2020-07-14T08:31:06-05:00 2019-06-30 350921680 CROWE LLP 175 Powder Forest Drive Simsbury CT 060897902 990 2018-07-01 020354549 The Cheshire Medical Center CHES 6033545400 580 - 590 Court Street Keene NH 034315400 KATHRYN F WILLBARGER VP OF FINANCE 2020-07-14 true Kristin Anderson P01231300 8606789200 2018 2021-01-29 14:40:06Z DON CARUSO 580 - 590 Court Street Keene NH 034315400 227976248 false X WWW.CHESHIRE-MED.COM X 1980 NH TO LEAD KEENE, NH TO BECOME THE NATION'S HEALTHIEST COMMUNITY THROUGH CLINICAL AND SERVICE EXCELLENCE, COLLABORATIONS, AND COMPASSION FOR EVERY PATIENT, EVERY TIME. 19 10 1417 135 0 -152629 1195644 1608883 205101323 219021174 1096844 2693828 3032783 4652363 210426594 227976248 274182 452850 0 0 129738571 130306525 0 0 1663235 86108890 87482331 216121643 218241706 -5695049 9734542 125320625 128808055 56849924 56569972 68470701 72238083 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. false false 186770925 452850 221693638 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. 186770925 true true false true false false false false false true false false true true false false true false false false false false false false false true true true true true true false false false false false false true false true false true false false false false true true true false false true 155 0 true 1417 true true true false false false false false true false false false false false X 19 10 false false false false true true true true true false false true true true true true true false true false NH X KATHRYN WILLBARGER 6033545454 580-590 COURT STREET KEENE NH 034315400 JENNIFER DINUBILA DO TRUSTEE/Med Staff Pres. thru 11/30/18 1.0 40.5 X X 0 323567 44206 Michael Ormont MD Trustee/Med Staff Pres., Starting 11/1/2018 40.0 1.0 X X 0 393324 44901 DON CARUSO MD TRUSTEE/CEO/PRES 40.0 1.0 X X 0 494230 44511 H ROGER HANSEN TRUSTEE/CHAIR 1.0 0.5 X X 0 0 0 MARTHA LANDRY TRUSTEE/TREASURER 1.0 0.5 X X 0 0 0 NATHALIE HOULDER TRUSTEE/VICE CHAIR 1.0 0.5 X X 0 0 0 Wendy Fielding MBA TRUSTEE 1.0 40.0 X 0 247327 49988 Cherie Holmes MD Trustee, Medical Director 1.0 40.0 X 0 429451 54176 Maria Padin MD TRUSTEE 1.0 46.0 X 0 405936 74170 Steven A Paris MD TRUSTEE 1.0 41.0 X 0 431163 53561 GEOF MOLINA TRUSTEE 1.0 0 X 0 0 0 LESLIE PITTS MD TRUSTEE 40.0 1.0 X 0 321507 53696 KATHERINE SNOW TRUSTEE 1.0 1.0 X 0 0 0 GREGG TEWKSBURY CPA TRUSTEE 1.0 0 X 0 0 0 JOHN ROUND TRUSTEE 1.0 0 X 0 0 0 ANDREW TREMBLAY MD TRUSTEE 1.0 40.0 X 0 307371 44099 MARK GAVIN TRUSTEE 1.0 0.5 X 0 0 0 SUSAN ABERT TRUSTEE 1.0 0 X 0 0 0 MICHAEL KAPILOFF TRUSTEE 1.0 0 X 0 0 0 CINDI COUGHLIN Chief Nursing Officer Thru 10/2018 40.0 0 X 264552 0 24194 AMY MATTHEWS CHIEF NURSING OFFICER STARTING 10/2018 40.0 0 X 178981 0 844 KATHRYN WILLBARGER Senior VP FINANCE 40.0 1.0 X 204291 0 2764 PAUL PEZONE VP FACILITIES & SUPPORT SRVCS 40.0 0 X 194128 0 25067 David Quigley VP Clinical Operations 40.0 0 X 0 232354 24816 ERLI CHEN PHYSICiST 40.0 0 X 226943 0 13626 LATASHA HEAPE CHIEF CRNA 40.0 0 X 223991 0 27933 SANDRA PHIPPS VP PHILANTHROPY/COMM RELATIONS 40.0 0 X 157030 0 24962 MICHAEL W FRANK NURSE ANESTHETIST CRNA 40.0 0 X 218467 0 4541 Shawn V Lafrance VP Population Health 40.0 0 X 178853 0 29934 1847236 3586230 