CHESHIRE MEDICAL CENTER: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CHESHIRE MEDICAL CENTER (EIN 02-0354549)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-16
- IRS object ID
- 201921369349301092
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-16T18:13:35-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET 302 | AddressLine1Txt |
| City | MANCHESTER | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020354549 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Cheshire Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KATHRYN WILLBARGER | InCareOfNm |
| Business Name Control | CHES | BusinessNameControlTxt |
| Phone | 6033545400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580-590 Court Street | AddressLine1Txt |
| City | Keene | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 034315400 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHRYN F WILLBARGER | PersonNm |
| Person Title | VP of Finance | PersonTitleTxt |
| Phone | 6033545454 | PhoneNum |
| Signature | 2019-05-15 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Timothy R Hepburn | PreparerPersonNm |
| PTIN | P00182393 | PTIN |
| Phone | 8002447444 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 130.189.185.98 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 02156120191355000000 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2019-05-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | A12FE54CFB960D0D5F63549EF4E38325C94959EB | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 8754BDCA76DE6AB38AF93E83577F37D68CF10907 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Don Caruso | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580-590 Court Street | AddressLine1Txt |
| City | Keene | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 034315400 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $210,426,594 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.cheshire-med.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1980 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To lead Keene, NH to become the nation's healthiest community through clinical and service excellence, collaborations, and compassion for every patient, every time | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1529 | TotalEmployeeCnt |
| Total Volunteers | 131 | TotalVolunteersCnt |
| Total Gross UBI | $101,273 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $87,740 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,019,827 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,195,644 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $200,628,728 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $205,101,323 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,442,230 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,096,844 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,927,245 | PYOtherRevenueAmt |
| CY Other Revenue | $3,032,783 | CYOtherRevenueAmt |
| PY Total Revenue | $205,018,030 | PYTotalRevenueAmt |
| CY Total Revenue | $210,426,594 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,156,399 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $274,182 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $121,758,429 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $129,738,571 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,720,905 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $84,227,294 | PYOtherExpensesAmt |
| CY Other Expenses | $86,108,890 | CYOtherExpensesAmt |
| PY Total Expenses | $207,142,122 | PYTotalExpensesAmt |
| CY Total Expenses | $216,121,643 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,124,092 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,695,049 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $126,657,747 | TotalAssetsBOYAmt |
| Total Assets EOY | $125,320,625 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $63,505,786 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $56,849,924 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $63,151,961 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $68,470,701 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE CHESHIRE MEDICAL CENTER IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE WITH A MISSION TO LEAD OUR COMMUNITY TO BECOME THE NATIONS HEALTHIEST COMMUNITY THROUGH OUR CLINICAL AND SERVICE EXCELLENCE, COLLABORATION, AND COMPASSION FOR EVERY PATIENT, EVERY TIME. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $184,708,762 | ExpenseAmt |
| Grant | $274,182 | GrantAmt |
| Revenue | $206,028,632 | RevenueAmt |
| Desc | The Cheshire Medical Center (CMC), is a community hospital located in Keene, New Hampshire. CMC is a not-for-profit organization, as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. On March 2, 2014, CMC affiliated with Dartmouth-Hitchcock Health ("D-HH") a non-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 FY18 CMC provided 21,637 days of inpatient care and had 4,559 hospital discharges, while the emergency department was open to the public 24 hours per day, 7 days per week and had 22,519 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 they provide. The most recent Community Benefit Reports are available upon request or can be found on Cheshire'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 $8 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 $25 million dollars in unreimbursed Medicaid and Medicare costs absorbed by CMC. | Desc |
| Total Program Service Expenses | $184,708,762 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 214 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1529 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHRYN WILLBARGER | PersonNm |
| Phone | 6033545454 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580-590 COURT STREET | AddressLine1Txt |
| City | Keene | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 034315400 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| H Roger Hansen | ||||||||||
| Trustee/Vice Chair | 1.0 | 2.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Nathalie Houder | ||||||||||
| Trustee/Treasurer | 1.0 | 1.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Michael Kapiloff | ||||||||||
| Trustee/Vice Chair | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Geof Molina | ||||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Steven Paris MD | ||||||||||
| Trustee | 1.0 | 42.01 | Yes (X) | $0 | $423,373 | $52,401 | ||||
| Leslie Pitts MD | ||||||||||
| Trustee | 1.0 | 40.0 | Yes (X) | $0 | $326,340 | $323,762 | ||||
| Kary Shumway | ||||||||||
| Trustee end 7/1/17 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Katherine Snow | ||||||||||
| Trustee/Secretary | 1.0 | 2.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Gregg Tewksbury CPA | ||||||||||
| Trustee | 2.0 | 1.5 | Yes (X) | $0 | $0 | $0 | ||||
| Don Caruso MD | ||||||||||
| Trustee/CEO/Pres/CMO | 1.0 | 54.0 | Yes (X) | Yes (X) | $0 | $495,531 | $322,442 | |||
| Cherie Holmes MD | ||||||||||
| Trustee/Ex-Officio | 1.0 | 40.0 | Yes (X) | $0 | $422,507 | $144,417 | ||||
| Wendy Fielding | ||||||||||
| Trustee | 1.0 | 40.0 | Yes (X) | $0 | $244,771 | $40,257 | ||||
| Maria Padin | ||||||||||
| Trustee eff 1/1/17 | 1.0 | 61.0 | Yes (X) | $0 | $399,509 | $275,686 | ||||
| Anne Huot | ||||||||||
| Trustee end 7/24/17 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Martha Landry | ||||||||||
| Trustee eff 1/1/17 | 1.0 | 1.5 | Yes (X) | $0 | $0 | $0 | ||||
| John Round | ||||||||||
| Trustee eff 1/1/17 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Andrew Tremblay MD | ||||||||||
| Trustee eff 1/1/17 | 1.0 | 40.0 | Yes (X) | $0 | $291,341 | $59,833 | ||||
| Jennifer DiNubila DO | ||||||||||
| Trustee eff 11/2016 end11/2018 | 1.0 | 40.5 | Yes (X) | $0 | $323,005 | $34,693 | ||||
| Mark Gavin | ||||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Susan Abert | ||||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| Cindi Coughlin | ||||||||||
| CNO | 40.0 | 0.0 | Yes (X) | $229,180 | $0 | $62,337 | ||||
| Kathryn Willbarger | ||||||||||
| VP Finance | 40.0 | 2.0 | Yes (X) | $162,492 | $0 | $3,594 | ||||
| Christine Schon | ||||||||||
| Trustee/COO | 1.0 | 40.0 | Yes (X) | $0 | $274,102 | $42,542 | ||||
| Paul Pezone | ||||||||||
| VP Facilities & Support Srvcs | 40.0 | 0.0 | $206,896 | $0 | $18,011 | Yes (X) | ||||
| Julie Green | ||||||||||
| VP Human Resources | 40.0 | 0.0 | $250,092 | $0 | $6,239 | Yes (X) | ||||
