2020-07-13T18:02:15-05:00 2019-06-30 350921680 CROWE LLP 175 Powder Forest Drive Simsbury CT 060897902 990 2018-07-01 020222140 Mary Hitchcock Memorial Hospital MARY 6036505000 One Medical Center Drive Lebanon NH 03756 DANIEL P JANTZEN CPA CFO 2020-07-13 true Kristin Anderson P01231300 8606789200 2018 2021-01-29 14:40:06Z JOANNE M CONROY MD One Medical Center Drive Lebanon NH 03756 1561895119 false X WWW.DARTMOUTH-HITCHCOCK.ORG X 1889 NH ADVANCING HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, COMMUNITY PARTNERSHIPS, AND PROVIDING EACH PERSON THE BEST CARE IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME 19 14 6225 623 8763980 0 29386191 28349009 1152052585 1295829353 33767195 20877294 45841245 44780872 1261047216 1389836528 3236772 4155379 0 0 679850538 746284236 0 0 205841 527386727 575126652 1210474037 1325566267 50573179 64270261 1448110334 1550625147 820807995 868932139 627302339 681693008 WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 1025233195 1285795504 AS A COMPONENT OF NEW HAMPSHIRE'S ONLY INTEGRATED ACADEMIC MEDICAL CENTER, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) PROVIDES THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH (GSM) SUPPORT FOR PHYSICIANS' UNPAID TEACHING TIME AS PART OF ITS COMMUNITY BENEFIT INITIATIVES. THIS SUPPORT CONSISTS OF THE TIME PHYSICIANS SPEND PROVIDING CLINICAL SUPERVISION AND EDUCATION FOR RESIDENTS AND MEDICAL STUDENTS. IN ADDITION, THE HOSPITAL PROVIDES IN-KIND SUPPORT FOR RESEARCH AND OTHER GRANTS REPRESENTING COSTS IN EXCESS OF AWARDS FOR NUMEROUS GRANT-FUNDED HEALTH RESEARCH AND SERVICE INITIATIVES AWARDED TO DARTMOUTH-HITCHCOCK CLINIC (DHC) AND GSM. OTHER COMMUNITY BENEFIT INITIATIVES INCLUDE SUBSIDIZING THE COSTS OF PROVIDING MEDICAL AND CLINICAL EDUCATION TO PROFESSIONALS ACROSS NEW HAMPSHIRE, VERMONT AND BEYOND AS WELL AS UNCOMPENSATED COSTS OF ACADEMIC AND MEDICAL RESEARCH ACTIVITIES. IN FY19, MHMH CONTINUED THE TRANSITION OF RESEARCH ACTIVITIES AND MANAGEMENT FROM GSM TO MHMH UNDER THE LEADERSHIP OF THE VICE PRESIDENT FOR RESEARCH OPERATIONS. 70106578 4155379 43430658 MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IS AN ACUTE AND TERTIARY CARE TEACHING HOSPITAL LOCATED IN LEBANON, NEW HAMPSHIRE. MHMH PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A MAJOR TEACHING HOSPITAL, A TERTIARY CARE REFERRAL HOSPITAL, AND AS A PROSPECTIVE PAYMENT SYSTEM HOSPITAL (AS DEFINED BY CMS). MHMH PROVIDES A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, PSYCHIATRY AND REHABILITATION FOR INFANTS, CHILDREN AND ADULTS. DURING FY 2019, MHMH PROVIDED 131,587 ACUTE PATIENT DAYS OF INPATIENT SERVICE AND HAD 28,148 TOTAL ACUTE CARE DISCHARGES, WHILE MHMH'S EMERGENCY ROOM WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 29,458 DISCHARGES. DARTMOUTH-HITCHCOCK CLINIC (DHC) PROVIDES THE PHYSICIAN STAFF FOR THE HOSPITAL AND THE SOPHISTICATION ESSENTIAL FOR THE DEVELOPMENT OF THE HOSPITAL AS THE LARGEST AND ONLY TEACHING HOSPITAL IN NEW HAMPSHIRE AND THE DESIGNATION BY THE FEDERAL GOVERNMENT AS A RURAL REFERRAL CENTER FOR NORTHERN NEW ENGLAND. THE SHARED MISSION OF MHMH AND DHC IS TO ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. CONSISTENT WITH THIS MISSION AND IN PARTNERSHIP WITH DHC, MHMH PROVIDES HIGH-QUALITY, COST-EFFECTIVE, COMPREHENSIVE, AND INTEGRATED HEALTH CARE TO INDIVIDUALS, FAMILIES, AND THE COMMUNITIES IT SERVES, REGARDLESS OF A PATIENT'S ABILITY TO PAY. THROUGH FORMAL AFFILIATIONS AND OTHER CLINICAL COLLABORATIONS, MHMH ALSO SEEKS TO PARTNER WITH OTHER AREA HEALTH CARE PROVIDERS TO IMPROVE THE HEALTH STATUS OF THE REGION. THE JACK BYRNE CENTER FOR PALLIATIVE & HOSPICE CARE COORDINATES MHMH'S CLINICAL, EDUCATIONAL, AND RESEARCH EFFORTS AND VISITING NURSE ALLIANCES AROUND THE REGION TO OFFER MUCH-NEEDED END-OF-LIFE CARE FOR PATIENTS IN A CLINICAL SETTING THAT MEETS THE NEEDS OF PATIENTS AND THEIR FAMILIES. MHMH ALSO CONTINUES TO BUILD ITS TELEMEDICINE PROGRAM TO PROVIDE CARE ACROSS ITS RURAL REGION AND IN PARTICULAR TO MAKE SPECIALIST CONSULTATION AND CARE AVAILABLE TO CRITICAL ACCESS AND COMMUNITY HOSPITALS. THIS ALLOWS CAREGIVERS AT REMOTE LOCATIONS TO ACCESS SPECIALISTS AT MHMH AND DHC AND TO BRING THEM "VIRTUALLY" TO THE PATIENT'S BEDSIDE. MHMH'S CONNECTED CARE CENTER FOR TELEHEALTH IN LEBANON OFFERS A 24/7 TEAM OF PHYSICIANS, PHARMACISTS, AND NURSES SUPPORTING THE FOLLOWING ACUTE CARE TELEHEALTH SERVICE LINES: TELE-EMERGENCY, TELE-PHARMACY, TELE-NEUROLOGY, TELE-ICU, TELE PSYCHIATRY, AND TELE-NEONATOLOGY; OUTPATIENT TELE-URGENTCARE 7 DAYS/WEEK; AND OUTPATIENT VIRTUAL VISITS IN PEDIATRICS AND MORE THAN 30 SPECIALTY SERVICES TO PATIENTS IN 17 LOCATIONS, INCLUDING PATIENT HOMES. IN AN EFFORT TO INTEGRATE BEHAVIORAL HEALTH AND PRIMARY CARE, MHMH CONTINUES TO BE THE LEAD CONVENER FOR THE STATE OF NEW HAMPSHIRE DELIVERY SYSTEM REFORM INCENTIVE PROGRAM ("DSRIP") FOR THE REGION 1 INTEGRATED DELIVERY NETWORK. THIS PROGRAM IS FUNDED THROUGH A SECTION 1115 WAIVER RESEARCH AND DEMONSTRATION TRANSFORMATION WAIVER THAT THE STATE OF NEW HAMPSHIRE RECEIVED FROM CMS. THE WAIVER ENABLES HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS WITHIN A REGION TO FORM RELATIONSHIPS FOCUSED ON TRANSFORMING CARE, TO COMBAT THE OPIOID CRISIS, AND STRENGTHEN THE STATE'S STRAINED MENTAL HEALTH SYSTEM. THIS WORK BEGAN IN JULY 2016 AND WILL CONTINUE THROUGH DECEMBER 31, 2020. IN ADDITION TO MHMH, DARTMOUTH-HITCHCOCK CLINIC (DHC) AND CHESHIRE MEDICAL CENTER (CHESHIRE) ARE PLAYING LEADERSHIP ROLES IN THIS INITIATIVE. MHMH FILES AN ANNUAL COMMUNITY BENEFITS REPORT WITH THE STATE OFNEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS IT PROVIDES. THE MOST RECENT COMMUNITY BENEFITS REPORTIS AVAILABLE UPON REQUEST OR CAN BE FOUND ON MHMH'S WEBSITE.FINANCIAL ASSISTANCE (FORMERLY CALLED "CHARITY CARE") REPRESENTS SERVICES PROVIDED TO PATIENTS WHO CANNOT AFFORDHEALTH CARE SERVICES DUE TO INADEQUATE FINANCIAL RESOURCES WHICH RESULT FROM BEING UNINSURED OR UNDERINSURED. FOR THE YEAR ENDED JUNE 30, 2019 MHMH PROVIDED FINANCIAL ASSISTANCE TO 16,838 PATIENTS IN THE AMOUNT OF $19,351,105 AS MEASURED BY GROSS CHARGES. THE ESTIMATED COST OF PROVIDING THIS CARE FOR THE YEAR ENDED JUNE 30, 2019 WAS $7,545,627. MHMH ALSO ROUTINELY PROVIDES SERVICES TO MEDICAID PATIENTS AT REIMBURSEMENT LEVELS THAT ARE BELOW THE COST OF THE CARE PROVIDED. THE COMMUNITY HEALTH ACTIVITIES NOTED INCLUDE THE COST OR VALUE OF SEVERAL DIFFERENT TYPES OF PROGRAMS INCLUDING THE COST OF COMMUNITY-BASED EDUCATION, HEALTH FAIRS, HEALTH SCREENINGS, SUPPORT GROUPS, AND PROGRAMS AND MATERIALS THAT PROMOTE WELLNESS AND PREVENT ILLNESS. EXAMPLES OF THESE TYPES OF EFFORTS INCLUDE PARTNERING WITH THE HEALTHY EATING ACTIVE LIVING NH INITIATIVE, THE WOMEN'S HEALTH RESOURCE CENTER, AND SMOKING PREVENTION AND CESSATION. THIS CATEGORY OF SUPPORT ALSO INCLUDES FINANCIAL CONTRIBUTIONS AND THE CONTRIBUTION OF TIME AND SERVICES TO COMMUNITY PROGRAMS, HOSPITALS AND AGENCIES. MHMH ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO ITS PATIENTS THAT IS REPORTED AS PROVISION FOR BAD DEBT, WHICH IS NOT INCLUDED IN THE AMOUNTS REPORTED ABOVE. DURING THE YEAR ENDED JUNE 30, 2019, THE HOSPITAL REPORTED A PROVISION FOR BAD DEBT OF $58,565,692. 