641989 48 false true false CONIFER REVENUE CYCLE SOLUTIONS PO BOX 655025 DALLAS TX 752655025 Revenue Management 6984963 American Health Services Association 226 E Sixteenth St Traverse City MI 49684 Staffing 1375029 Comprehensive Pharmacy Services 6409 North Quail Hollow Road Memphis TN 38120 Pharmacy Management 622802 Mayo Collaborative Services 3050 Superior Drive Northwest Rochester MN 55905 Laboratory 596631 Claro Healthcare LLC 6632 Telegraph Rd Bloomfield Hills MI 40301 Consulting 216373 11 X 120000 930726 558157 40683 1608883 NET PATIENT SERVICE REVENUE 621300 218571739 218571739 PHARMACY AND DRUGS 446110 213145 213145 LAB SERVICES 621500 236290 236290 0 0 0 0 219021174 2688478 2688478 0 0 5350 0 5350 5350 5350 FOOD SERVICES 722210 1108018 1108018 CHILDCARE INCOME 624410 635591 635591 REBATES AND DISCOUNTS 900099 788259 788259 2120495 2120495 0 0 4652363 227976248 221693638 0 4673727 404870 404870 47980 47980 1330512 133813 1196699 105125455 85992622 18081578 1051255 1298537 1062204 223348 12985 18779947 15361997 3230151 187799 3772074 3085556 648797 37721 12363 10113 2250 5133 4199 934 17876 17876 17093975 14199938 2735024 159013 209684 171521 36066 2097 922494 754600 158669 9225 7398211 6051737 1272492 73982 202420 165580 34816 2024 1052533 860972 181036 10525 7989211 6535175 1374144 79892 1210438 990139 208195 12104 MEDICAL SUPPLIES 34204233 34204233 MEDICAID ENHANCEMENT & PILOT TAXES 8355729 8355729 FOOD AND CAFETERIA EXPENSES 951355 951355 EQUIPMENT RENTAL AND MAINTENANCE 5395359 5395359 2461317 2013357 423347 24613 218241706 186770925 29807546 1663235 6687629 9411695 16862239 12440780 0 0 0 3205530 3444158 2011991 1027424 231681950 164535433 66758838 67146517 26029147 0 192141 2920513 71667 0 3501443 32416968 125320625 128808055 6262231 15140408 103896 49521 26164093 25333583 0 24319704 16046460 56849924 56569972 X 63506628 65993601 4964073 6244222 260 68470701 72238083 125320625 128808055 X 9734542 -2037175 -3929985 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 17876 17876 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY CHESHIRE MEDICAL CENTER PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1i REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS. 231151 231151 77681840 51972721 25709119 21237067 7160113 14076954 132531892 105402599 27129293 67146517 Due from Affiliate 24181189 Temp restricted Specific Purpose Fund 6969840 457(b) Plan Assets 1073798 Other 192141 32416968 PENSION LIABILITY 10261933 DUE TO RELATED PARTY 5681153 RESERVES FOR INSURANCE RELATED ESTIMATED 3RD PARTY SETTLEMENT 103374 ACCRUED EARNED TIME 16046460 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. true true X true X 225 true X true true false true true 1012294 0 1012294 0.0046 16082177 13276238 2805939 0.0129 0 0 0 0.0 0 0 17094471 13276238 3818233 0.0175 2451695 207402 2244293 0.0103 1691855 78896 1612959 0.0074 470978 880428 0 0.0 70866 0 70866 0.0003 566843 0 566843 0.0026 0 0 5252237 1166726 4494961 0.0206 0 0 22346708 14442964 8313194 0.0381 0 0 0 0.0 0 0 0 0.0 1 17012 286696 217150 69546 0.0003 0 0 0 0.0 0 0 0 0.0 4 3122 285258 167187 118071 0.0005 1 220296 0 220296 0.0010 0 0 0 0.0 4 760624 40814 719810 0.0033 10 20134 1552874 425151 1127723 