| Amy Matthews | ||||||||||
| Sr. Dir Patient Care Services | 40.0 | 0.0 | $164,054 | $0 | $2,905 | Yes (X) | ||||
| Erli Chen | ||||||||||
| Physicist | 40.0 | 0.0 | $224,548 | $0 | $14,990 | Yes (X) | ||||
| Latasha Heape | ||||||||||
| Chief CRNA | 50.0 | 0.0 | $179,216 | $0 | $20,267 | Yes (X) | ||||
| Sandra Phipps | ||||||||||
| VP Philanthropy/Comm Relations | 40.0 | 0.0 | $154,336 | $0 | $15,465 | Yes (X) | ||||
| Frank Michael | ||||||||||
| Nurse Anesthetist CRNA | 40.0 | 0.0 | $185,136 | $0 | $1,334 | Yes (X) | ||||
| John Genovese | ||||||||||
| Pharmacy Manager | 40.0 | 0.0 | $160,161 | $0 | $40,793 | Yes (X) | ||||
| Robert Cochrane | ||||||||||
| Former CFO | 0.0 | 0.0 | $110,959 | $0 | $2,727 | Yes (X) | ||||
| Arthur W Nichols | ||||||||||
| Former President | 0.0 | 0.0 | $184,787 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,211,857 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,200,479 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,484,695 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 63 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Conifer Revenue Cycle Solutions | |||||
| PO Box 655025 | DALLAS | TX | 752655025 | Rev Management Srvcs | $2,253,868 |
| Quest Diagnostics | |||||
| 12436 Collections Center Drive | CHICAGO | IL | 606932436 | Lab Services | $1,200,894 |
| AHSA LLC | |||||
| PO Box 945 | TRAVERSE CITY | MI | 49685 | Staffing Services | $1,092,135 |
| Helmsman Management Srvcs | |||||
| PO Box 2027 | KEENE | NH | 03431 | Claims Mngt Srvcs | $715,952 |
| SymQuest Group Inc | |||||
| 66 Benning Street Suite 7 | WEST LEBANON | NH | 03784 | Information Services | $636,729 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 71 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $444,547 | GovernmentGrantsAmt |
| All Other Contributions | $751,097 | AllOtherContributionsAmt |
| Noncash Contributions | $35,871 | NoncashContributionsAmt |
| Total Contributions | $1,195,644 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $204,877,101 | $204,775,828 | $101,273 |
| PHARMACY AND DRUGS | 446110 | $118,879 | $118,879 | |
| MISCELLANEOUS HEALTH SERVICES | 621300 | $83,625 | $83,625 | |
| ALL OTHER PROGRAM SERVICE REVENUE | 621300 | $21,718 | $21,718 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $205,101,323 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $567,046 | TotalRevenueColumnAmt |
| Exclusion | $567,046 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,056 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,056 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,056 | TotalRevenueColumnAmt |
| Exclusion | $1,056 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $529,798 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $529,798 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $529,798 | TotalRevenueColumnAmt |
| Exclusion | $529,798 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| FOOD SERVICES | 722210 | $1,220,746 | $1,220,746 | |
| CHILDCARE INCOME | 624410 | $671,289 | $671,289 | |
| REBATES AND DISCOUNTS | 621300 | $795,157 | $795,157 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $344,535 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $233,425 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $111,110 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,031,727 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $210,426,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $206,028,632 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $101,273 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,101,045 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,678 | TotalAmt |
| Program Services | $165,678 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,504 | TotalAmt |
| Program Services | $108,504 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,380,790 | TotalAmt |
| Program Services | $1,129,486 | ProgramServicesAmt |
| Management And General | $237,496 | ManagementAndGeneralAmt |
| Fundraising | $13,808 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,394 | TotalAmt |
| Management And General | $92,394 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,834,560 | TotalAmt |
| Program Services | $78,392,670 | ProgramServicesAmt |
| Management And General | $16,483,544 | ManagementAndGeneralAmt |
| Fundraising | $958,346 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,016,856 | TotalAmt |
| Program Services | $831,788 | ProgramServicesAmt |
| Management And General | $174,899 | ManagementAndGeneralAmt |
| Fundraising | $10,169 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,619,281 | TotalAmt |
| Program Services | $22,592,572 | ProgramServicesAmt |
| Management And General | $4,750,516 | ManagementAndGeneralAmt |
| Fundraising | $276,193 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,794,690 | TotalAmt |
| Program Services | $3,104,056 | ProgramServicesAmt |
| Management And General | $652,687 | ManagementAndGeneralAmt |
| Fundraising | $37,947 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,346 | TotalAmt |
| Program Services | $50,181 | ProgramServicesAmt |
| Management And General | $10,552 | ManagementAndGeneralAmt |
| Fundraising | $613 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,835 | TotalAmt |
| Program Services | $17,835 | ProgramServicesAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,868 | TotalAmt |
| Program Services | $49,868 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,142,238 | TotalAmt |
| Program Services | $14,840,351 | ProgramServicesAmt |
| Management And General | $3,120,465 | ManagementAndGeneralAmt |
| Fundraising | $181,422 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,575 | TotalAmt |
| Program Services | $181,248 | ProgramServicesAmt |
| Management And General | $38,111 | ManagementAndGeneralAmt |
| Fundraising | $2,216 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,347 | TotalAmt |
| Program Services | $1,143,848 | ProgramServicesAmt |
| Management And General | $240,516 | ManagementAndGeneralAmt |
| Fundraising | $13,983 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,123,726 | TotalAmt |
| Program Services | $7,463,208 | ProgramServicesAmt |
| Management And General | $1,569,281 | ManagementAndGeneralAmt |
| Fundraising | $91,237 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,385 | TotalAmt |
| Program Services | $210,541 | ProgramServicesAmt |
| Management And General | $44,270 | ManagementAndGeneralAmt |
| Fundraising | $2,574 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,003 | TotalAmt |
| Program Services | $43,003 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,004,242 | TotalAmt |
| Program Services | $821,470 | ProgramServicesAmt |
| Management And General | $172,730 | ManagementAndGeneralAmt |
| Fundraising | $10,042 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,217,146 | TotalAmt |
| Program Services | $8,357,626 | ProgramServicesAmt |
| Management And General | $1,757,349 | ManagementAndGeneralAmt |
| Fundraising | $102,171 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $795,110 | TotalAmt |
| Program Services | $650,400 | ProgramServicesAmt |
| Management And General | $136,759 | ManagementAndGeneralAmt |
| Fundraising | $7,951 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $33,243,658 | $33,243,658 |
| MET AND PILOT TAXES | $8,414,900 | $8,414,900 |
| FOOD AND CAFETERIA EXPENSES | $1,072,014 | $1,072,014 |
| CHILD CARE EXPENSES | $841,037 | $841,037 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,205,460 | TotalAmt |
| Program Services | $982,820 | ProgramServicesAmt |
| Management And General | $210,407 | ManagementAndGeneralAmt |
| Fundraising | $12,233 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $216,121,643 | TotalAmt |
| Program Services | $184,708,762 | ProgramServicesAmt |
| Management And General | $29,691,976 | ManagementAndGeneralAmt |
| Fundraising | $1,720,905 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,644,911 | BOYAmt |
| EOY | $6,687,629 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,222,925 | BOYAmt |
| EOY | $16,862,239 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,135,600 | BOYAmt |
| EOY | $3,205,530 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,953,881 | BOYAmt |
| EOY | $2,011,991 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $223,307,410 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $156,548,572 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,933,035 | BOYAmt |