1095339773 true true false true false false false false true true true false true true false false true false false true false false false false false true true true true true true false false false false false true true false true false true false false false true true true true false false true 1178 0 true 6225 true true true false false false false true true true false false false false false X 19 14 false false false false true true true true true false false true true true true true true false true true true NH X DANIEL P JANTZEN CPA 6036505634 ONE MEDICAL CENTERD RIVE LEBANON NH 03756 Joanne M Conroy MD Trustee, Ex-Officio, CEO 37.8 22.3 X X 0 1246925 52162 Vincent S Conti MHA Trustee/Board Chair (Effective 1/1/19) 0.8 1.3 X X 0 0 0 Barbara J Couch MS Trustee/ Board Secretary (Through 12/31/18) 1.5 2.5 X X 0 0 0 Robert A Oden Jr PHD Trustee/ Vice Chair thru 12/31/18 1.5 2.5 X X 0 0 0 Charles G Plimpton MBA Board Treasurer (Through 12/18)/Secretary (Effective 1/19) 1.5 2.5 X X 0 0 0 Edward H Stansfield III MA Trustee/ Vice Chair (Effective 1/1/19) 0.8 1.8 X X 0 0 0 Anne-Lee Verville Trustee/ Board Chair (Through 12/31/18) 1.5 2.5 X X 0 0 0 ROBERTA L HINES MD TRUSTEE/TREASURER 28.0 12.0 X X 0 0 0 Jocelyn Chertoff MD VP Service Line / DPT CHR Diagnostic Radiology 28.0 12.0 X 0 612747 42285 Jeffrey A Cohen MD Trustee (Through 12/31/18) 28.0 15.0 X 0 439846 64361 Duane A Compton PHD Trustee / Ex-Officio 0.8 1.7 X 0 0 0 William J Conaty Trustee 0.8 1.3 X 0 0 0 Paul P Danos PHD Trustee 0.8 1.3 X 0 0 0 Cherie Holmes MD Trustee 28.0 13.0 X 0 429451 54176 Senator Judd A Greg Trustee 0.8 0.8 X 0 0 0 Laura K Landy MBA Trustee 0.8 1.3 X 0 0 0 Kari M Rosenkranz MD Trustee / Physician 28.0 12.0 X 0 521915 35773 Brian C Spence MDMHCDS Trustee (Through 12/31/18) / Physician 28.0 12.0 X 0 473411 57091 Pamela Thompson MSRNCENP Trustee 0.8 1.3 X 0 0 0 Jon Wahrenberger MDFAHAFAC Trustee 28.0 12.0 X 0 346803 65665 Marc B Wolpow JDMBA Trustee 0.8 1.3 X 0 0 0 KURT K RHYNHART MD TRUSTEE 28.0 12.0 X 0 477049 42072 Aimee M Giglio Chief HR Officer 28.0 18.0 X 358762 0 47278 DANIEL P JANTZEN CPA Chief Financial Officer 39.0 22.0 X 802407 0 55803 Patrick Jordan III MBA Chief Operating Officer 39.0 21.0 X 595187 0 58364 JOHN KACAVAS Chief Legal Officer 28.0 19.0 X 628988 0 52416 Stephen Leblanc Chief Strategy Officer 28.0 20.0 X 0 678320 60874 EDWARD MERRENS Chief Clinical Officer 28.0 19.0 X 0 710556 48934 Maria Padin MD Chief Medical Officer 28.0 19.0 X 0 405936 74170 Susan A Reeves EDDRN Chief Nursing Officer 28.0 26.0 X 460665 0 56959 Matthew Haag VP Development 28.0 18.0 X 100204 0 7675 GEORGE T BLIKE MD Chief Quality & Value Officer 28.0 13.0 X 0 488455 89309 Karen Clements RNBSNMSB Chief Nursing Officer 28.0 12.0 X 354860 0 33093 Staci Hermann PHARMDMS Int. Chief Pharm Officer 28.0 12.0 X 198201 0 22260 Simon Hillier Dept. Chair - Anesthesiology 28.0 12.0 X 0 528291 56469 Jeffrey Obrien MHA VP Clinical Operations 28.0 12.0 X 365136 0 57115 Peter D Solberg MD Chief Medical Information Officer 28.0 12.0 X 0 384275 56111 Sandra Wong MD Chief ACO Officer 28.0 12.0 X 0 788615 32833 Kimberly Troland JD Deputy Gen Counsel 28.0 12.0 X 405537 0 50301 BRUCE KING PRES/CEO NEW LNDN HSPTL 40.0 X 359492 584 55770 Martin Purcell MBA VP IS OPERATIONS 28.0 0 X 378886 0 71703 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 28.0 0 X 324192 0 57798 Leigh Burgess VP RESEARCH OPS 28.0 0 X 327151 0 41277 Steven Boyce FMR KEY EMP / ADM. VP MED SPCLTS 28.0 12.0 X 0 128301 30179 Wendy Fielding MBA FMR KEY EMP / VP FINANCE PLNNING 28.0 13.0 X 247327 0 49988 Robert Greene MDMHCDSFACP FMR CHF POPUL MGMT OFR 28.0 12.0 X 0 122058 0 John S Malanowski MILR Chief HR Officer 0 X 138656 0 0 Tina E Naimie CPA FMR KEY EMP / VP CORP FINANCE 28.0 13.0 X 257299 0 28591 Christine Schon MPA FMR KEY EMP/ ADM VP PRMRY CARE 42.0 X 0 280023 43714 Thomas J Siepka Chief Pharm Officer 28.0 12.0 X 113190 0 6151 Wendy Wells MD FMR KEY EMP / DPT CHR PATHOLOGY 28.0 12.0 X 0 506952 60768 Thomas Dodds MD FRMR KEY EMP / DEPT CHR ANESTH 28.0 12.0 X 0 123247 12597 John Birkmeyer MD Former CCO / EVP ENTPRS SP 0.0 0.0 X 0 328004 0 Richard I Rothstein MD Former Dept. Chair / Service Line LDR - MED 28.0 12.0 X 0 787038 56413 Sowmya Viswanathan MD Former Chief ACO Officer 0.0 0.0 X 0 161538 0 James N Weinstein DO MS Former Trustee/CEO 0.0 0.0 X 0 963321 34820 6416140 11933661 1823318 454 true true false Conifer Revenue Cycle Solutions LLC 1500 S Douglas Rd Ste 200 Ananheim CA 92806 Revenue Management Services 29631793 American Healthcare Association PO Box 945 Traverse City MI 49685 Staffing Services 10509738 Trustees of Dartmouth College 37 Dewey Field Hanover NH 03755 Admin & Direct Support 9422672 Optio Health 390 Spaulding Ave SE Ada MI 49301 Information Technology Services 6651347 PC Construction Company 193 Tilley Drive South Burlington VT 05403 Construction Services 5134761 124 X 15379035 12969974 1204593 28349009 NET PATIENT SERVICE REVENUE 621110 1189522229 1188475351 1046878 RESEARCH RELATED ACTIVITIES 621110 6744200 6744200 PHARMACY INCOME 446110 97667361 95550255 2117106 NEAH & PROGRAM RELATED INVESTMENTS 541990 1895563 740711 1154852 0 0 0 0 1295829353 7411272 7411272 943298 1408166 -464868 0 -464868 -464868 184116447 170272291 378134 13844156 -378134 13466022 13466022 MEANINGFUL USE REFUND 621110 545644 545644 VENDOR & VHA REBATES 621110 3907827 3907827 CAFETERIA 722212 3084951 3084951 37707318 33262174 4445144 0 45245740 1389836528 1329226162 8763980 23497377 2588875 2588875 1566504 1566504 9223669 2934893 6131315 157461 2011743 865947 1097416 48380 587121736 512687196 74434540 30954938 27033798 3921140 78387653 68458092 9929561 38584497 33696902 4887595 2018585 61210 1957375 681645 681645 27300 27300 87700222 73703826 13996396 0 2964943 23134 2941809 16717677 12414846 4302831 16227747 1228031 14999716 17113671 916512 16197159 4239392 2488441 1750951 199879 198676 1203 15177429 1517743 13659686 66841109 19367238 47473871 8182838 5686172 2496666 MEDICAL SUPPLIES 251475172 251320703 154469 MEDICAID ENHANCEMENT TAX 54954120 54954120 EQUIPMENT RENTAL & MAINT 15033110 10107172 4925938 ACADEMIC, GME, TEACHING & EDUCATIONAL 7305867 5615675 1690192 8265946 5904067 2361879 0 1325566267 1095339773 230020653 205841 22093437 47978831 637853 639155 165736371 162813811 357428 372244 0 0 10970000 11722180 19449482 19562504 12380174 10655043 1199120458 787169355 420784300 411951103 478587381 554941393 156301755 157549243 7382716 6282288 153429437 166157352 1448110334 1550625147 141043055 180227192 5835994 4113693 0 0 0 581255207 581142070 92673739 103449184 820807995 868932139 X 541814181 591992644 54254505 57277999 31233653 32422365 627302339 681693008 1448110334 1550625147 X 64270261 13291280 -23170872 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 265356 false true 125391 390747 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINES IB & 1G MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) EMPLOYS THREE FULL TIME STAFF WHOSE DUTIES INCLUDE LOBBYING. TYPICAL EXPENSES ASSOCIATED WITH THE LOBBYING ACTIVITIES INCLUDE STAFF SALARY, TRAVEL, MEMBERSHIP FEES AND DUES. FROM TIME TO TIME, MARY HITCHCOCK MEMORIAL HOSPITAL, THROUGH ITS EMPLOYEES AND THE USE OF CONSULTANTS, CONTACTS GOVERNMENT OFFICIALS AND LEGISLATORS. THIS CONTACT IS FOR THE PURPOSE OF PROPOSING LEGISLATION OR EXPRESSING AN OPINION ON CHANGES IN LEGISLATION THAT AFFECT MHMH AND ITS ABILITY TO CARRY OUT ITS MISSION. THE ACTIVITIES INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. FOR THE FISCAL YEAR ENDED JUNE 30, 2019, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $265,356 IN CONJUCTION WITH THESE ACTIVITIES. LINE 1I MHMH PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1I REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS. 58012839 1209274 1592942 1081356 59733699 56795299 338335 2065129 1185924 58012839 54754800 137888 2553792 651181 56795299 72720335 378941 -377000 17967476 54754800 74609411 208107 -516882 1580301 72720335 0.2753 0.5428 0.1819 false false 50342245 50342245 575082462 354737505 220344957 4111615 3901391 210224 540666910 428530459 112136451 28917226 28917226 411951103 PRIVATE EQUITIES 27630565 F HEDGE FUNDS 61932447 F OTHER INVESTMENTS 67986231 F 157549243 INVESTMENT IN CAPTIVE 24122229 DUE FROM AFFILIATES 129421305 CAPITAL LEASE RECEIVABLE 8553866 OTHER MISC ASSETS 4059952 166157352 THIRD PARTY RESERVES 23066443 ACCRUED POST RETMNT PENS & MED 80382741 103449184 Schedule D, Part X, Line 2 ASC 740 (FIN 48) FOOTNOTE NO ASC 740 (FIN 48) FOOTNOTE WAS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS AS THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT OR SINCE ADOPTION. Schedule D, Part V, Line 4 Intended uses of endowment funds THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROMOTE AND ADVANCE THE FOLLOWING MISSION-RELATED PROGRAMS: HEALTHCARE SERVICES, RESEARCH, CHARITY