0.0052 true 4400320 95654036 108494790 -12840754 X true true 1 1 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 WWW.CHESHIRE-MED.COM 00014 X X X CHESHIRE MEDICAL CENTER 1 false false true X X X X X X X X X 19 true true true true X https://cheshire-med.co/documents/pdf/2019_chna.pdfm X true 19 true https://www.cheshire-med.com/documents/pdf/2019_chna_implementation_plan.pdf false true X 225.0 300.0 X X X X true true X X X X true X https://www.cheshire-med.com X https://www.cheshire-med.com X https://www.cheshire-med.com X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WHICH ARE IDENTIFIED THROUGH CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - CHESHIRE MEDICAL CENTER. The hospital took into account a cross-section of community members through an RDD telephone survey conducted by the UNH Survey Center that was analyzed by age, education, income, etc. The Council for a Healthier Community is a group, established in 1995, that includes community leaders representing local and county government, business, education sector, social service agencies, health care and public health organizations, faith-based groups and non-profit organizations providing childcare, mental health and substance abuse prevention. The hospital worked with the Council for a Healthier Community to determine the priorities from our community health needs assessment. Key people involved include: Tim Murphy (Southwest Regional Planning Commission); Ellen Avery (Community Volunteer Transportation Co.); Chris Coates (Greater Monadnock Public Health Advisory Council); Phil Wyzik (Monadnock Family Services); Phil Suter (Greater Keene Chamber of Commerce); NH State Senator Jay Kahn; George Tremblay (Antioch University); Liz LaRose (Monadnock United Way); and others. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - CHESHIRE MEDICAL CENTER. THE CHESHIRE MEDICAL CENTER COLLABORATED WITH MONADNOCK COMMUNITY HOSPITAL. 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. 2 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 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 true Community Volunteer Transportation Company (CVTC) 375 Jaffrey Rd 3 Peterborough NH 03458 262838428 501(c)3 22660 FMV Program Support County of Cheshire 12 Court St Keene NH 03431 026000141 GOVERNMENTAL 26400 FMV Program Support Monadnock Family Services 64 Main St Keene NH 03431 026012230 501(c)3 10000 FMV Program Support Dental Health Works 69V Island St Suite 2B Keene NH 03431 300275867 501(c)3 35000 FMV Program Support Foundation for Healthy Communities 125 Airport Rd Concord NH 03301 020275078 501(c)3 308978 FMV Program Support 5 0 AWARDS AND EDUCATIONAL ASSISTANCE 55 47980 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALL GRANTS AND ASSISTANCE ARE PAID TO 501(C)(3) ORGANIZATIONS OR GOVERNMENTAL ENTITIES. true false false false false false false false false JENNIFER DINUBILA DO TRUSTEE/Med Staff Pres. thru 11/30/18 0 304247 0 250 0 19070 0 21080 0 23126 0 367773 0 0 Michael Ormont MD Trustee/Med Staff Pres., Starting 11/1/2018 0 367991 0 250 0 25083 0 21851 0 23050 0 438225 0 0 DON CARUSO MD TRUSTEE/CEO/PRES 0 399577 0 39410 0 55243 0 26580 0 17931 0 538741 0 0 Wendy Fielding MBA TRUSTEE 