| EOY | $66,758,838 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,868,744 | BOYAmt |
| EOY | $26,029,147 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,008,141 | BOYAmt |
| EOY | $192,141 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $179,167 | BOYAmt |
| EOY | $71,667 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,711,343 | BOYAmt |
| EOY | $3,501,443 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $126,657,747 | BOYAmt |
| EOY | $125,320,625 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,276,717 | BOYAmt |
| EOY | $6,262,231 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,463 | BOYAmt |
| EOY | $103,896 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,964,602 | BOYAmt |
| EOY | $26,164,093 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,163,004 | BOYAmt |
| EOY | $24,319,704 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,505,786 | BOYAmt |
| EOY | $56,849,924 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,249,962 | BOYAmt |
| EOY | $63,506,628 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,901,999 | BOYAmt |
| EOY | $4,964,073 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,151,961 | BOYAmt |
| EOY | $68,470,701 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $126,657,747 | BOYAmt |
| EOY | $125,320,625 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$5,695,049 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $919,905 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $10,093,884 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $18,838 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $18,838 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990 Schedule C, Part II B, Line 1I | FormAndLineReferenceDesc |
| Explanation | Cheshire Medical Center pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,860,497 | BeginningYearBalanceAmt |
| Contributions | $195,687 | ContributionsAmt |
| Investment Earnings Or Losses | $483,937 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $620,000 | OtherExpendituresAmt |
| End Year Balance | $4,920,121 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,542,620 | BeginningYearBalanceAmt |
| Contributions | $209,216 | ContributionsAmt |
| Investment Earnings Or Losses | $175,241 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $66,580 | OtherExpendituresAmt |
| End Year Balance | $4,860,497 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,646,853 | BeginningYearBalanceAmt |
| Contributions | $264,489 | ContributionsAmt |
| Investment Earnings Or Losses | $60,023 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $428,745 | OtherExpendituresAmt |
| End Year Balance | $4,542,620 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,487,520 | BeginningYearBalanceAmt |
| Contributions | $968,233 | ContributionsAmt |
| Investment Earnings Or Losses | $414,873 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,223,773 | OtherExpendituresAmt |
| End Year Balance | $4,646,853 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,602,059 | BeginningYearBalanceAmt |
| Contributions | $272,723 | ContributionsAmt |
| Investment Earnings Or Losses | $929,038 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $316,300 | OtherExpendituresAmt |
| End Year Balance | $4,487,520 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,632 | OtherCostOrOtherBasisAmt |
| Book Value | $69,632 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $91,011,895 | OtherCostOrOtherBasisAmt |
| Depreciation | $53,920,147 | DepreciationAmt |
| Book Value | $37,091,749 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,423,874 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,550,798 | DepreciationAmt |
| Book Value | $873,176 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $128,798,909 | OtherCostOrOtherBasisAmt |
| Depreciation | $100,077,627 | DepreciationAmt |
| Book Value | $28,721,281 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,000 | OtherCostOrOtherBasisAmt |
| Book Value | $3,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $66,758,838 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| PENSION LIABILITY | $5,322,061 |
| DUE TO RELATED PARTY | $15,026,315 |
| RESERVES FOR INSURANCE RELATED | $464,929 |
| ESTIMATED 3RD PARTY SETTLEMENT | $0 |
| ACCRUED EARNED TIME | $3,506,399 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $24,319,704 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Intended uses of Endowment Funds | FormAndLineReferenceDesc |
| Explanation | Form 990, Schedule D, Part V, Line 4 The intended use of the endowment funds is to promote and advance mission-related programs of The Cheshire Medical Center. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (2 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Region Total ExpendituresRegionTotalExpendituresAmt |
|---|---|---|
| Central America and the Caribbean | Investments | $3,130,622 |
| North America | Investments | $1,687,276 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $4,817,898 | SubtotalSpentAmt |
| Total Spent | $4,817,898 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (true) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | Yes (true) | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Activities per region | FormAndLineReferenceDesc |
| Explanation | Form 990, Schedule F, Part I, Line 3 The legal owner of The Cheshire Medical Center's foreign investments is a related organization, The Cheshire Health Foundation. Since a portion of the total foreign investments are allocated to the Medical Center's assets on the financial statements, those allocated investments have been disclosed on Schedule F, Part I, line 3 of The Cheshire Medical Center's Form 990. However, any required IRS Forms 926 and other foreign tax reporting obligations are filed by the legal owner, The Cheshire Health Foundation. Ownership interest in a foreign corporation Form 990, Schedule F, Part IV, Line 3 The Cheshire Medical Center did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 are not required to be filed. Direct or Indirect shareholder of a PFIC or QEF during the tax year Form 990, Schedule F, Part IV, Line 4 The Cheshire Medical Center meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Medical Center. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 225. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,500,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $360,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,140,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,096,938 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,623,324 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,473,614 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06700 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,597,375 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,983,324 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,614,051 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07230 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,274,096 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $620,811 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,653,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00760 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $462,569 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $462,569 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,353,616 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,353,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $213,712 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,569 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $212,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $257,385 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,200 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $256,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,561,378 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $623,580 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,937,798 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,158,753 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,606,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,551,849 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09050 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 3044 | PersonsServedCnt |