CARE, COMMUNITY OUTREACH AND ADVOCACY, EQUIPMENT PURCHASES, AND HEALTH EDUCATION. true North America (Canada & Mexico only) Program Services Advertising 16019 North America (Canada & Mexico only) Program Services Honorarium Payments 2451 North America (Canada & Mexico only) Program Services Dues & Licenses 352 North America (Canada & Mexico only) 3 Program Services Consultant 22642 Central America and the Caribbean 5 Program Services Medical services in Haiti (TB & HIV) and Nicaragua (hearing loss) 26797 South Asia 4 Program Services Medical Services in India 186065 Sub-Saharan Africa 6 Program Services Medical services in Rwanda and Tanzania for infectious diseases & healthcare development 130220 North America (Canada & Mexico only) Program Services Software 201567 Central America and the Caribbean Program Services Medical Program 4089 East Asia and the Pacific Program Services Medical program 872 Europe (Including Iceland and Greenland) Program Services Medical program 4882 Central America and the Caribbean Investments Investment in captive 20884346 0 18 0 0 0 18 21480302 0 21480302 true false true true true false Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. Schedule F, Part I, Line 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE HOSPITAL PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY. true true true X 225 true X true true false true true 7545627 0 7545627 0.0057 166497493 78198253 88299240 0.0666 0 0 0 0.0 0 0 174043120 78198253 95844867 0.0723 7883596 4511670 3371926 0.0025 51805340 13366137 38439203 0.0290 21845247 16861063 4984184 0.0038 4031632 414887 3616745 0.0027 2231131 45578 2185553 0.0016 0 0 87796946 35199335 52597611 0.0397 0 0 261840066 113397588 148442478 0.1120 25000 25000 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 2469485 1554447 915038 0.0007 83467 83467 0.0001 70992 21447 49545 0.0000 0 0.0 0 0 2648944 1575894 1073050 0.0008 false 20651366 0 346887244 373259598 -26372354 X true true 1 1 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 WWW.DARTMOUTH-HITCHCOCK.ORG 01799 X X X X X X PSYCH UNIT AND TRANSPLANT UNIT CANCER CENTER MARY HITCHCOCK MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 18 true true true true X WWW.DARTMOUTH-HITCHCOCK.ORG X X true 19 true WWW.DARTMOUTH-HITCHCOCK.ORG false true X 225.0 300.0 X X X X X X X true true X X X true X a. https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html X b. https://www.dartmouth-hitchcock.org/documents/financial_assistance_application_2019_dhh1.pdf X c. https://www.dartmouth-hitchcock.org/documents/financial-assistance-policy-2019.pdf X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC, COLLECTIVELY KNOWN AS D-H) ARE ACTIVELY ENGAGED IN THE DEVELOPMENT OF THE UPPER VALLEY REGIONAL PUBLIC HEALTH ADVISORY COUNCIL AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL (WITH 60+ COMMUNITY REPRESENTATIVES). MEMBERS OF THESE TWO COMMUNITY HEALTH ADVISORY GROUPS HAVE HAD THE OPPORTUNITY TO REVIEW AND COMMENT ON DRAFTS OF DARTMOUTH-HITCHOCK'S COMMUNITY HEALTH IMPROVEMENT PLAN. THE PLAN DOCUMENT HAS ALSO BEEN CIRCULATED TO PUBLIC HEALTH OFFICIALS IN NEW HAMPSHIRE AND VERMONT FOR THEIR COMMENT. IN ADDITION, DARTMOUTH-HITCHCOCK REPRESENTATIVES SERVE ON NUMEROUS BOARDS, TASK FORCES, MUNICIPAL HEALTH LEADERSHIP AND PLANNING TEAMS, AND OTHER COMMUNITY HEALTH LEADERSHIP ENTITIES IN ORDER TO ENSURE THAT BOTH ORGANIZATIONS PARTICIPATE IN AND BETTER-UNDERSTAND THE NEEDS OF OUR COMMUNITY. MHMH CONTRACTED WITH JOHN SNOW RESEARCH AND TRAINING INSTITUTE/COMMUNITY HEALTH INSTITUTE TO PROVIDE CONSULTATION AND TECHNICAL EXPERTISE TO OUR ASSESSMENT PROCESS. JOHN SNOW RESEARCH AND TRAINING INSTITUTE IS A PUBLIC HEALTH MANAGEMENT CONSULTING AND RESEARCH ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES THROUGHOUT THE WORLD. DURING THE PERIOD MARCH THROUGH AUGUST 2018, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY DARTMOUTH-HITCHCOCK AND ALICE PECK DAY MEMORIAL HOSPITAL IN PARTNERSHIP WITH NEW LONDON HOSPITAL, VALLEY REGIONAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES, AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. WHILE DARTMOUTH-HITCHCOCK MEDICAL CENTER SERVES AS A TERTIARY REFERRAL MEDICAL CENTER FOR A LARGE, MULTI-STATE AREA, THE GEOGRAPHIC AREA OF INTEREST FOR THE PURPOSES OF THIS ASSESSMENT WAS THE PRIMARY SERVICE AREA OF MARY HITCHCOCK MEMORIAL HOSPITAL AND ALICE PECK DAY MEMORIAL HOSPITAL. THIS PRIMARY SERVICE AREA WAS DEFINED AS 19 MUNICIPALITIES COMPRISING THE UPPER VALLEY OF NEW HAMPSHIRE AND VERMONT WITH A TOTAL RESIDENT POPULATION OF APPROXIMATELY 70,000 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE PRIMARY SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), POPULATIONS EXPERIENCING HEALTH DISPARITIES OR VULNERABLE TO POOR HEALTH OUTCOMES ARE PRIMARILY DEFINED AS THOSE POPULATIONS FACING SIGNIFICANT INCOME AND SOCIAL DETERMINANTS CHALLENGES, WHICH IN THIS REGION ARE MORE STRONGLY ASSOCIATED WITH NEGATIVE IMPACTS ON HEALTH THAN RACE OR ETHNICITY. ENHANCED EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THESE POPULATIONS THROUGH TARGETED SURVEYS AND COMMUNITY CONVERSATIONS, INCLUDING FACILITATED SURVEYS AND DISCUSSIONS AT COMMUNITY SUPPERS, A REGIONAL FREE CLINIC, HOMELESS PROGRAMS, AND OTHER COMMUNITY SETTINGS SERVING ECONOMICALLY-VULNERABLE RESIDENTS. IN ADDITION, WE CONVENED A FOCUS GROUP OF BLACK AND AFRICAN-AMERICAN COMMUNITY MEMBERS. FINDINGS OF THIS ASSESSMENT HAVE BEEN SHARED WITH PUBLIC HEALTH OFFICIALS IN NH AND VT, AS WELL AS WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY. DURING THIS ASSESSMENT, MARY HITCHCOCK MEMORIAL HOSPITAL USED SURVEYS FROM MARCH 2018 THROUGH AUGUST 2018 TO GENERATE INPUT FROM 2,100 RESIDENTS. SURVEYS WERE MADE AVAILABLE THROUGH PRIMARY CARE CLINICS, FREE CARE CLINICS, A SHELTER FOR THE HOMELESS, A FREE COMMUNITY DINNER, ANNUAL TOWN MEETINGS/ELECTIONS, AND NUMEROUS OTHER COMMUNITY LOCATIONS. VISITING NURSES AND OTHERS PROVIDED PRE-PAID MAILERS AND SURVEYS TO HOMEBOUND RESIDENTS. RESIDENTS COMPLETING SURVEYS INCLUDED MEMBERS OF AFRICAN-AMERICAN, HISPANIC, NATIVE AMERICAN, AND ASIAN POPULATIONS. SURVEYS WERE DISTRIBUTED THROUGH REGIONAL HEALTH CLINICS, THE REGION'S SHELTER FOR HOMELESS POPULATIONS; THE REGION'S LOW-INCOME HOUSING TRUST; SENIOR CENTERS; SUBSTANCE USE DISORDER TREATMENT PROGRAMS, DELIVERED DIRECTLY TO RESIDENT HOMES, AND OTHER LOCATIONS WHERE POPULATIONS MOST AFFECTED BY HEALTH DISPARITIES CONGREGATE. MARY HITCHCOCK MEMORIAL HOSPITAL DISSEMINATED THE SURVEY TOGETHER WITH MULTIPLE COMMUNITY ORGANIZATIONS THAT SERVE LOW-INCOME, FRAIL, AND HEALTH DISPARITY POPULATIONS. COMMUNITY PARTNERS, PROVIDED ASSISTANCE DISSEMINATING THE SURVEY, INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPERVALLEY, WHOSE MEMBERSHIP INCLUDES COMMUNITY MENTAL HEALTH SERVICES, SUBSTANCE USE SERVICES, MENTAL HEALTH PEER LEADERS, WIC PROVIDERS, SENIOR SERVICES ADVOCATES, SERVICES WORKING WITH PEOPLE WITH PHYSICAL AND DEVELOPMENTAL DISABILITIES, COMMUNITY NURSING, VISITING NURSES, AND OTHER CORE HUMAN SERVICES. IN ADDITION TO ASSISTING IN SURVEY DISSEMINATION, THESE PROVIDERS ADVOCATED FOR UNDERSERVED AND VULNERABLE POPULATIONS IN OUR REGION AS A PART OF THE CHNA PROCESS. DURING THIS CHNA PROCESS, OUR CHNA COLLABORATIVE TEAM CONVENED ONE REGIONAL DISCUSSION GROUP OF PERSONS IDENTIFYING AS BLACK/AFRICAN-AMERICAN (MAY 10, 2018); WE MADE RESIDENT SURVEYS WIDELY AVAILABLE TO COMMUNITY RESIDENTS THROUGH PUBLIC LIST SERVES, DIRECT E-MAIL INVITATIONS TO PATIENTS OF OUR PRIMARY CARE CLINICS, SURVEY LINKS ON TOWN WEB SITES AND E-NEWS, EMPLOYEE E-NEWS IN MAJOR EMPLOYERS, AND THROUGH OTHER SYSTEMS THAT PROVIDED WIDESPREAD ACCESS TO OUR SURVEYS. WE ALSO REVIEWED MEETING MINUTES FROM TWO REGIONAL COMMUNITIES (HARTFORD, VT, AND CLAREMONT, NH), WHERE ISSUES OF RACIAL EQUITY AND RACISM HAVE BEEN EXPLORED AT TOWN AND SCHOOL GOVERNANCE LEVELS. WE PARTNERED CLOSELY WITH ORGANIZATIONS SERVING POPULATIONS AFFECTED BY POVERTY, LACK OF INSURANCE, HOMELESSNESS, BEHAVIORAL HEALTH CONDITIONS, AND SERIOUS AND CHRONIC ILLNESSES IN ORDER TO SURVEY THESE MEMBERS OF POPULATIONS IN OUR COMMUNITY, AND HOSTED MULTIPLE DISCUSSION GROUPS WITH PEOPLE AFFECTED BY POVERTY AND CHRONIC ILLNESS. WE RECOGNIZE THE LIMITATIONS OF OUR ENGAGEMENT OF RACIAL AND ETHNIC MINORITY MEMBERS OF OUR COMMUNITY, AND ARE WORKING TO IMPROVE THIS PART OF OUR CHNA PROCESS. OUR MINORITY POPULATION IS QUITE SMALL: 0.9% OF THE POPULATION OF GRAFTON COUNTY, NH IDENTIFIES AS AFRICAN AMERICAN, 0.4% AS NATIVE AMERICAN, 1.8% AS HISPANIC/LATINO, 3.0% AS ASIAN. 