY AND IDENTIFIES TRENDS FOR SEVERAL CATEGORIES OF SELF-PAY ACCOUNTS (UNINSURED, RESIDUAL BALANCES, PRECOLLECTION ACCOUNTS AND CHARITY) TO ESTIMATE THE APPROPRIATE ALLOWANCE PERCENTAGES IN ESTABLISHING THE ALLOWANCE FOR BAD DEBT EXPENSE. MANAGEMENT PERFORMS COLLECTION RATE LOOK-BACK ANALYSES ON A QUARTERLY BASIS TO EVALUATE THE SUFFICIENCY OF THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLES. THROUGHOUT THE YEAR, AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED (INCLUDING CONTRACTUAL ADJUSTMENTS AND UNINSURED DISCOUNTS) WILL BE WRITTEN OFF AGAINST THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLES. IN ADDITION TO THE REVIEW OF THE CATEGORIES OF REVENUE, MANAGEMENT MONITORS THE WRITE OFFS AGAINST ESTABLISHED ALLOWANCES AS OF A POINT IN TIME TO DETERMINE THE APPROPRIATENESS OF THE UNDERLYING ASSUMPTIONS USED IN ESTIMATING THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLES.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	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 60% 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.cheshire-med.com;
Schedule H, Part V, Section B, Line 16b FAP Application website	- CHESHIRE MEDICAL CENTER: Line 16b URL: https://www.cheshire-med.com;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- CHESHIRE MEDICAL CENTER: Line 16c URL: https://www.cheshire-med.com;
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. PATIENTS ARE NOTIFIED OF THEIR POTENTIAL TO OBTAIN FINANCIAL ASSISTANCE THROUGHOUT THE REGISTRATION AND BILLING PROCESSES. UPON REGISTRATION, DISCHARGE, OR REQUESTS, PATIENTS ARE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION INFORMATION IS POSTED ON THE INTRANET AND BROCHURES DESCRIBING THE PROGRAM ARE READILY AVAILABLE TO PATIENTS, ALONG WITH SIGNS POSTED IN REGISTRATION AND THROUGHOUT THE FACILITY EDUCATING PATIENTS OF FINANCIAL ASSISTANCE. PATIENTS ARE INFORMED OF THE PROGRAM AVAILABILITY ON ANY INVOICES THEY RECEIVE AND INDIVIDUALS WHO ATTEMPT TO COLLECT PATIENT BALANCES ARE ALSO TRAINED TO REFER PATIENTS TO THE FINANCIAL ASSISTANCE PROCESS.
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 2019, THE POVERTY RATE FOR CHESHIRE COUNTY WAS 10.2%. THE MEDIAN HOUSEHOLD INCOME IS $63,057. ACCORDING TO THE SEPTEMBER 2018 NEW HAMPSHIRE EMPLOYMENT SECURITY, ECONOMIC & LABOR MARKET INFORMATION BUREAU REPORT, THE STATE AND CHESHIRE COUNTY HAD AN UNEMPLOYMENT RATE OF 2.3% (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 19 VOTING MEMBERS OF THE CHESHIRE MEDICAL CENTER BOARD OF TRUSTEES AT FY19 END, 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
Community Volunteer Transportation Company (CVTC)
375 Jaffrey Rd 3	Peterborough	NH	03458	262838428	501(c)3	$22,660	FMV	Program Support
County of Cheshire
12 Court St	Keene	NH	03431	026000141	GOVERNMENTAL	$26,400	FMV	Program Support
Monadnock Family Services
64 Main St	Keene	NH	03431	026012230	501(c)3	$10,000	FMV	Program Support
Dental Health Works
69V Island St Suite 2B	Keene	NH	03431	300275867	501(c)3	$35,000	FMV	Program Support
Foundation for Healthy Communities
125 Airport Rd	Concord	NH	03301	020275078	501(c)3	$308,978	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	AWARDS AND EDUCATIONAL ASSISTANCE	GrantTypeTxt
Recipient	55	RecipientCnt
Cash Grant	$47,980	CashGrantAmt