| Total Community Benefit Expns | $317,695 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $236,215 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $81,480 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 2710 | PersonsServedCnt |
| Total Community Benefit Expns | $459,250 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $35,864 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $423,386 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $176,610 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,610 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,320,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,547 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,288,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 5754 | PersonsServedCnt |
| Total Community Benefit Expns | $2,273,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $303,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,969,929 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00920 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,926,176 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $981,544 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $86,905,069 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $107,654,030 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$20,748,961 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cheshire Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 Court Street | AddressLine1Txt |
| City | Keene | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03431 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.cheshire-med.com | WebsiteAddressTxt |
| State License | 00014 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cheshire Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Section C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 225. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Section C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Input from persons representing broad community interests | Form 990, Schedule H, Part V, Section B, Line 5 Needs were prioritized based on data collected from several current assessment processes. Prioritization was completed by CHNA Leadership team. Several hundred people participated in forums and surveys to identify needs. |
| CHNA conducted with one or more organizations | Form 990, Schedule H, Part V, Section B, Line 6A & 6B The Cheshire Medical Center collaborated with Dartmouth-Hitchcock Clinic and Mary Hitchchcock Memorial Hospital; New Hampshire Department of Health and Human Servces; Greater Monadnock Public Health Network; The New Hampshire Hospital Association; Foundation for Healthy Communities; Antioch University New England; Monadnock United Way; New Hampshire Center for Public Policy Studies; Southwestern Regional Planning Commission; and Home Healthcare, Hospice, and Community Services. |
| Community health needs assessment public availability | FORM 990, SCHEDULE H, PART V, SECTION B, LINE 7a The Cheshire Medical Center's 2015 CHNA is available on the Medical Center's website at: http://www.cheshire-med.com/about_us/communityben_report.html |
| Community health needs implementation strategy | FORM 990, SCHEDULE H, PART V, SECTION B, LINE 10a The Cheshire Medical Center's 2015 CHNA Implementation Strategy is available on the Medical Center's website at: http://www.cheshire-med.com/about_us/communityben_report.html |
| Community health needs identified | FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11 The Cheshire Medical Center has implemented strategies to address all but two of the needs identified in its most recent CHNA. Access to behavioral health outpatient services is addressed by Community Partners Monadnock Family Services, Phoenix House, and MAPS Counseling Services. Expansion of personal and public transportation options is addressed by Community Partners Monadnock Regional Transportation Management Association, Home Healthcare Hospice and Community Services, and Southwest Regional Planning Commission. |
| Method for applying for financial assistance | Form 990, Schedule H, Part V, Section B, Line 15e 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. |
| Measures to publicize the Financial Assistance Policy | Form 990, Schedule H, Part V, Lines 16a, b, c, and i The Cheshire Medical Center's Financial Assistance Policy is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html The Cheshire Medical Center's FAP application is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html The Cheshire Medical Center's Plain Language Summary was available at all registration desks and by request and is available on the Medical Center's website at: http://www.cheshire-med.com/patients_visitors/financial_assistance.html |
| Maximum charges to financial assistance policy eligible individuals | Form 990, Schedule H, Part V, Section B, Line 22d 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. For fiscal year 2018, the uninsured discount rate was 64.7%. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Cheshire Med Center Collecting Station | ||||
| 580-590 Court Street | Keene | NH | 03431 | Collecting Station |
| Cheshire Health Services Inc | ||||
| 580-590 Court Street | Keene | NH | 03431 | Non-Emergency Walk In Clinic |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Community Building Activities | Form 990, Schedule H, Part II The Medical Center has been actively engaged since the spring of 2006 in Healthy Monadnock (HM): to make Keene and the surrounding region the healthiest in the nation. Healthy Monadnock is a community engagement initiative designed to foster and sustain a positive culture of health through the Monadnock region. The initiative engages individuals, organizations, and partners to increase healthy eating and active living, increase income and jobs, improve mental wellbeing, increase emergency preparedness, reduce substance misuse including tobacco, increase educational attainment and increase access and quality of healthcare. The Healthy Monadnock website links the Community Health Improvement Plan, invites the public to get involved, and promotes partner strategies and successes. Healthy Monadnock initiative supports the implementation of population level environmental strategies that promote wellness and prevent the leading causes of death in the community. Community Champions made up of, individuals, schools, employers, non-profit agencies, and civic and faith-based organizations take steps to improve health at a personal and institutional level. As of June 30, 2018, there are 3,588 individual champions, 49 worksite wellness champions, 122 outreach champions, and 32 school champions. Individuals are either improving their personal health or working in support of the Healthy Monadnock goals and strategies. Organizations and schools are working to implement evidence based environmental and policy changes that supports the health of their employees/members/students. There are 10 community partners involved in forwarding the majority of the 37 HM action strategies to increase healthy eating and active living, improve mental wellbeing, increase emergency preparedness, reduce substance misuse including tobacco, and increase access and quality of healthcare. Partner identification and engagement is on-going to implement the remaining action strategies to increase educational attainment and improve income and jobs. The organization is a founding member of the Leadership Council for a Healthy Monadnock (LCHM) which has been in existence for over 20 years and has developed a variety of prevention, transportation, referral, and health promotion programs and now serves as the Public Health Advisory Council for the Monadnock Region. The purpose of the LCHM is to lead the Healthy Monadnock community driven process for providing strategic directions, setting priorities, facilitating implementation, aligning activities, and ensuring evaluation that will improve health outcomes in the Greater Monadnock region. Membership is diverse, open to representatives from all institutions and organizations. It includes unaffiliated individuals, to allow for independent voices and real grass roots engagement. SCALE (Spreading Community Accelerators through Learning and Evaluation) The Center for Population Health (CPH) was awarded a grant from the Institute for Healthcare Improvement to be one of 18 communities in Spreading Community Accelerators through Learning and Evaluation (SCALE) 2.0. As part of SCALE 2.0 the CPH in alignment with the Healthy Monadnock initiative is working with 6 other communities, both inside and outside of the Greater Monadnock Region to spread the Community of Solution Skills as well as improvement science tools to help accelerate and evaluate population health improvement work in new ways. This project is directly connected to the 100 Million Healthier Lives initiative which is a global version of our local Healthy Monadnock initiative. The goal of this work is to improve well-being for all while keeping a focus on equity and continuing to have tough conversations and find those who are not thriving. Through the grant we have been able to train hundreds of NH residents on the Community of Solution skills and provided opportunities to learn and practice improvement science. |