92.1% OF THE MHMH HOSPITAL SERVICE AREA'S RESIDENTS IDENTIFY AS CAUCASIAN. WIDE DISPERSAL OF THIS POPULATION ACROSS A LARGE GEOGRAPHY FURTHER COMPLICATES ENGAGEMENT EFFORTS. OUR SUMMER 2018 DISCUSSION GROUP WITH COMMUNITY MEMBERS IDENTIFYING AS BLACK/AFRICAN AMERICAN WAS A POSITIVE, BUT LIMITED IMPROVEMENT OVER PRIOR YEARS. HOUSEHOLD MEDIAN INCOME, INSURANCE STATUS, AND OTHER INDICATORS OF POVERTY ARE SIGNIFICANT DRIVERS OF DISPARITY IN OUR REGION. POVERTY RATES RANGE WIDELY BY TOWN, WITH A RANGE BY TOWN OF 2.9% TO 31.7% OF HOUSEHOLDS LIVING ON INCOMES BELOW 200% OF FEDERAL POVERTY LEVEL. THESE POPULATIONS FACE NOTABLE HEALTH DISPARITY CONDITIONS ASSOCIATED WITH POVERTY AND OTHER SOCIAL DETERMINANTS OF HEALTH NEEDS. DURING OUR ASSESSMENT PROCESS, MHMH MADE SPECIFIC EFFORTS TO CONTACT AND RECEIVE INPUT FROM MEMBERS OF INCOME-VULNERABLE POPULATIONS, INCLUDING: * A DISCUSSION GROUP WITH PREGNANT AND PARENTING TEENS PARTICIPATING IN AN ALTERNATIVE HIGH SCHOOL ENVIRONMENT AT THE FAMILY PLACE PARENT CHILD CENTER (MAY 1, 2018). * A DISCUSSION GROUP WITH ADULTS LIVING WITH DEVELOPMENTAL DISABILITIES AND THEIR FAMILIES/CAREGIVERS (MAY 4TH, 2018). * A DISCUSSION GROUP WITH PREGNANT WOMEN IN TREATMENT FOR SUBSTANCE USE DISORDERS (APRIL 9, 2018). * A DISCUSSION GROUP WITH COMMUNITY NURSES SERVING CHRONICALLY ILL, HOMEBOUND, AND OTHERWISE VULNERABLE OLDER ADULTS IN REGIONAL TOWNS (MAY 8, 2018). * A DISCUSSION GROUP WITH THE BOARD AND LEADERSHIP OF THE MASCOMA COMMUNITY HEALTH CLINIC, A COMMUNITY HEALTH CLINIC SEEKING FQHC-LOOKALIKE STATUS AND SERVING A SET OF COMMUNITIES WITH HEALTH DISPARITIES (MAY 14, 2018) * WORKING WITH THE GOOD NEIGHBOR HEALTH CLINIC AND MASCOMA COMMUNITY HEALTH CENTER TO DISSEMINATE SURVEYS TO PATIENTS WHO ARE UNINSURED AND LOW-INCOME. DISSEMINATING SURVEYS AT THE HAVEN (SHELTER); LISTEN COMMUNITY SERVICES (BASIC NEED SUPPORT, FOOD SHELF, AND COMMUNITY DINNERS); TO PARENTS OF CHILDREN IN DARTMOUTH-HITCHCOCK AND ALICE PECK DAY'S PEDIATRICS CLINICS; VIA WOMEN, INFANTS, AND CHILDREN'S CLINICS; THROUGH GRAFTON COUNTY SENIOR CITIZENS COUNCIL (HOME-DELIVERED MEALS AND CONGREGATE MEALS); THROUGH VISITING NURSE AND HOSPICE OF VT AND NH (HOME-VISITING PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FOR SENIORS WITH COMPLEX HEALTH NEEDS); AND THROUGH OTHER COMMUNITY ORGANIZATIONS SERVING PEOPLE AFFECTED BY POVERTY AND POOR HEALTH. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING MARCH 2018 - JUNE 2019, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO PARTNERED WITH NEIGHBORING HOSPITALS AND ORGANIZATIONS INCLUDING VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL, MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH. USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING MARCH 2018- JUNE 2019, IN ADDITION TO WORKING WITH DARTMOUTH-HITCHCOCK CLINIC, MHMH WORKED CLOSELY WITH THE MEMBER ORGANIZATIONS OF THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY (40+ MEMBER ORGANIZATIONS) AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISROY COUNCIL TO DISSEMINATE SURVEYS, SERVE AS KEY INFORMANTS, AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE NEEDS ASSESSMENT WAS DISTRIBUTED TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE REGION INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHICH IS A MEMBERSHIP GROUP OF REIGONAL NON-PROFIT, MUNICIPAL, SAFETY, HUMAN SERVICE, AND PUBLIC HEALTH ORGANIZATIONS. IT IS ALSO AVAILABLE FROM THE ORGANIZATION UPON REQUEST AND IS POSTED ON THE MHMH WEB PAGE. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH IS INCREASING COMMUNITY BENEFITS SPENDING TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE MOST RECENT CHNA IN AREAS OF TRAUMA AND VIOLENCE, SOCIAL DETERMINANTS OF HEALTH, IMPROVING ACCESS TO HEALTH CARE, AND NEEDS OF OLDER ADULTS, AS WELL AS MAINTAINING ONGOING INVESTMENTS IN BEHAVIORAL HEALTH AND SUBSTANCE USE NEEDS, STRENGTHENING FAMILIES AND CHILDREN, AND CANCER CARE AND TREATMENT. IN FY 2019, MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN OUR FY2016 AND FY2019 COMMUNITY HEALTH IMPROVEMENT PLANS. AREAS WERE ANALYZED AND MHMH RESPONDED BY INCREASING INVESTMENTS, MAINTAINING SIMILAR LEVELS OF INVESTMENTS FOR SERVICES AND INITIATIVES, OR LIMITING INVESTMENT IN AREAS WHERE OTHER COMMUNITY ORGANIZATIONS ALREADY PROVIDE LEADERSHIP AND SERVICES TO ADDRESS THE NEED, AND/OR WHERE THE IDENTIFIED NEED IS SIGNIFICANTLY OUTSIDE THE MISSION/SERVICES/SCOPE OF MHMH. MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT PLAN IS A 3-YEAR DOCUMENT IDENTIFYING ANTICIPATED INVESTMENTS AND ACTIVITIES THAT IT WILL TAKE TO ADDRESS NEEDS IDENTIFIED IN THE MOST RECENT UPPER VALLEY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MARY HTCHCOCK MEMORIAL HOSPITAL. PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF MHMH. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON MHMH'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. MHMH PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. MHMH CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, MHMH POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. MHMH SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, MHMH CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME. 0 Schedule H, Part V, Section C MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY CAN BE FOUND AT HTTPS://WWW.DARTMOUTHHITCHCOCK.ORG/BILLINGCHARGES/FINANCIAL_ASSISTANCE.HTML. MHMH HAS PLAIN LANGUAGE SUMMARY BROCHURES AVAILABLE AT ALL ADMISSION SITES AS WELL AS PLAIN LANGUAGE SUMMARY POSTERS AT ALL PHYSICAL LOCATIONS. Schedule H, Part VI, Line 2 FACILITY INFORMATION THE HOSPITAL HAS A 2ND CANCER TREATMENT CENTER LOCATED IN SAINT JOHNSBURY, VERMONT. THIS LOCATION IS REGISTERED UNDER THE SAME LICENSE AS THE ORGANIZATION'S MAIN CAMPUS LOCATED IN LEBANON, NEW HAMPSHIRE. Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG MHMH USES THE FPG GUIDELINES IN DETERMINING THE INITIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED. IN ADDITION, MHMH ALLOWS FOR CATASTROPHIC ASSISTANCE CONSIDERATION BASED ON A CALCULATION OF 10% OF TWO YEARS INCOME PLUS 10% OF AMOUNT OVER SHELTERED ASSETS. IF THE PROJECTED OR CURRENT SELF-PAY BALANCE IS GREATER THAN THIS CALCULATION, THE SELF-PAY BALANCE IS REDUCED TO THE SUM OF 10% OF TWO YEARS INCOME PLUS 10% OF ASSETS. EACH HOUSEHOLD IS ALLOWED CERTAIN SHELTERED ASSETS WHICH ARE NOT USED WHEN CALCULATING HOUSEHOLD INCOME OR ASSETS SAVINGS IS SHELTERED UP TO 100% OF FPL BASED ON FAMILY SIZE, EQUITY IN PRIMARY RESIDENCE UP TO $200,000 UP TO 55 AND $250,000 FOR AGED 55 AND OLDER, AND A RETIREMENT SHELTER OF UP TO $100,000 IN RETIREMENT ASSETS AS LONG AS IT IS EMPLOYER BASED CONTRIBUTIONS IF WORKING OR IRA IF SELF-EMPLOYED. IF A PATIENT IS RETIRED, PRIOR RETIREMENT ACCOUNTS WOULD BE INCLUDED AS A SHELTERED ASSET. Schedule H, Part I, Line 6a COMMUNITY BENEFITS REPORT MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT WITH THE STATE OF NEW HAMPSHIRE. FOR PURPOSES OF IRS FORM 990, SCHEDULE H, ONLY MHMH HOSPITAL NUMBERS WERE USED. ALL AMOUNTS RELATING TO DHC WERE EXCLUDED. THE NEW HAMPSHIRE COMMUNITY BENEFITS REPORT FILED FOR FISCAL YEAR 2019, DHC AND MHMH COMBINED, TOTALED $194,476,971. Schedule H, Part I, Line 7g Subsidized Health Services The organization did not include any subsidized health service costs attributable to a physician clinic on part I, line 7G. Schedule H, Part I, Line 7 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 III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNTS REPORTED ON PART III, SECTION A, LINE 2 WERE DERIVED FROM MHMH'S AUDITED FINANCIAL STATEMENTS (PROVISION FOR BAD DEBT). MHMH'S POLICY IS TO EXERT EVERYTHING IN THE ORGANIZATION'S POWER TO OBTAIN SUFFICIENT AND ADEQUATE INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. MHMH'S DISCOUNT FOR UNINSURED PATIENTS IS CURRENTLY 58.1% (BEFORE FINANCIAL ASSISTANCE IS APPLIED). AS PART OF MHMH'S FINANCIAL ASSISTANCE POLICY, MHMH MAKES INFORMATION AVAILABLE TO PATIENTS FOR ELIGIBILITY AND HOW TO APPLY FOR FREE OR DISCOUNTED CARE IF THE PATIENT DOES NOT RESPOND TO THE HOSPITAL'S ATTEMPTS TO COMPLETE THE FINANCIAL ASSISTANCE PACKAGE, THESE PATIENTS MAY BE WRITTEN OFF TO BAD DEBT. IN OCTOBER 2017, D-H BEGAN USING A PRESUMPTIVE CHARITY REVIEW FOR BAD DEBT PATIENTS. THIS REVIEW IS THE LAST STEP PRIOR TO TRANSFERRING UNPAID BALANCES TO BAD DEBT Schedule H, Part III, Line 3 Bad Debt Expense Methodology The hospital is unable to estimate accurately the amount of bad debt expense attributable to patients eligible for financial assistance. Although a portion of bad debt expense may be related to patients who would qualify for charity care, a reportable figure cannot be reasonably estimated. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote MHMH FILES A CONSOLIDATED AUDITED FINANCIAL STATEMENT WITH DARTMOUTH-HITCHCOCK CLINIC AND OTHER SUBSIDIARIES. THE AMOUNT REPORTED ON SCHEDULE H REPRESENTS MHMH'S PORTION ONLY. MHMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR FINANCIAL ASSISTANCE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MHMH DOES NOT ANTICIPATE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. MHMH 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 DEBT 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. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED AS MEDICARE SHORTFALLS WAS DERIVED FROM THE INTERNAL REVENUE SERVICE'S WORKSHEET B AS PROVIDED FOR PART III CALCULATIONS. MHMH HAD REVENUES OF $53,195,313 AND COSTS OF $68,213,437 FOR SERVICES NOT INCLUDED ON THE MEDICARE COST REPORT (AMBULANCE SERVICES, LABORATORY AND OTHER FEES SCREENS, AND MEDICARE PART C & D SERVICES) MHMH INCURRED A NET LOSS OF $15,018,124 ON THE PROVISION OF THESE SERVICES BECAUSE OF THE CENTRAL ROLE OF THE ORGANIZATION IN SERVING THE HEALTHCARE NEEDS OF ITS COMMUNITY AND THE DEMOGRAPHIC CHARACTERISTICS OF THE COMMUNITY SERVED, IT IS LIKELY THAT A PORTION OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT EXPENDITURE. MHMH HAS NOT IDENTIFIED A SPECIFIC AMOUNT OF MEDICARE SHORTFALL THAT SHOULD BE REPORTED AS SUCH. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance MHMH HAS A CREDIT AND COLLECTION POLICY THAT ADDRESSES THE PROCEDURES FOR PATIENTS WHO QUALIFY FOR REDUCED-COST CARE. THE POLICY PROHIBITS USING EXTRAORDINARY COLLECTION PRACTICES OR PLACING AMOUNTS WITH COLLECTION AGENCIES. IF A FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENT HAS A BALANCE FOR WHICH THEY ARE RESPONSIBLE AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE STANDARD PRACTICES ARE FOLLOWED AS OUTLINED IN THE D-H CREDIT AND COLLECTIONS POLICY. Schedule H, Part V, Section B, Line 16a FAP website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16a URL: a. https://www.dartmouth-hitchcock.org/billing-charges/financial_assistance.html; Schedule H, Part V, Section B, Line 16b FAP Application website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16b URL: b. https://www.dartmouth-hitchcock.org/documents/financial_assistance_application_2019_dhh1.pdf; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16c URL: c. https://www.dartmouth-hitchcock.org/documents/financial-assistance-policy-2019.pdf; Schedule H, Part VI, Line 2 Needs assessment .MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY NEEDS ASSESSMENT AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT. DARTMOUTH-HITCHCOCK PARTICIPATES WITH OTHER HEALTH CARE CHARITABLE TRUSTS AND COMMUNITY PARTNERS IN EACH OF OUR SERVICE AREAS TO COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENTS. DURING FY2019, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL, TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO WORKED TOGETHER WITH NEIGHBORING HOSPITALS, INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CARE, VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL , AND VISTING NURSE & HOSPICE OF VT & NH TO USE SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENTS TOOLS AND APPROACH, TO ALLOW COMPARABILITY OF HEALTH DATA ACROSS A WIDER GEOGRAPHIC REGION. COLLECTIVELY D-H AND PARTNERED HOSPITALS HIRED COMMUNITY HEALTH INSTITUTE/JOHN SNOW RESEARCH AND TRAINING INSTITUTE, A PUBLIC HEALTH CONSULTING FIRM, TO PROVIDE TECHNICAL ASSISTANCE AND ANALYSIS RELATED TO OUR COMMUNITY HEALTH NEEDS ASSESSMENTS. THE NEEDS ASSESSMENT INCLUDED REVIEWING SELECTED SERVICE AREA DEMOGRAPHICS; PUBLIC HEALTH DATA AVAILABLE THROUGH NH AND VT HEALTH DEPARTMENTS, HOSPITAL DISCHARGE DATA, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND YOUTH RISK BEHAVIOR SURVEYS; FOCUS GROUPS WITH EMPLOYERS AND WITH COMMUNITY MEMBERS RECEIVING SERVICES AT REGIONAL SAFETY NET SERVICE ORGANIZATIONS; ELECTRONIC SURVEYS OF PROFESSIONAL HEALTH AND SOCIAL SERVICE PROVIDERS; AS WELL AS PAPER AND ELECTRONIC CONVENIENCE SURVEYS OF COMMUNITY RESIDENTS. THE FY2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AT 3 LARGE COMMUNITY MEETING (100+ TOTAL STAKEHOLDERS) HOSTED IN CONCERT WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY AND OTHERS FOR FURTHER COMMENTS AND FEEDBACK. ADDITIONALLY, MHMH COMMUNITY HEALTH STAFF PARTICIPATE IN OR LEAD MULTIPLE COMMUNITY COALITIONS AND PROJECTS CONNECTING US TO A WIDE ARRAY OF COMMUNITY-BASED HEALTH, MUNICIPAL, SCHOOL, SERVICE ORGANIZATION, REGIONAL PLANNING AND STATE PUBLIC HEALTH STAKEHOLDERS. WE REGULARLY REVIEW EMERGING NH & VT STATE HEALTH DATA; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS), AND CONVERSATIONS WITH COMMUNITY PARTNERS TO IDENTIFY CONCERNS THAT ARE EMERGING, INTENSIFYING, OR ARE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST CHNA WAS CONDUCTED. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PRO-ACTIVELY SCREENED USING PAPER AND/OR AN AUTOMATED TOOL TO IDENTIFY POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. IN ADDITION, SPECIFIC OUTPATIENT ACTIVITIES DEEMED TO HAVE A HIGHER RATE OF NEED ARE SCREENED AS PART OF REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTION REGARDING HOW TO COMPLETE THE QUALIFICATION PROCESS. IN SOME CASES A FINANCIAL COUNSELOR WILL ACT ON BEHALF OF THE PATIENT, AT THEIR SIGNED CONSENT, IN ORDER TO COMPLETE THE APPLICATION PROCESS (FOR EXAMPLE, IN NEW HAMPSHIRE A PATIENT MUST BE PHYSICALLY PRESENT AT THE DISTRICT OFFICE). IF A PATIENT DOESN'T QUALIFY FOR SPECIFIC PROGRAMS, THEY ARE ALSO CONSIDERED FOR FINANCIAL ASSISTANCE AS PART OF THEIR SCREENING. FOR OUTPATIENT SERVICES THAT ARE NOT ROUTINELY SCREENED, STAFF INTERACTING WITH PATIENTS ARE INSTRUCTED TO PROVIDE EITHER A FINANCIAL ASSISTANCE APPLICATION OR CONTACT INFORMATION FOR A FINANCIAL COUNSELOR WHEN A PATIENT EXPRESSES THEIR INABILITY TO MAKE PAYMENT. EVERY APPLICATION IS SCREENED FOR COMPLETED INCOME AND ASSET DOCUMENTATION. APPLICATIONS ARE ALSO SCREENED TO ASSURE THERE ARE NO OTHER POTENTIAL OPTIONS OF FEDERAL, STATE, OR LOCAL PROGRAMS. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY. Schedule H, Part VI, Line 4 Community information THE ORGANIZATION DEFINES ITS SERVICE REGION AS NEW HAMPSHIRE AND EASTERN VERMONT, WITH THE LARGEST PRESENCE IN A 19-TOWN REGION ADJOINING LEBANON, NEW HAMPSHIRE, SITE OF DARTMOUTH-HITCHCOCK MEDICAL CENTER WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC'S MAIN NORTHERN CLINIC. THE REGION HAS A POPULATION OF 70,000 PEOPLE, WITH TOWNS RANGING IN POPULATION FROM 200-14,000 PEOPLE. THESE TOWNS ARE GENERALLY CONSIDERED RURAL, THOUGH THE HANOVER, AND LEBANON, NH AND HARTFORD, VT COMMUNITIES ARE CONSIDERED TO BE A MICROPOLITAN AREA. AMONG THE REGION'S 19 TOWNS, MEDIAN HOUSEHOLD INCOME VARIES WIDELY, FROM $50K-$120K ANNUALLY 17.5% OF THE POPULATION IS OVER THE AGE OF 65; 11% OF CHILDREN LIVE IN HOUSEHOLDS WHOSE MEDIAN HOUSEHOLD INCOME IS LESS THAN 100% OF FEDERAL POVERTY LEVEL, 26.8% OF CHILDREN LIVE IN HOUSEHOLDS WITH INCOME LESS THAN 200% OF FEDERAL POVERTY LEVEL; 1.5% OF THE REGION'S RESIDENTS HAVE LIMITED ENGLISH PROFICIENCY; AND 7.1% LACKED HEALTH INSURANCE. 