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)
Severance Payment	Yes (true)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	false	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
TRUSTEE/Med Staff Pres. thru 11/30/18	$0	$304,247	$0	$250	$0	$19,070	$0	$21,080	$0	$23,126	$0	$367,773	$0	$0
Michael Ormont MD
Trustee/Med Staff Pres., Starting 11/1/2018	$0	$367,991	$0	$250	$0	$25,083	$0	$21,851	$0	$23,050	$0	$438,225	$0	$0
DON CARUSO MD
TRUSTEE/CEO/PRES	$0	$399,577	$0	$39,410	$0	$55,243	$0	$26,580	$0	$17,931	$0	$538,741	$0	$0
Wendy Fielding MBA
TRUSTEE	$0	$228,163	$0	$250	$0	$18,914	$0	$19,118	$0	$30,870	$0	$297,315	$0	$0
Cherie Holmes MD
Trustee, Medical Director	$0	$393,474	$0	$250	$0	$35,727	$0	$38,328	$0	$15,848	$0	$483,627	$0	$0
Maria Padin MD
TRUSTEE	$0	$369,274	$0	$5,250	$0	$31,412	$0	$37,334	$0	$36,836	$0	$480,106	$0	$0
Steven A Paris MD
TRUSTEE	$0	$391,287	$0	$250	$0	$39,626	$0	$26,580	$0	$26,981	$0	$484,724	$0	$0
LESLIE PITTS MD
TRUSTEE	$0	$302,231	$0	$250	$0	$19,026	$0	$30,603	$0	$23,093	$0	$375,203	$0	$0
ANDREW TREMBLAY MD
TRUSTEE	$0	$290,172	$0	$13,280	$0	$3,919	$0	$21,080	$0	$23,019	$0	$351,470	$0	$0
CINDI COUGHLIN
Chief Nursing Officer Thru 10/2018	$196,260	$0	$0	$0	$68,292	$0	$14,127	$0	$10,067	$0	$288,746	$0	$0	$0
AMY MATTHEWS
CHIEF NURSING OFFICER STARTING 10/2018	$178,981	$0	$0	$0	$0	$0	$0	$0	$844	$0	$179,825	$0	$0	$0
KATHRYN WILLBARGER
Senior VP FINANCE	$202,670	$0	$0	$0	$1,621	$0	$0	$0	$2,764	$0	$207,055	$0	$0	$0
PAUL PEZONE
VP FACILITIES & SUPPORT SRVCS	$194,128	$0	$0	$0	$0	$0	$772	$0	$24,295	$0	$219,195	$0	$0	$0
David Quigley
VP Clinical Operations	$0	$229,649	$0	$250	$0	$2,455	$0	$21,468	$0	$3,348	$0	$257,170	$0	$0
ERLI CHEN
PHYSICiST	$226,943	$0	$0	$0	$0	$0	$0	$0	$13,626	$0	$240,569	$0	$0	$0
LATASHA HEAPE
CHIEF CRNA	$223,991	$0	$0	$0	$0	$0	$0	$0	$27,933	$0	$251,924	$0	$0	$0
SANDRA PHIPPS
VP PHILANTHROPY/COMM RELATIONS	$157,030	$0	$0	$0	$0	$0	$0	$0	$24,962	$0	$181,992	$0	$0	$0
MICHAEL W FRANK
NURSE ANESTHETIST CRNA	$208,665	$0	$0	$0	$9,802	$0	$0	$0	$4,541	$0	$223,008	$0	$0	$0
Shawn V Lafrance
VP Population Health	$178,853	$0	$0	$0	$0	$0	$0	$0	$29,934	$0	$208,787	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION.
Schedule J, Part I, Line 4a Severance or change-of-control payment	DURING CALENDAR YEAR 2018, FORMER CHIEF NURSING OFFICER CYNTHIA COUGHLIN RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $68,292 FROM CHESHIRE MEDICAL CENTER. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III.

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	$4,505,000	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	0.0	PrivateBusConcerningUBIPct
Total Private Business Use	0.0	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

Grnt Asst Bnft Interested Prsn GrntAsstBnftInterestedPrsnGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Amy Matthews	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Relationship With Org	Officer of Cheshire Medical Center	RelationshipWithOrgTxt
Cash Grant	$13,000	CashGrantAmt
Type Of Assistance	Scholarship	TypeOfAssistanceTxt
Assistance Purpose	Educational Assistance	AssistancePurposeTxt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
ASHLEY COPELAND
FAMILY MEMBER of TRUSTEE H. ROGER HANSON	$52,053	Employment Compensation	false
ELIZABETH LEHR
FAMILY MEMBER OF TRUSTEE H. ROGER HANSON	$38,680	Employment Compensation	false

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTradedGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$40,515	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Market value	MethodOfDeterminingRevenuesTxt

Food Inventory FoodInventoryGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$168	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Market value	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	false	ReviewProcessUnusualNCGiftsInd
Third Parties Used	false	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule M, Part I Explanations of reporting method for number of contributions	FormAndLineReferenceDesc
Explanation	Securities - Publicly traded - Number of contribution Food inventory - Number of contributions	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 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, THE DIRECTOR OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER 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 FY '19, COMPENSATION FOR THE FOLLOWING POSITIONS WERE REVIEWED: CHIEF OPERATING OFFICER, CHIEF NURSING OFFICER, AND SENIOR VP OF FINANCE.
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: 2120495, Related or Exempt Function Revenue: 2120495, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	PENSION LIABILITY ADJUSTMENT - -7720083; NET ASSET TRANSFERS - 3790098;
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 2019, 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 ORG	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	PHYS SVCS	NH	501(c)(3)	10	D-HH	false
DARTMOUTH-HITCHCOCK HEALTH
ONE MEDICAL CENTER DRIVE	LEBANON	NH	03756	264812335	PARENT ORG	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
VNA & HOSPICE OF VT AND NH INC
205 BILLINGS FARM ROAD 5	WILDER	VT	05088	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 EST HLDG	NH	CMC	C Corporation	$0	$0	1	Yes (true)
KEENE HEALTH REALTY
580 COURT STREET	KEENE	NH	03431	020374998	REAL EST HLDG	NH	CMC	C Corporation	$5,384	$607,647	1	Yes (true)
KEENE HEALTH SERVICES
580 COURT STREET	KEENE	NH	03431	020374997	REAL EST HLDG	NH	CMC	C Corporation	$0	$0	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	false	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	false	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Cheshire Health Services
P	$2,399,421	FMV
Cheshier Health Foundation
S	$613,395	FMV
Cheshire Health Foundation
M	$360,619