| Bad Debt expense | Form 990, Schedule H, Part III, Section A, Line 2 At cost bad debt expense of $3,926,176 is 35.8% of the bad debt reported on The Cheshire Medical Center's Audited Financial Statements, which totals $10,966,972. |
| Estimated bad debt expense attributable to FAP eligible patients | Form 990, Schedule H, Part III, Section A, Line 3 Cheshire Medical Center Management estimates that approximately 25% of bad debt expense (approximately 5 times the region's poverty rate) is an appropriate estimation of patients who would have been eligible for the organization's financial assistance program but did not apply. This estimation is based on the recognition that the financial assistance program is available to residents with incomes of up to three times the federally defined poverty income levels and the assumption that patients who choose not to pay their bills are more likely to fall within the lower income levels. For 2018, the estimated amount of bad debt expense (at cost) attributable to patients who would have been eligible for financial assistance is $981,544. |
| Financial statement footnote describing bad debt expense | Form 990, Schedule H, Part III, Section A, Line 4 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 (Notes 1 and 3). 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. |
| Medicare shortfalls | Form 990, Schedule H, Part III, Section B, Line 8 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. |
| Credit and Collection Policy | Form 990, Schedule H, Part III, Section C, Line 9b Systems are in place to capture financial assistance accounts prior to a bill going to the patient. FAP eligible patients are not charged more than the amount generally billed. |
| Needs Assessment | Form 990, Schedule H, Part VI, Line 2 In 2016, a Community Health Needs Assessment (CHNA) was completed with an implementation strategy identified for community benefit activities for the next three years. The Council for a Healthier Community (CHC) serves as the CHNA Leadership Team (see Attachment A: CHC Membership List). Note that in 2017 the CHC changed their name to the Leadership Council for a Healthy Monadnock (LCHM). The LCHM is the Public Health Advisory Council for the Greater Monadnock region. The primary purpose of the LCHM, which was updated on 8/7/18, is to provide a community framework that supports open communication and sets priorities for community collaboration and funding that encourages the health and wellness of the Greater Monadnock region. As such, their responsibilities include: 1. Educate, advocate, and promote collaboration for the community health improvement needs for the region 2. Identify and encourage action planning that aligns with the needs assessment and data collection activities of the region and provide oversight of the Community Health Improvement Plan (CHIP) 3. Leverage resources to support implementation of strategies to improve the health of the region 4. Advise and make recommendations as appropriate, regarding programs, policies, and funding opportunities that support improvement of the health of the region The members of the CHNA Leadership Team represent the 33 towns in the Monadnock region. In addition, they represent, and are able to speak to the issues of our most vulnerable populations including the medically underserved and persons with low income. The FY2016 CHNA report summarizes the work of the Leadership Council for a Healthy Monadnock (LCHM) and the collaborative efforts of other local groups to assess the needs of our region. This report is the compilation of work that occurred over the last three years, beginning in September of 2014 when the CHC reviewed the State Health Improvement Plan and identified regional assets and needs. The first Greater Monadnock Community Health Improvement Plan was finalized in September 2015, which serves as the foundation of this Community Health Needs Assessment. In addition, to ensure a comprehensive assessment and avoid duplication of efforts, the results of other community partner's needs assessments were used to strengthen and support our process. The CHNA Leadership Team reviewed health and social well-being information from existing sources, recent assessments and neighboring service area CHNAs. They identified secondary data to review and then prioritized needs using a nominal group voting process. The results revealed five priority areas: . Behavioral Health: covering the full range of mental and emotional well-being; from daily stress and satisfaction to the treatment of mental illness . Substance & Alcohol Misuse: pose some of the greatest risks to individuals and community health and safety . Tobacco use: the most preventable cause of death . Obesity: increases the risk for many chronic diseases and impacts 25% of the region's adult population . Emergency Preparedness: Natural, accidental, or even intentional public health threats are all around us. The more prepared we are as a community; the more resilient we will be to recover from a disaster or emergency. Though not articulated as a stand-alone priority area, the need to address the social determinants of health is a focus in the Implementation Strategy that is embedded within each of these priority areas. We know that education, jobs, income, family stability, safety and transportation will contribute to health and wellbeing and require special attention given our rural location and socioeconomic pressures. In addition to these priorities, the implementation strategy also provides an overview of other CMC/DH community benefit activities that are aligned with our mission or considered necessary to support ongoing efforts from previously identified community needs. The community health needs identified in the FY2016 CHNA provide the basis for the development of the Implementation Strategy. The FY2016 CHNA, Implementation Strategy and Community Benefit report is available to the public on the Cheshire Medical Center website: www.cheshire-med.org. |
| Patient education of eligibility for assistance | Form 990, Schedule H, Part VI, Line 3 The Cheshire Medical Center is committed to providing medically necessary care to patients regardless of their ability to pay for services. Non-emergent patients sign a financial responsibility statement upon admission to certify recognition of their responsibility for payment of their bills. However, there will be instances where the patient, due to lack of funds or third party coverage, will not be able to meet this obligation. The Cheshire Medical Center notifies patients of their potential to obtain assistance through the registration and billing processes. Upon registration, patients without insurance are offered the opportunity to apply for financial assistance. In addition, receptionists and clinicians in all areas are educated to refer patients to the financial assistance process in the event patients express concerns with their ability to pay for services. The application information is posted on the intranet and brochures describing the program are readily available to patients. There are signs posted in Registration and throughout the facility informing patients about 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. The financial assistance application process is comprehensive and evaluates a patient's eligibility for a variety of federal, state, and local government programs in addition to The Cheshire Medical Center's internally funded financial assistance program. |