0 228163 0 250 0 18914 0 19118 0 30870 0 297315 0 0 Cherie Holmes MD Trustee, Medical Director 0 393474 0 250 0 35727 0 38328 0 15848 0 483627 0 0 Maria Padin MD TRUSTEE 0 369274 0 5250 0 31412 0 37334 0 36836 0 480106 0 0 Steven A Paris MD TRUSTEE 0 391287 0 250 0 39626 0 26580 0 26981 0 484724 0 0 LESLIE PITTS MD TRUSTEE 0 302231 0 250 0 19026 0 30603 0 23093 0 375203 0 0 ANDREW TREMBLAY MD TRUSTEE 0 290172 0 13280 0 3919 0 21080 0 23019 0 351470 0 0 CINDI COUGHLIN Chief Nursing Officer Thru 10/2018 196260 0 0 0 68292 0 14127 0 10067 0 288746 0 0 0 AMY MATTHEWS CHIEF NURSING OFFICER STARTING 10/2018 178981 0 0 0 0 0 0 0 844 0 179825 0 0 0 KATHRYN WILLBARGER Senior VP FINANCE 202670 0 0 0 1621 0 0 0 2764 0 207055 0 0 0 PAUL PEZONE VP FACILITIES & SUPPORT SRVCS 194128 0 0 0 0 0 772 0 24295 0 219195 0 0 0 David Quigley VP Clinical Operations 0 229649 0 250 0 2455 0 21468 0 3348 0 257170 0 0 ERLI CHEN PHYSICiST 226943 0 0 0 0 0 0 0 13626 0 240569 0 0 0 LATASHA HEAPE CHIEF CRNA 223991 0 0 0 0 0 0 0 27933 0 251924 0 0 0 SANDRA PHIPPS VP PHILANTHROPY/COMM RELATIONS 157030 0 0 0 0 0 0 0 24962 0 181992 0 0 0 MICHAEL W FRANK NURSE ANESTHETIST CRNA 208665 0 0 0 9802 0 0 0 4541 0 223008 0 0 0 Shawn V Lafrance VP Population Health 178853 0 0 0 0 0 0 0 29934 0 208787 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION. Schedule J, Part I, Line 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. A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 644614V48 2012-11-15 30360529 REFUND OF EXISTING DEBT; ACQUISITION false false false A 4505000 30360529 379754 554125 4777102 24649548 2013 true false true true A false true false false 0.0 0.0 0.0 false false true A false false true false false false false false true A true Amy Matthews Officer of Cheshire Medical Center 13000 Scholarship Educational Assistance ASHLEY COPELAND FAMILY MEMBER of TRUSTEE H. ROGER HANSON 52053 Employment Compensation false ELIZABETH LEHR FAMILY MEMBER OF TRUSTEE H. ROGER HANSON 38680 Employment Compensation false X 1 40515 Market value X 1 168 Market value 0 false false false Schedule M, Part I Explanations of reporting method for number of contributions Securities - Publicly traded - Number of contribution Food inventory - Number of contributions 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. CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE NH 03431 020202220 SUPPORTING ORG NH 501(c)(3) Type I CMC true CHESHIRE HEALTH SERVICES 580-590 COURT STREET KEENE NH 03431 473379283 HEALTHCARE NH 501(c)(3) 3 CMC true DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 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 KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE NH 03431 020374999 REAL EST HLDG NH CMC C Corporation 0 0 1 true KEENE HEALTH REALTY 580 COURT STREET KEENE NH 03431 020374998 REAL EST HLDG NH CMC C Corporation 5384 607647 1 true KEENE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 020374997 REAL EST HLDG NH CMC C Corporation 0 0 1 true false false true true false false false false false true true true true true true true true true false Cheshire Health Services P 2399421 FMV Cheshier Health Foundation S 613395 FMV Cheshire Health Foundation M 360619