11.8% OF NH RESIDENTS AND 24.9% OF VERMONT RESIDENTS ARE MEDICAID BENEFICIARIES. THE REGION IS SERVED BY MHMH AND BY ALICE PECK DAY MEMORIAL HOSPITALS. THERE ARE NO FEDERALLY QUALIFIED HEALTH CENTERS OPERATING WITHIN THE REGION. THE GOOD NEIGHBOR HEALTH CLINIC, IN HARTFORD, VT, OFFERS CARE TO UNINSURED COMMUNITY MEMBERS. TWO MINOR CIVIL DIVISIONS IN OUR REGION, DORCHESTER NH AND PIERMONT NH, ARE CONSIDERED MEDICALLY UNDERSERVED AREAS. MHMH SERVES THE GENERAL POPULATION WITH A WIDE RANGE OF SERVICES. IN ADDITION TO GENERAL HOSPITAL POPULATIONS, THE ORGANIZATION PROVIDES SERVICES TO PATIENTS WITH HIGHLY-SPECIALIZED NEEDS THAT ARE NOT AVAILABLE ELSEWHERE IN NEW HAMPSHIRE. MHMH IS THE STATE'S ONLY TERTIARY REFERRAL CENTER, PROVIDES THE STATE'S ONLY COMPREHENSIVE CANCER CENTER (NORRIS COTTON CANCER CENTER ~ NCCC), OPERATES THE ONLY LEVEL I TRAUMA CENTER IN NEW HAMPSHIRE, OPERATES THE ONLY COMPREHENSIVE CHILDREN'S HOSPITAL AND ACCREDITED PEDIATRIC TRAUMA CENTER IN NEW HAMPSHIRE (CHILDREN'S HOSPITAL AT DARTMOUTH - CHAD), HOSTS THE ONLY LEVEL IV NEONATAL INTENSIVE CARE NURSERY AND ONE OF TWO PEDIATRIC INTENSIVE CARE UNITS IN NEW HAMPSHIRE, AND OPERATES THE ONLY HELICOPTER TRANSPORT SERVICE IN THE STATE. AS SUCH, THE SERVICE POPULATION IS BOTH THE GENERAL PUBLIC SEEKING PRIMARY HEALTH CARE SERVICES AS WELL AS RESIDENTS WITH UNIQUE AND HIGHLY-SPECIALIZED HEALTH CARE NEEDS. Schedule H, Part VI, Line 5 Promotion of community health MHMH SUPPORTS ORGANIZATIONS AND INITIATIVES THAT FURTHER HEALTH BY STRENGTHENING AND DEVELOPING KEY COMMUNITY CAPACITIES TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. THIS INCLUDES HOSTING OR LEADING COMMUNITY PARTNERSHIPS TO ADDRESS SUBSTANCE MISUSE AND TREATMENT AND TO IMPROVE PUBLIC HEALTH; PROVIDING FUNDING FOR CHILD AND ADULT ORAL HEALTH INITIATIVES, AND PARTICIPATION OF OUR STAFF IN OTHER PARTNERSHIPS INCLUDING THE OUTPATIENT FALLS PREVENTION TASK FORCE, THE TRANSPORTATION MANAGEMENT ASSOCIATION, AND THE UPPER VALLEY HOUSING COALITION. IN ADDITION, MHMH OPERATES HEALTH EDUCATION AND SUPPORT SERVICES SUCH AS A WOMEN'S HEALTH RESOURCE CENTER, THE AGING RESOURCE CENTER, AND A HEALTH EDUCATION CENTER. MHMH USES CASH CONTRIBUTIONS, CONTRACTED SERVICES, AND IN KIND CONTRIBUTION OF STAFF TIME AND EXPERTISE, TO SUPPORT THESE STRATEGIES WHICH IMPROVE COMMUNITY HEALTH. AT MHMH'S LEBANON, NH CAMPUS, THE HOSPITAL EXTENDS PROFESSIONAL STAFF PRIVILEGES TO QUALIFIED AND APPROPRIATE PHYSICIANS WHO ARE EMPLOYEES OF DARTMOUTH HITCHCOCK CLINIC, MARY HITCHCOCK MEMORIAL HOSPITAL, AND DARTMOUTH COLLEGE, WHO ALSO HOLD A FACULTY APPOINTMENT AT GEISEL SCHOOL OF MEDICINE. MARY HITCHCOCKS'S TRUSTEES ANNUALLY SET STRATEGIC PRIORITIES FOR THE INSTITUTION AND APPROVE OPERATING AND CAPITAL BUDGETS WHICH SUPPORT IMPROVEMENTS, PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. EXAMPLES OF THESE INVESTMENTS INCLUDE THE DEVELOPMENT OF MARY HITCHCOCKS'S PATIENT SAFETY AND TRAINING CENTER; ONGOING QUALITY AND PATIENT SAFETY INITIATIVES; PURCHASES OF NEW AND EMERGING MEDICAL TECHNOLOGIES; SUPPORT TRANSLATIONAL RESEARCH, AND MEDICAL EDUCATION OF THE 19 VOTING MEMBERS OF THE MARY HITCHCOCK BOARD OF TRUSTEES AT FY19 END, 14 ARE NEITHER CONTRACTORS NOR EMPLOYEES OF MHMH . Schedule H, Part VI, Line 6 Affiliated health care system COMMUNITY BENEFITS ARE PROVIDED BY THE DARTMOUTH HITCHCOCK HEALTH CARE SYSTEM, WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, AND OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IN LEBANON IS NEW HAMPSHIRE'S LARGEST HOSPITAL IN FISCAL YEAR 2019 MHMH HAD 396 LICENSED INPATIENT BEDS. THE DARTMOUTH-HITCHCOCK CLINIC (DHC) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE WITH A NETWORK OF PROVIDERS ACROSS NEW HAMPSHIRE AND VERMONT. WHILE DHC'S MAIN OFFICES ARE LOCATED IN LEBANON, THE CLINIC ALSO HAS MULTI-SPECIALTY PRACTICES IN MANCHESTER, NASHUA, CONCORD, AND KEENE, NH AREAS AS WELL AS BENNINGTON, VT. IN ADDITION, THE CLINIC PROVIDES PRIMARY CARE IN RURAL COMMUNITIES IN VERMONT AND NORTHERN NEW HAMPSHIRE. THE HOSPITAL AND CLINIC OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING AND MANAGEMENT AND SHARE IDENTICAL MISSIONS. THE MEDICAL SCHOOL, WHICH WORKS CLOSELY WITH THE HOSPITAL AND CLINIC, IS FOCUSED ON MEDICAL EDUCATION AND RESEARCH. Schedule H, Part VI, Line 7 State filing of community benefit report NH true Greater Nashua Chamber of Commerce 142 Main Street Nashua NH 03060 020116973 501 (c) (6) 7700 FMV Program Support The New England Council 98 N Washington St Ste 201 Boston MA 02114 041661090 501 (c) (3) 7700 FMV Program Support Rock On Foundation 175 Canal Street Manchester NH 03101 461600795 501 (c) (3) 5250 FMV Program Support March of Dimes 1550 Crystal Drive Ste 1300 Arlington VA 22202 131846366 501 (c) (3) 14000 FMV Program Support Upper Valley Haven 713 Hartford Ave White River Junction VT 05001 030277908 501 (c) (3) 41738 FMV Program Support StayWorkPlay NH 235 Hanover Street Suite 1 Manchester NH 03101 270327032 501 (c) (3) 10150 FMV Program Support American Heart Association 7272 Greenville Avenue Dallas TX 75231 135613797 501 (c) (3) 24500 FMV Program Support Grafton County Senior Citizens Council 10 Campbell Street Lebanon NH 03766 237248316 501 (c) (3) 12600 FMV Program Support Public Health Council of the Upper Valley One Court Street 378 Lebanon NH 03766 752991608 501 (c) (3) 38500 FMV Program Support Manchester Community Health Center 145 Hollis Street Manchester NH 03101 020458174 501 (c) (3) 36750 FMV Program Support Good Neighbor Health Clinic 70 North Main Street White River Junction VT 05001 030346949 501 (c) (3) 56000 FMV Program Support NH Hospital Association 125 Airport Road Concord NH 03301 026012527 501 (c) (3) 796709 FMV Program Support Mt Ascutney Hospital and Health Center 289 County Road Windsor VT 05089 030183721 501 (c) (3) 28000 FMV Program Support New London Hospital 273 Country Road New London NH 03257 020222171 501 (c) (3) 17500 FMV Program Support Tri-Valley Transit 279 Creek Road Middlebury VT 05753 030335768 501 (c) (3) 29750 FMV Transportation Subsidy Advance Transit PO BOX 1027 Wilder VT 05088 222558708 501 (c) (3) 78214 FMV Transportation Subsidy Southeast VT Transit 45 Mill Street Wilmington VT 05363 030353976 501 (c) (3) 21000 FMV Transportation Subsidy Hanover Area Chamber of Commerce 53 South Main Street Suite 208 Hanover NH 03755 020406892 501 (c) (6) 7000 FMV Program Support Business and Industry Association 122 North Main Street Concord NH 03301 020172300 501 (c) (6) 8050 FMV Program Support Riverbend Community Mental Health PO Box 2032 Concord NH 03302 020264383 501 (c) (3) 5250 FMV Program Support Cheshire Medical Center 580 Court Street 590 Keene NH 03431 020354549 501 (c) (3) 84000 FMV Program Support New Hampshire Charitable Foundation 37 Pleasant Street Concord NH 03301 026005625 501 (c) (3) 42000 FMV Program Support Listen Community Services 60 Hanover Street Lebanon NH 03766 237225952 501 (c) (3) 35000 FMV Program Support Families in Transition 122 Market St Manchester NH 03101 020475414 501 (c) (3) 44625 FMV Program Support Twin Pines Housing Trust 226 Holiday Drive Suite 20 White River Junction VT 05001 222809527 501 (c) (3) 35000 FMV Program Support Southwestern Community Services PO Box 603 63 Community Way Keene NH 03741 026013808 501 (c) (3) 96082 FMV Program Support Mascoma Community Healthcare Inc 18 Roberts Road PO Box 550 Canaan NH 03741 465672753 501 (c) (3) 35000 FMV Program Support Conservation Law Foundation 62 Summer Street Boston MA 02110 046149986 501 (c) (3) 35000 FMV Program Support American Cancer Society 2 Commerce Drive Suite 110 Bedford NH 03110 131788491 501 (c) (3) 27650 FMV Program Support Upper Valley Community Nursing Project PO Box 1302 Lebanon NH 03766 831224873 501 (c) (3) 21000 