| Community information | Form 990, Schedule H, Part VI, Line 4 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, Nelson/Munsonville, Richmond, Roxbury, Stoddard, Sullivan, Surry, Swanzey, Troy, Walpole, Westmoreland and Winchester, all located in Cheshire County. Based on US Census Bureau 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 . 11,164 or 14.7% over the age of 64 . In 2016, the poverty rate for Cheshire County was 8.5%, which is the same as the State of New Hampshire. The median household income is $58,359 compared to the state average of $68,485. 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). |
| Promotion of community health | Form 990, Schedule H, Part VI, Line 5 The Medical Center plays an active role in promoting community health and offers educational programs including classes and workshops. CMC/DH 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 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 tool to manage stress. A total of 723 community members participated in the 84 educational programs offered. All programs are offered free of charge. In addition, the Medical Center offers several community programs including: Cheshire Smiles, a school-based dental health program for children in grades K-3, provides screening, prevention and restorative dental care for children in Cheshire County schools. Cheshire Medical Center /Dartmouth-Hitchcock 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. The Medical Center sponsors patient visits at Dental Health Works, a public/private program serving underserved residents of Cheshire County. The Medical Center also provides leadership and support to the Dental Public Health Task Force, a coalition of dental staff, hospital staff and concerned citizen addressing the oral health needs of adults. Cheshire Medical Center is committed to supporting healthy and resilient living for all members of the community. In addition to health information from our medical and nursing staff, our website links to reliable and up-to-date sources of health information and provides details regarding health and wellness programs offered at no charge. Cheshire's community benefits report and service quality information are shared on the website for public viewing. During Fiscal Year 2018 the website had a total of 308,013 visits and 785,964-page views for an average of 25,668 visits and 65,497-page views per month. Health + Wellness eBulletin, an electronic newsletter, delivering timely medical news, useful health tips, and wellness information is distributed to an average of 6,300 patients and community members monthly. The Health + Wellness Website has an average of 1,100 users monthly. In addition to the website, Cheshire's Facebook page serves as a tool to distribute health and wellness information. As of June 30, 2018, our Facebook page has 2,108 "likes". Cheshire Medical Center has 707 followers on Twitter as of June 30, 2018. The Cheshire Medical Center YouTube channel has 56 videos and an estimated 5,695 minutes watched during the 2018 fiscal year. The Cheshire Coalition for Tobacco Free Communities addresses the use of tobacco products by people who live and work in the communities served by CMC/DH. The Coalition is comprised of hospital staff, healthcare providers, community members and representatives of schools and colleges, law enforcement, and the general public. The group meets bi-monthly working to engage schools and the greater community with tobacco prevention initiatives which include retailer education and enforcement of tobacco laws. The Program Manager, a CMC/DH employee, actively engages in tobacco-free activities in our local community and coordinates with state agencies and organizations. The Coalition offered 10 training slots through the University of Massachusetts Center for Tobacco Treatment and Research and Training for area providers in order to increase tobacco treatment capacity in our region for behavioral health and substance use treatment providers. Major accomplishments of the Coalition during this period were initiatives to increase access to services through "Butt Stops" staged at 13 sites around the community prior to the Great American Smoke-out and an initiative which is gaining attention in the region to increase the age of tobacco use from 18 to 21, called Tobacco 21. The Medication Assistance Program provides assistance to patients needing help to secure medications because they lack insurance coverage or financial resources to pay for their medications, which now includes elderly residents with Medicare who experience a gap in their Medicare D coverage. In FY18 the program supplied 376 prescriptions to 296 individuals valued at $412,094. Senior Passport is a program for area residents aged 60 years and above. It encompasses low cost complete evening and weekend meals; free health education programs oriented to seniors; exercise programs; and the Cheshire Walkers Program, a walking group that takes organized nature and historic walks. An average of ten walks are offered each spring and fall. Walks are typically led by a community member with participation by CMC/DH staff and occur at a variety of locations throughout the region. During FY18 22 walks were offered with a total of 486 participants. During FY18 4,762 meals were provided to program members. Though there was not an overall increase in the total number of walkers in FY18 from FY17, there was an increase in the number of walkers that participated in more than one walk this year. Prescribe for Health: Cheshire Medical Center outpatient providers refer patients to Prescribe for Health to identify and address issues about the social determinants of health via two full-time Population Health Workers. In fiscal year 2018, 168 patients were referred. In addition to providing patients with support and referrals to appropriate community resources, Prescribe for Health has developed focused and integrative relationships with the Lions Club, TADS, the Keene YMCA, the Keene Senior Center, Mothers in Recovery and the Family Medicine department to facilitate more specific and facilitated care. In addition, The Prescribe for Health Program facilitated two Deliberative Dialogues on the public health issue of social isolation at the Keene Senior Center in April of 2018 and presented on the topic to community partner Community Volunteer Transportation Company. Advance Care Planning (ACP): Cheshire Medical Center's Advance Care Planning (ACP) effort has provided outreach to the community to raise awareness about the importance of an advance directive and engage people in ACP conversations this past year. This effort augments what is offered to our hospital in-patients. Staff collaborate with 10 volunteers who have received training through the Honoring Care Decisions/Respecting Choices program. We offered 13 group education sessions attended by 98 participants and 15 outreach sessions that engaged 298 people with information about ACP. Behavioral Health Services: The Behavioral Health Consult Liaison Team (BHT) is a consultative, interdisciplinary team of Behavioral Health Clinicians that will mobilize to see patients in the inpatient units and the Emergency Department to ensure their behavioral health needs are met during their inpatient stays. The team is comprised of psychiatric providers, behavioral health nurses, and behavioral health social workers. This team was developed in response to the closing of the inpatient mental health unit and the identification of behavioral health needs not being adequately addressed within the current service arrays within the inpatient medical setting and emergency department. The services offered include: . Assessment and identification of the needs of individual patients, including access to various resources as needed. . Consultation with primary care providers to ensure coordinated care. . Individual meetings with patients to address their behavioral health needs with re-evaluation occurring every day for 3 days. . Patients on inpatient units with containment plans are seen by a team member on a daily basis, if consult has been requested. Psychiatric consults are generally available Monday-Friday and behavioral health nurse/social worker services are available on a daily basis. During FY18 the Behavioral Health Consult Liaison Team provided consultation to 885 patients. Substance Use Disorder-Medication Assisted Treatment: The Substance Use Disorder-Medication Assisted Treatment Project (SUD MAT) is a partnership between Cheshire Medical Center and the Foundation for Healthy Communities to help provide Medication Assisted Treatment to those patients that have been identified by CMC/DH staff as having an opioid use disorder. The work during FY2018 focused on a number of infrastructure mo |
