2019-05-16T18:13:35-05:00 2018-06-30 990 2017-07-01 222519596 DARTMOUTH-HITCHCOCK CLINIC % DANIEL P JANTZEN DART 6036531155 ONE MEDICAL CENTER DRIVE LEBANON NH 03756 DANIEL P JANTZEN CPA CFO 6036505634 2019-05-13 130.189.185.98 02156120191345000001 2019-05-14 P A12FE54CFB960D0D5F63549EF4E38325C94959EB 8754BDCA76DE6AB38AF93E83577F37D68CF10907 2017 2019-02-21 02:37:17Z Joanne M Conroy MD One Medical Center Drive Lebanon NH 03756 456585526 false X www.dartmouth-hitchcock.org X 1983 NH Advancing Health Through Research, Education, Clinical Practice, Community Partnerships, providing each person the best care in the right place, at the right time,every time. 21 15 5227 647 346093 150042 0 0 355759149 364143295 -15584 76287 83452570 91703961 439196135 455923543 1176295 1387188 0 0 289545698 285481234 0 0 69102 151704092 162397835 442426085 449266257 -3229950 6657286 219113552 218528160 444484717 424050787 -225371165 -205522627 X WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME. false false 331563472 1387188 419083385 Dartmouth-Hitchcock Clinic (the Clinic) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. The Clinic and subsidiaries, a multispecialty physician practice group which operates clinics throughout New Hampshire and Vermont, provides, among other things, medical services to patients, medical education and research. Health care services in 2018 resulted in 1,334,758 office visits recorded by Clinic personnel, with 364,061 unique patients served. The promotion of health through the medical practice activities of the Clinic provides the basis for the organization's tax exempt activities. The Clinic operates as an integral component of Dartmouth-Hitchcock Medical Center (DHMC), a New Hampshire nonprofit corporation organized for the exploration and coordination of matters of mutual interest among its members: the Clinic, Mary Hitchcock Memorial Hospital (the Hospital), Geisel School of Medicine (GSM), a component of Dartmouth College, and the Veterans Affairs Medical Center in White River Junction, Vermont. The Clinic provides the physician staff to the Hospital and the sophistication essential for the development of the Hospital as the largest and only teaching hospital in New Hampshire and the designation by the federal government as a Rural Referral Center for Northern New England. The shared mission of the Clinic and Hospital is to advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. Consistent with this mission, and in partnership with Mary Hitchcock Memorial Hospital, the Clinic provides high quality, cost effective, comprehensive, and integrated health care to individuals, families, and the communities it serves regardless of a patient's ability to pay. The Clinic actively supports community-based health care and promotes the coordination of services among health care providers and social services organizations. The Clinic also seeks to work collaboratively with other area health care providers to improve the health status of the region. Dartmouth-Hitchcock and Cheshire Medical Center are playing key coordinating roles in the implementation of CMS's Delivery System Reform Incentive Payment (DSRIP) Program, better known as a "1115 waiver." This statewide initiative will integrate and improve behavioral and physical health care. The effort ties together mental health and substance use disorder treatment, physical health, social needs, housing, transportation, and the criminal justice system into a coordinated effort that provides care for New Hampshire's most vulnerable residents. The DSRIP activities are also an integral part of Dartmouth-Hitchcock's efforts at addressing the opioid abuse crisis, which impacts so many patients in the Clinic's service area. In addition to the alternative payment models and integrated care delivery relationships noted above for D-HH and MHMH, the Clinic has several shared risk contracts with the largest commercial insurance carriers in its market. The Clinic was responsible for managing the cost of care and health of approximately 100,000 attributed members across these patient populations during fiscal year 2018. The Jack Byrne Center for Palliative & Hospice Care, coordinates the clinical, educational, and research efforts of the Clinic and visiting nurse alliances around the region, to offer much-needed care for patients at the end of life, in a clinical setting that meets the needs of patients and their families. The Clinic files an annual Community Benefits Report with the State of New Hampshire which outlines the community and charitable benefits they provide. The complete and updated Community Benefits Reports are available upon request or can be found on Dartmouth-Hitchcock's web site. The broad categories used in the Community Benefit Report to summarize these