FMV Program Support Alice Peck Day Memorial Hospital 10 Alice Peck Day Dr Lebanon NH 03766 020222791 501 (c) (3) 17500 FMV Program Support St Joseph Hospital 172 Kinsley Street Nashua NH 030603648 020222215 501 (c) (3) 17500 FMV Program Support Granite United Way 22 Concord Street Floor 2 Manchester NH 03101 026006033 503 (c) (3) 31500 FMV Program Support Visions for Creative Housing Solutions 8 Sunrise Farm Lane Enfield NH 03748 800868234 501 (c) (3) 17500 FMV Program Support JSI Research & Training Institute 501 South Street Bow NH 03304 042679824 501 (c) (3) 14000 FMV Program Support City Year Inc 248 Elm Street Suite 201 Manchester NH 03101 222882549 501 (c) (3) 15750 FMV Program Support Health Care Without Harm 12355 Sunrise Valley Dr Suite 680 Reston VA 20191 522358837 501 (c) (3) 21000 FMV Program Support Granite YMCA Corporate Office 117 market Street Manchester NH 03104 020222248 501 (c) (3) 13650 FMV Program Support Boys & Girls Club of Manchester 555 Union Street Manchester NH 03104 020226033 501 (c) (3) 14350 FMV Program Support TLC Family Resource Center PO Box 1098 Claremont NH 03743 522439830 501 (c) (3) 38089 FMV Program Support Valley Regional Healthcare 243 Elm Street Claremont NH 03743 020397338 501 (c) (3) 77003 FMV Program Support NH Children's Trust 10 Ferry Street Suite 315 Concord NH 03301 272458454 501 (c) (3) 8750 FMV Program Support Willing Hands Enterprises PO Box 172 Lebanon NH 03766 202204811 501 (c) (3) 7000 FMV Program Support New Hampshire Women's Foundation 18 Low Avenue Suite 205 Concord NH 03301 020495092 501 (c) (3) 5250 FMV Program Support New Hampshire College & University Council 3 Barrell Court Suite 100 Concord NH 03301 020271139 501 (c) (3) 5950 FMV Program Support Vital Communities Transportation 195 North Main Street White River Junction VT 05001 030355283 501 (c) (3) 10500 FMV Program Support Headrest Inc 141 Mascoma St Lebanon NH 03766 237256865 501 (c) (3) 29540 FMV Program Support Monadnock Collaborative 105 Castle St Keene NH 03431 020526791 501 (c) (3) 12974 FMV Program Support The Albert Schweitzer Fellowship Program 330 Brookline Ave Boston MA 02215 131982786 501 (c) (3) 8400 FMV Program Support 46 3 Awards and Educational Assistance 22 675315 FMV D-H tuition Reimbursement Programs 468 831285 FMV Patient Assistance 181 59904 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) HAS WRITTEN GUIDELINES AND PROCEDURES. AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE DARTMOUTH INSTITUTE SCHOLARSHIPS (TDI) ARE PAID DIRECTLY TO DARTMOUTH COLLEGE ON BEHALF OF THE INDIVIDUALS RECEIVING THE AWARDS. THE COORDINATORS OF THE PROGRAM ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. X true true true false false false false false false false false James N Weinstein DO MS Former Trustee/CEO 0 782744 0 0 0 180577 0 26580 0 8240 0 998141 0 0 Joanne M Conroy MD Trustee, Ex-Officio, CEO 0 954614 0 253555 0 38756 0 26580 0 25582 0 1299087 0 0 Jocelyn Chertoff MD VP Service Line / DPT CHR Diagnostic Radiology 0 559809 0 250 0 52688 0 26580 0 15705 0 655032 0 0 Jeffrey A Cohen MD Trustee (Through 12/31/18) 0 394582 0 250 0 45014 0 26580 0 37781 0 504207 0 0 Cherie Holmes MD Trustee 0 393474 0 250 0 35727 0 38328 0 15848 0 483627 0 0 Kari M Rosenkranz MD Trustee / Physician 0 495650 0 250 0 26015 0 21080 0 14693 0 557688 0 0 Brian C Spence MDMHCDS Trustee (Through 12/31/18) / Physician 0 451894 0 250 0 21267 0 21080 0 36011 0 530502 0 0 Jon Wahrenberger MDFAHAFAC Trustee 0 342647 0 250 0 3906 0 26580 0 39085 0 412468 0 0 KURT K RHYNHART MD TRUSTEE 0 436988 0 250 0 39811 0 21343 0 20729 0 519121 0 0 John Birkmeyer MD Former CCO / EVP ENTPRS SP 0 0 0 0 0 328004 0 0 0 0 0 328004 0 0 Richard I Rothstein MD Former Dept. Chair / Service Line LDR - MED 0 780410 0 250 0 6378 0 26640 0 29773 0 843451 0 0 Sowmya Viswanathan MD Former Chief ACO Officer 0 0 0 0 0 161538 0 0 0 0 0 161538 0 0 Aimee M Giglio Chief HR Officer 318913 0 10250 0 29599 0 12648 0 34630 0 406040 0 0 0 DANIEL P JANTZEN CPA Chief Financial Officer 621847 0 10250 0 170310 0 26580 0 29223 0 858210 0 0 0 Patrick Jordan III MBA Chief Operating Officer 593349 0 250 0 1588 0 21080 0 37284 0 653551 0 0 0 JOHN KACAVAS Chief Legal Officer 528095 0 10250 0 90643 0 21080 0 31336 0 681404 0 0 0 Stephen Leblanc Chief Strategy Officer 0 640573 0 10250 0 27497 0 26580 0 34294 0 739194 0 0 EDWARD MERRENS Chief Clinical Officer 0 629398 0 10250 0 70908 0 28864 0 20070 0 759490 0 0 Maria Padin MD Chief Medical Officer 0 369274 0 5250 0 31412 0 37334 0 36836 0 480106 0 0 Susan A Reeves EDDRN Chief Nursing Officer 457787 0 250 0 2628 0 26580 0 30379 0 517624 0 0 0 Steven Boyce FMR KEY EMP / ADM. VP MED SPCLTS 0 127572 0 250 0 479 0 10843 0 19336 0 158480 0 0 Wendy Fielding MBA FMR KEY EMP / VP FINANCE PLNNING 228163 0 250 0 18914 0 19118 0 30870 0 297315 0 0 0 Robert Greene MDMHCDSFACP FMR CHF POPUL MGMT OFR 0 0 0 0 0 122058 0 0 0 0 0 122058 0 0 John S Malanowski MILR Chief HR Officer 0 0 0 0 138656 0 0 0 0 0 138656 0 0 0 Tina E Naimie CPA FMR KEY EMP / VP CORP FINANCE 256492 0 250 0 557 0 19498 0 9093 0 285890 0 0 0 Christine Schon MPA FMR KEY EMP/ ADM VP PRMRY CARE 0 251113 0 250 0 28660 0 26580 0 17134 0 323737 0 0 Thomas J Siepka Chief Pharm Officer 104506 0 5000 0 3684 0 5492 0 659 0 119341 0 0 0 Wendy Wells MD FMR KEY EMP / DPT CHR PATHOLOGY 0 460678 0 250 0 46024 0 37543 0 23225 0 567720 0 0 Thomas Dodds MD FRMR KEY EMP / DEPT CHR ANESTH 0 120987 0 250 0 2010 0 8783 0 3814 0 135844 0 0 GEORGE T BLIKE MD Chief Quality & Value Officer 0 420654 0 5250 0 62551 0 52781 0 36528 0 577764 0 0 Karen Clements RNBSNMSB Chief Nursing Officer 325478 0 600 0 28782 0 21080 0 12013 0 387953 0 0 0 Staci Hermann PHARMDMS Int. Chief Pharm Officer 197813 0 250 0 138 0 8349 0 13911 0 220461 0 0 0 Simon Hillier Dept. Chair - Anesthesiology 0 481194 0 250 0 46847 0 26580 0 29889 0 584760 0 0 Jeffrey Obrien MHA VP Clinical Operations 326402 0 250 0 38484 0 24226 0 32889 0 422251 0 0 0 Peter D Solberg MD Chief Medical Information Officer 0 357928 0 5250 0 21097 0 21497 0 34614 0 440386 0 0 Sandra Wong MD Chief ACO Officer 0 729365 0 250 0 59000 0 21080 0 11753 0 821448 0 0 Kimberly Troland JD Deputy Gen Counsel 362975 0 250 0 42312 0 21080 0 29221 0 455838 0 0 0 BRUCE KING PRES/CEO NEW LNDN HSPTL 309810 584 250 0 49432 0 26580 0 29190 0 415262 584 0 0 Martin Purcell MBA VP IS OPERATIONS 306454 0 250 0 72182 0 36066 0 35637 0 450589 0 0 0 David Gladstone MD CHF CLNCL PHYSCN - RADIOLOGY 296178 0 250 0 27764 0 30315 0 27483 0 381990 0 0 0 Leigh Burgess VP RESEARCH OPS 324124 0 250 0 2777 0 21080 0 20197 0 368428 0 0 0 Schedule J, Part II NOTE REGARDING COMPENSATION FORM 990, SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY MHMH AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS AS WELL AS ANY CHANGES IN PENSION ACTUARIAL VALUE (IF APPLICABLE) IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY D-H ON BEHALF OF ITS EMPLOYEES. Schedule J, Part I, Line 1a Health or social club dues or initiation fees THE ORGANIZATION HAS IN PLACE A MANAGEMENT SELF DEVELOPMENT PLAN (MSDP) DESIGNED TO PROMOTE PROFESSIONAL AND PERSONAL DEVELOPMENT. THE MSDP IS CAPPED AT 2% OF GROSS PAY AND MAY BE UTILIZED FOR EXPENSES SUCH AS PROFESSIONAL DUES, MEETINGS AND SEMINARS, TUITION REIMBURSEMENT, AND OTHER MISCELLANEOUS ITEMS THAT PROMOTE PROFESSIONAL KNOWLEDGE. THE MONIES MAY ALSO BE USED FOR UP TO A 50% REIMBURSEMENT OF THE COST OF A FITNESS/WELLNESS PROGRAM DESIGNED TO MAINTAIN THE HEALTH OF MANAGEMENT PERSONNEL. ALL EXPENSES ARE SUBMITTED FOR APPROVAL BEFORE REIMBURSEMENT. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC (DHC), A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULANT, 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 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2018. DURING CALENDAR YEAR 2018, FORMER CHIEF CLINICAL OFFICER JOHN BIRKMEYER RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $328,004 FROM DHC. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2018, FORMER CHIEF HR OFFICER JOHN MALANOWSKI RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $138,656 FROM MHMH. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B) III. DURING CALENDAR YEAR 2018, FORMER CHIEF POPULATION MANAGEMENT OFFICER ROBERT GREENE RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $122,058 FROM MHMH. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2018, FORMER CHIEF AGO OFFICER SOWMYA VISWANATHAN RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $161,538 FROM DHC. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 6646142B4 2014-08-13 41242990 REFUND ISSUE DATED 08/19/2009 false false false B NH HEALTH AND ED FACILITIES AUTHORITY 020279866 000000000 2016-07-01 35575000 SEE PART VI false false false A 41242990 352990 40890000 2014 true false true true B 24605000 35575000 408058 15936616 19230326 2017 true false true true A false false false false 0.0 0.0 0.0 false false true B false true false false 0.0 0.0 0.0 false false true A false true false false false false false false true B false true false false false false false false true A true B true Schedule K, Part I, Column (f) Bond B THE PURPOSE OF THE ISSUE WAS TO REFUND AN ISSUE DATED 10/24/2013 AND FINANCE CAPITAL PROJECTS. DANIEL JANTZEN OFFICER SPLIT DOLLAR LIFE X 0 126415 false true true DEBORAH JANTZEN FAMILY MEMBER SPLIT DOLLAR LIFE X 0 62841 false true true BRUCE KING OFFICER SPLIT DOLLAR LIFE X 0 155636 false true true MARY KING FAMILY MEMBER SPLIT DOLLAR LIFE X 0 27352 false true true 372244 Victoria LeBlanc Family member of Officer Stephen LeBlanc 33097 Employment Compensation false X 19 1204593 Market value 0 false true true Schedule M, Part I, Line 32b Third parties used to solicit, process, or sell noncash contributions THE ORGANIZATION USES DARTMOUTH-HITCHCOCK HEALTH, MHMH'S PARENT ORGANIZATION, FOR SOLICITATION OF CONTRIBUTIONS AND ANNUAL FUND ACTIVITIES. Form 990, Part VI, Line 15a OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR UNDERTAKEN ALTHOUGH PAID BY A RELATED ORGANIZATION, DARTMOUTH-HITCHCOCK CLINIC, THE COMPENSATION FOR THE CEO IS EVALUATED BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSIDERATION WITH THE INDEPENDENT THIRD PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2019. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Mary Hitchcock Memorial Hospital (MHMH) board has a Governance Committee who has the authority/responsibility of the MHMH Board to ensure that MHMH continues to fulfill its central mission and vision. This committee has authority to act on behalf of the full Board when the need arises. Members include the following who are all members of the governing board: Edward H. Stansfield, III, MA (Board Chair and Chair of Governance Committee) William J. Conaty (Chair - Talent Development and Compensation Committee) Roberta L. Hines, MD (Chair - Research and Education Committee) Charles G. Plimpton, MBA (Chair- Finance Committee) Pamela A. Thompson, MS, RN, CENP, FAAN (Chair - Value Committee) Ex Officio member: Dr. Joanne Conroy (CEO) Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF MHMH'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL, AND OPERATIONAL DECISIONS OF MHMH'S TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders IN ADDITION TO RESERVED POWERS, DARTMOUTH-HITCHCOCK HEALTH (D-HH) SHALL HAVE THE AUTHORITY TO TAKE ACTIONS TO ESTABLISH, MANAGE, AND GOVERN MHMH TO CREATE AND MAINTAIN AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF THE MISSION OF MHMH AND OTHER ORGANIZATIONS WITHIN THE SYSTEM. THESE POWERS INCLUDE BUT ARE NOT LIMITED TO ITEMS SUCH AS THE ABILITY TO APPROVE, DISAPPROVE, OR MODIFY ALL MATERIAL GOVERNANCE, PROGRAMMATIC, AND FINANCIAL DECISIONS OF MHMH'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF MHMH'S BOARD OF TRUSTEES, ASSESS MHMH A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE MHMH'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY MHMH, APPROVE KEY STRATEGIC RELATIONSHIPS, APPROVE THE ELIMINATION OR ADDITION OF ANY MATERIAL HEALTH CARE SERVICE OR PROGRAM, AND OTHER AUTHORITY TO TAKE ACTION ON BEHALF OF MHMH. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS, THE DIRECTOR OF CORPORATE FINANCE, THE VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL FORM 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING. Form 990, Part VI, Line 12c Conflict of interest policy THE MARY HITCHCOCK MEMORIAL HOSPITAL BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA (ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS). THE LAST FORMAL PROCESS WAS COMPLETED IN 2019. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. THE PROCESS DESCRIBED ABOVE TO ESTABLISH COMPENSATION WAS USED FOR THE FOLLOWING POSITIONS: Chief Financial Officer, Chief Strategy Officer, Chief Clinical Officer, Chief Legal Officer, Chief Human Resources Officer, Chief Operating Officer, Chief Nursing - Executive, Chief Nursing Officer, Chief Pharmacy Officer, Chief Quality & Value Officer, Department Chair - Anesthesia, Department Chair - Radiology, Department Chair - Pathology and similar positions. Form 990, Part VI, Line 19 Required documents available to the public MHMH'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST EITHER IN ELECTRONIC OR HARD COPY FORM. Form 990, Part VII, Section A, Line 1a, Column (B) AVERAGE HOURS PER WEEK AS PART OF DARTMOUTH-HITCHCOCK CLINIC AND MARY HITCHCOCK MEMORIAL HOSPITAL'S AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS' 990'S EVEN THOUGH COMPENSATION REPORTED IN PART VII IS BASED ON THE ENTITY ISSUING THE W-2. IN ADDITION, CERTAIN OFFICERS SPEND TIME ON DARTMOUTH-HITCHCOCK HEALTH (THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC), DARTMOUTH-HITCHCOCK CLINIC, ALONG WITH THREE SUPPORTING ORGANIZATIONS DARTMOUTH-HITCHCOCK MEDICAL CENTER, EVERWELL, INC., HAMDEN RISK RETENTION GROUP, AND RELATED ENTITIES- ALICE PECK DAY MEMORIAL HOSPITAL, WINDSOR HOSPITAL CORPORATION (DBA MT ASCUTNEY HOSPITAL AND HEALTH CENTER), MT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER, CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION, VNA & HOSPICE OF VT AND NH, AND THE HITCHCOCK FOUNDATION Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Revenue - Total Revenue: 37707318, Related or Exempt Function Revenue: 33262174, Unrelated Business Revenue: 4445144, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSET TRANSFER TO AFFILIATES - 11602360; NET ASSETS RELEASED FROM RESTRICTION - -11907712; PENSION-RELATED AND OTHER CHANGES - -22865520; NEW ENGLAND ALLIANCE FOR HEALTH LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264232401 HLTH IMPROVMT NH 37360 590388 MHMH D-H SPECIALTY SERVICES LLC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 460876427 SHD SVGS PRGM NH 0 0 MHMH 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 true THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(c)(3) 3 D-HH false WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(c)(3) 3 D-HH false CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 501(c)(3) 3 D-HH false ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(c)(3) 3 D-HH false VISITING NURSE AND HOSPICE FOR VERMONT AND NEW HAMPSHIRE 205 BILLINGS FARM ROAD 5 WILDER VT 05088 036006494 HOSPICE VT 501(c)(3) 10 D-HH false DARTMOUTH -HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTING ORG. NH 501(c)(3) Type I NA false DARTMOUTH-HITCHCOCK MASTER INVESTMENT PROGRAM OF POOLED INVESTMENT ACCOUNTS 1 MED CTR DR LEBANON NH 03756 020205863 POOLED INVEST NH MHMH Excluded 29924954 658677570 false 25394 true false true true false true false false false false true true true true true true true true true true THE NEW LONDON HOSPITAL ASSOCIATION INC L 58096 FMV THE NEW LONDON HOSPITAL ASSOCIATION INC Q 1521454 FMV WINDSOR HOSPITAL CORPORATION L 86996 FMV WINDSOR HOSPITAL CORPORATION Q 1450319 FMV WINDSOR HOSPITAL CORPORATION R 103938 FMV DARTMOUTH-HITCHCOCK HEALTH R 14708458 FMV CHESHIRE MEDICAL CENTER L 23153748 FMV CHESHIRE MEDICAL CENTER Q 608398 FMV ALICE PECK DAY MEMORIAL HOSPITAL L 81640 FMV ALICE PECK DAY MEMORIAL HOSPITAL Q 835711 FMV