| Affiliated health care system | Form 990, Schedule H, Part VI, Line 6 In 2014, the Board of the Medical Center, accompanied by the Board of Dartmouth-Hitchcock Health, approved an affiliation agreement between the Medical Centers. This agreement integrated and streamlined patient care between the two healthcare systems. The affiliation, which became effective on March 2, 2015, strengthened The Cheshire Medical Center as a regional resource for southwestern New Hampshire and southeastern Vermont. The affiliation will allow more patients to receive care closer to home, will free up bed capacity for tertiary care patients at Dartmouth-Hitchcock Medical Center in Lebanon, and will allow the Cheshire Medical Center to continue its leadership role in population health and the Healthy Monadnock 2020 initiative. Cheshire Medical Center and Dartmouth-Hitchcock have worked together since 1998, by means of a Joint Operating Agreement involving Dartmouth-Hitchcock Keene, a multi-specialty group practice that comprises the majority of Cheshire Medical Center's medical staff. This affiliation agreement is seen as a natural step that 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. |
| State filing of community benefit report | Form 990, Schedule H, Part VI, Line 7 The Cheshire Medical Center files its Community Benefit Report with the State of New Hampshire. |
Schedule I IRS990ScheduleI
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Awards and Educational Assistance | GrantTypeTxt |
| Recipient | 78 | RecipientCnt |
| Cash Grant | $108,504 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (21 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Steven Paris MD | ||||||||||||||
| Trustee | $0 | $389,327 | $0 | $0 | $0 | $34,046 | $0 | $36,939 | $0 | $15,462 | $0 | $475,774 | $0 | $0 |
| Leslie Pitts MD | ||||||||||||||
| Trustee | $0 | $316,706 | $0 | $0 | $0 | $9,634 | $0 | $301,464 | $0 | $22,298 | $0 | $650,102 | $0 | $0 |
| Don Caruso MD | ||||||||||||||
| Trustee/CEO/Pres/CMO | $0 | $409,687 | $0 | $51,500 | $0 | $34,344 | $0 | $305,129 | $0 | $17,313 | $0 | $817,973 | $0 | $0 |
| Robert Cochrane | ||||||||||||||
| Former CFO | $110,959 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,727 | $0 | $113,686 | $0 | $0 | $0 |
| Cindi Coughlin | ||||||||||||||
| CNO | $229,180 | $0 | $0 | $0 | $0 | $0 | $50,269 | $0 | $12,068 | $0 | $291,517 | $0 | $0 | $0 |
| Paul Pezone | ||||||||||||||
| VP Facilities & Support Srvcs | $206,896 | $0 | $0 | $0 | $0 | $0 | $2,413 | $0 | $15,598 | $0 | $224,907 | $0 | $0 | $0 |
| Erli Chen | ||||||||||||||
| Physicist | $224,548 | $0 | $0 | $0 | $0 | $0 | $6,239 | $0 | $8,751 | $0 | $239,538 | $0 | $0 | $0 |
| Latasha Heape | ||||||||||||||
| Chief CRNA | $179,216 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $20,267 | $0 | $199,483 | $0 | $0 | $0 |
| Julie Green | ||||||||||||||
| VP Human Resources | $250,092 | $0 | $0 | $0 | $0 | $0 | $6,239 | $0 | $0 | $0 | $256,331 | $0 | $0 | $0 |
| Cherie Holmes MD | ||||||||||||||
| Trustee/Ex-Officio | $0 | $405,322 | $0 | $0 | $0 | $17,185 | $0 | $135,097 | $0 | $9,320 | $0 | $566,924 | $0 | $0 |
| Wendy Fielding | ||||||||||||||
| Trustee | $0 | $244,357 | $0 | $0 | $0 | $414 | $0 | $18,692 | $0 | $21,565 | $0 | $285,028 | $0 | $0 |
| Maria Padin | ||||||||||||||
| Trustee eff 1/1/17 | $0 | $386,729 | $0 | $0 | $0 | $12,780 | $0 | $253,282 | $0 | $22,404 | $0 | $675,195 | $0 | $0 |
| Andrew Tremblay MD | ||||||||||||||
| Trustee eff 1/1/17 | $0 | $286,901 | $0 | $0 | $0 | $4,440 | $0 | $37,552 | $0 | $22,281 | $0 | $351,174 | $0 | $0 |
| Jennifer DiNubila DO | ||||||||||||||
| Trustee eff 11/2016 end11/2018 | $0 | $317,010 | $0 | $0 | $0 | $5,995 | $0 | $12,384 | $0 | $22,309 | $0 | $357,698 | $0 | $0 |
| Arthur W Nichols | ||||||||||||||
| Former President | $0 | $0 | $0 | $0 | $184,787 | $0 | $0 | $0 | $0 | $0 | $184,787 | $0 | $0 | $0 |
| Kathryn Willbarger | ||||||||||||||
| VP Finance | $162,492 | $0 | $0 | $0 | $0 | $0 | $1,703 | $0 | $1,891 | $0 | $166,086 | $0 | $0 | $0 |
| Christine Schon | ||||||||||||||
| Trustee/COO | $0 | $264,798 | $0 | $0 | $0 | $9,304 | $0 | $26,040 | $0 | $16,502 | $0 | $316,644 | $0 | $0 |
| Sandra Phipps | ||||||||||||||
| VP Philanthropy/Comm Relations | $154,336 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,465 | $0 | $169,801 | $0 | $0 | $0 |
| Amy Matthews | ||||||||||||||
| Sr. Dir Patient Care Services | $164,054 | $0 | $0 | $0 | $0 | $0 | $2,170 | $0 | $735 | $0 | $166,959 | $0 | $0 | $0 |
| Frank Michael | ||||||||||||||
| Nurse Anesthetist CRNA | $185,136 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,334 | $0 | $186,470 | $0 | $0 | $0 |
| John Genovese | ||||||||||||||
| Pharmacy Manager | $160,161 | $0 | $0 | $0 | $0 | $0 | $25,292 | $0 | $15,501 | $0 | $200,954 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Compensation of top employees | Form 990, Schedule J, Part I, Line 3 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. Severance Payments Form 990, Schedule J, Part I line 4a DURING CALENDAR YEAR 2017, FORMER PRESIDENT ARTHUR NICHOLS RECEIVED A MULTI-YEAR SEVERANCE PACKAGE. CALENDAR YEAR 2017 INCLUDED PAYMENTS TOTALING $184,787 FROM CHESHIRE MEDICAL CENTER. THE PAYMENT REPRESENTS BASE PAY, BENEFITS, AS WELL AS A CASH PAYMENT GROSS UP FOR HEALTH, DENTAL, AND 457B CONTRIBUTIONS. THE PAYMENT IS INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. |
| Supplemental Nonqualified Retirement Plan | Form 990, Schedule J, Part I, Line 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): Don Caruso $32,249 Leslie Pitts $9,364 Steven Paris $25,400 Cherie Holmes $15,997 Maria Padin $10,686 Andrew Tremblay $4,170 Jennifer DiNubila $5,815 Dartmouth-Hitchcock Supplemental Retirement Plan Terms and Conditions: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the Plans for the plan year, but are limited by IRC Section 401(a)(17) and/or 415. For eligible employees, the Employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC Sections 401(a)(17) and/or 415. Non-fixed payments Form 990, Schedule J, Part I, Line 7 Senior management is eligible for incentive compensation at the discretion of the board based on, but not directly related to, overall organizational financial performance and discretionary measures. |
| Note Regarding Compensation | Schedule J, Part II Column B, parts I, II, and III represent actual amounts paid to employees. 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 the organization on behalf of its employees. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NH HEALTH AND ED FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 644614V48 | CUSIPNum |
| Bond Issued | 2012-11-15 | BondIssuedDt |
| Issue Price | $30,360,529 | IssuePriceAmt |
| Purpose | Refund of existing debt | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,695,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $30,360,529 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $379,754 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $554,125 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $4,777,102 | CapitalExpendituresAmt |
| Other Spent Proceeds | $24,649,548 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (true) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II, Column A, Line 11: | FormAndLineReferenceDesc |
| Explanation | The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Nancy Johnson | |||
| Officer Don Caruso | $172,957 | Family member employed by CMC | false |
| Susan Nabi-Tremblay | |||
| Trustee Andrew Tremblay | $198,777 | Family member employed by CMC | false |
| Ashley Copeland | |||
| Trustee H. Roger Hanson | $57,102 | Family member employed by CMC | false |
| Elizabeth Lehr | |||
| Trustee H. Roger Hanson | $65,515 | Family member employed by CMC | false |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp |
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $35,871 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp | |
| Real Estate Residential | RealEstateResidentialGrp | |
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp | |
| Food Inventory | FoodInventoryGrp | |
| Drugs And Medical Supplies | DrugsAndMedicalSuppliesGrp | |
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp | |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Business Relationships | Form 990, Part VI, Section A, Line 2 Cheshire Medical Center is part of the Dartmouth-Hitchcock Health System, which owns for-profit subsidiaries that provide services and support the mission of the organizations. As a result, some officers of The Cheshire Medical Center may also be officers of related for-profits entities. Classes of members and the nature of their rights Form 990, Part VI, Section A, Line 6 & 7a 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. Governance decisions reserved to or subject to approval by persons other than the governing body Form 990, Part VI, Section A, Line 7B 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. |
| Process used by management and/or Governing Body to Review 990 | Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by an independent accounting firm and CMC's Board of Trustees. A copy of the return is provided to the Board prior to filing. |
| Conflict of Interest Policy | Form 990, Part VI, Section B, Line 12C 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. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR UNDERTAKEN | Form 990, Part VI, Section B, Line 15a The Cheshire Medical Center/Dartmouth-Hitchcock Keene has retained Yaffe & Company, Inc. to provide consultation to the Executive Committee of the Board of Trustees regarding executive compensation, benefits, and prerequisites. Yaffe & Company, Inc. is an independent consulting firm with 35 years of service and provides services to not-for-profit hospitals and health systems. Further, Yaffe & Company, Inc. has been engaged directly by the Board of Trustees of The Cheshire Medical Center through its Executive Committee to only provide services to the Board. An Executive Committee d/b/a Compensation Committee Charter and Compensation Philosophy (approved by the Board) documents the compensation review process and guidelines so as to provide an orderly structure for executive total compensation decisions. Annually, a multi-tiered approach using independent comparability data is utilized 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 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 qualititative and quantitative goals. In conjunction with the Executive Committee, challenging and measurable goals are established for the Office of the President, which provide alignment between executive compensation and achievement of the hospital's strategic goals. |
| Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public | Form 990, Part VI, Section C, Line 19 The Cheshire Medical Center makes governing documents, conflict of interest policy, and financial statements available to members of the public upon request, through its annual report, and through state and federal filings. Fundraising Expenses Form 990, Part IX, Column D The Cheshire Health Foundation, a related organization, performs all fundraising activities on behalf of Cheshire Medical Center. All fundraising expenses are reported on the Foundation's Form 990. |
| Reconciliation of Net Assets | Form 990, Part XI, Line 9 Other changes in net assets include: Pension Liability Adjustment, net Assets released for capital purchases, and net asset transfers $10,093,884. |
| Audit Committee and Financial Statement Oversight | Form 990, Part XII, Question 2c 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. Financial Statements and Reporting Form 990, Part XII, Question 3a The Medical Center was included in the consolidated audited financial statements of the Dartmouth-Hitchcock Health System. During Fiscal Year 2018, 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Cheshire Health Foundation | ||||||||||
| 580 Court Street | Keene | NH | 03431 | 020202220 | Supportng Org | NH | 501(c)(3) | 12 TYPE I | CMC | Yes (true) |
| Cheshire Health Services | ||||||||||
| 580-590 Court Street | Keene | NH | 03431 | 473379283 | HEALTHCARE | NH | 501(C)(3) | 3 | CMC | Yes (true) |
| Dartmouth-Hitchcock Clinic | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222519596 | Phys Svcs | NH | 501(c)(3) | 10 | D-HH | Yes (true) |
| 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 | Yes (true) |
| The New London Hospital Association Inc | ||||||||||
| 273 County Road | New London | NH | 03257 | 020222171 | Hospital | NH | 501(c)(3) | 3 | D-HH | Yes (true) |
| Windsor Hospital Corporation | ||||||||||
| 289 County Road | Windsor | VT | 05089 | 030183721 | Hospital | VT | 501(c)(3) | 3 | D-HH | Yes (true) |
| Alice Peck Day Memorial Hospital | ||||||||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | 020222791 | Hospital | NH | 501(c)(3) | 3 | D-HH | Yes (true) |
| VNA & Hospice of VT and NH Inc | ||||||||||
| 205 Billings Farm Road 5 | Wilder | VT | 05088 | 036006494 | Hospice | VT | 501(c)(3) | 10 | D-HH | Yes (true) |
| The Hitchcock Foundation | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222139 | HLTHCRE RSRCH | NH | 501(c)3 | 7 | DHC | Yes (true) |
| Mt Ascutney Hosp Cmmty Hlth Found | ||||||||||
| 289 County Road | Windsor | VT | 05089 | 030300481 | HOSPITAL | VT | 501(c)3 | 3 | WHA | Yes (true) |
| Historic Homes of Runnemede | ||||||||||
| 289 County Road | Windsor | VT | 05089 | 237396147 | HEALTHCARE | VT | 501(c)3 | 10 | WHA | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | One Care VT ACO LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 Colchester Avenue | AddressLine1Txt |
| City | Burlington | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455399218 | EIN |
| Primary Activities | Shared Saving | PrimaryActivitiesTxt |
| Legal Domicile State | VT | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| UBI Code V | $0 | UBICodeVAmt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hitchcock Health Connect | ||||||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 800908979 | Telehealth | NH | D-HH | C Corp | Yes (true) | |||||
| Keene Health Enterprises | ||||||||||||||
| 580 Court Street | Keene | NH | 03431 | 020374999 | Real Est Hldg | NH | KHS | C Corp | Yes (true) | |||||
| Keene Health Realty | ||||||||||||||
| 580 Court Street | Keene | NH | 03431 | 020374998 | Real Est Hldg | NH | KHS | C Corp | Yes (true) | |||||
| Keene Health Services | ||||||||||||||
| 580 Court Street | Keene | NH | 03431 | 020374997 | Real Est Hldg | NH | CHF | C Corp | Yes (true) | |||||
| ImagineCare Inc | ||||||||||||||
| 1 Medical Ctr Dr | Lebanon | NH | 03756 | 813105071 | Software Tech | NH | D-HH | C Corp | Yes (true) | |||||
| Pompanoosuc Investment Corporation | ||||||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020352330 | Real Est Holding | NH | DHC | C Corp | Yes (true) | |||||
| Hamden Assurance Co LTD | ||||||||||||||
| 980121409 | Liab Insurance | DHC | Foreign Corp | Yes (true) | 3 Gorham Road | Hamilton | BD | 08 | BD | |||||
| Kearsarge Community Services Inc | ||||||||||||||
| 273 County Road | NEw London | NH | 03257 | 020460136 | Rl Estate Hld | NH | NLH | C Corp | Yes (true) | |||||
| New London Physician Group Inc | ||||||||||||||
| 273 County Road | New London | NH | 03257 | 020494420 | Physician Grp | NH | NLH | C Corp | Yes (true) | |||||
| New London Medical Center East Inc | ||||||||||||||
| 273 County Road | New London | NH | 03257 | 020480857 | Rl Estate Hld | NH | NLH | C Corp | Yes (true) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Mary Hitchcock Memorial Hospital | ||
| M | $29,984,964 | FMV |
| Mary Hitchcock Memorial Hospital | ||
| P | $1,135,875 | FMV |
| Dartmouth-Hitchcock Clinic | ||
| M | $12,850,699 | FMV |
| Dartmouth-Hitchcock Clinic | ||
| P | $486,804 | FMV |
| The Cheshire Health Foundation | ||
| m | $2,145,994 | FMV |
| Cheshire Health Services | ||
| q | $2,327,536 | FMV |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Related Party Controlling Entity Disclosure | FormAndLineReferenceDesc |
| Explanation | Form 990, Schedule R, Part II, Line G, and Part IV, column I The Organization has checked "yes" as a section 512(b) controlled entity. Although the filing organization does not directly control each of the organizations listed, as part of its affiliation with Dartmouth-Hitchcock Health (parent organization), all organizations related under D-HH are defined as a controlled entity within the meaning of IRC 512(b)(13). | ExplanationTxt |