benefits are as follows: Financial assistance, formerly called charity care, represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended June 30, 2018, the Clinic provided financial assistance to 7,096 patients in the amount of $12,951,955 as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2018 was $3,736,639. The Clinic also routinely provides services to Medicaid patients at reimbursement levels that are below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the year ended June 30, 2018 was $33,199,304. Community health activities includes the cost or value of several different types of programs including the cost of community based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include Granite State Fit Kids health program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, and smoking prevention and cessation. This category also includes financial contributions and the contribution of time and services to community programs, hospitals and agencies. The Clinic also provides a significant amount of uncompensated care to its patients that is reported as provision for bad debts, which is not included in the amounts reported above. For the year ended June 30, 2018, the Clinic reported a provision for bad debts of approximately $20,997,019. 53652814 0 35345645 As a component of an integrated academic medical center, the Clinic provides significant support for academic and research programs through its support of The Geisel School of Medicine at Dartmouth (GSM). DHC provides support for Physicians' unpaid teaching time as part of its Community Benefit Initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, the Clinic provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to the Hospital and GSM. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across New Hampshire, Vermont, and beyond as well as uncompensated costs of academic and medical research activities. In FY18, Dartmouth-Hitchcock continued the transition of research activities and management from the Geisel School to D-H, under the leadership of the Vice President for Research Operations, developing the research enterprise. 385216286 true false false true false false false false false true true false false true true false false true false true true false false false false false false true true true false false false true true true true true false false false false true true true true false false true 0 0 5227 true true true true BD false false false false false false false false X 21 15 true false false false true true true true true false false true true true true true true true true false NH X DANIEL P JANTZEN 6036505634 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 X James N Weinstein DO MS Trstee Ex-Off/CEO end 7/2/17 16.95 44.56 X X 3173507 0 113137 Vincent S Conti MHA Trustee 0.75 1.25 X 0 0 0 Barbara Couch MS Trustee/Board Secretary 1.5 2.5 X X 0 0 0 Anne-Lee Verville Trustee/Board Chair 1.5 2.5 X X 0 0 0 William J Conaty Trustee 0.75 1.25 X 0 0 0 Robert A Oden Jr PhD Trustee/Vice Chair 1.5 2.5 X X 0 0 0 Denis A Cortese MD Trustee end 6/23/18 0.75 1.25 X 0 0 0 Senator Judd A Gregg Trustee 0.75 0.75 X 0 0 0 Laura K Landy MBA Trustee 0.75 1.25 X 0 0 0 Paul P Danos PhD Trustee 0.75 1.25 X 0 0 0 Troyen Brennan MD MPH Trustee end 7/31/17 0.75 1.25 X 0 0 0 Duane A Compton PhD Trustee/Ex-Officio 0.75 1.56 X 0 0 0 M Brooke Herndon MD Trustee/physician end 12/31/17 12.0 28.0 X 208792 0 63175 Charles G Plimpton MBA Trustee/Board Treasurer 1.5 2.5 X X 0 0 0 Jeffrey A Cohen MD Trustee/VP Service Line 12.0 31.0 X 437776 0 88112 Timothy D Scherer MD Trustee end 7/1/17/Physician 12.0 28.0 X 519777 0 81712 Brian C Spence MD MHCDS Trustee/Physician 12.0 28.0 X 461954 0 49478 Kari M Rosenkranz MD Trustee/Physician 12.0 28.0 X 545731 0 29955 Cherie Holmes MD Trustee eff 3/15/18 12.0 29.0 X 422507 0 144417 Edward H Stansfield III MA Trustee eff 7/1/17 0.75 1.75 X 0 0 0 Joanne M Conroy MD Ttee eff 8/7/17 Ex-Officio CEO 16.2 43.81 X X 412873 0 6750 Pamela Thompson MS RN CENP FAAN Trustee eff 7/1/17 0.75 1.25 X 0 0 0 Jon Wahrenberger MD FAHA FACC Trustee eff 1/1/18 0.75 0.75 X 0 0 0 Marc B Wolpow JD MBA Trustee eff 1/1/18 0.75 1.25 X 0 0 0 Daniel P Jantzen CPA CFO 15.0 48.01 X 0 719087 138886 Stephen LeBlanc Chief Administrative Officer 15.0 47.01 X 790399 0 221976 Edward Merrens MD Chief Clinical Officer 18.0 44.0 X 672063 0 66216 Maria Padin MD Chief Medical Officer 18.0 44.0 X 399509 0 275686 Sowmya Viswanathan MD Chief ACO Officer end 12/2/17 18.0 42.0 X 362126 0 38957 Susan A Reeves EdD RN Chief Nursing Executive 18.0 50.0 X 0 197910 28709 Patrick Jordan III MBA Chief Oper Offcr eff 11/20/17 15.0 46.0 X 0 46154 2396 George Blike MD Chief Quality & Value Officer 12.0 30.0 X 479654 0 354998 Jocelyn Chertoff MD VP Srvc Ln/Dpt Chr Dgnstc Rad 12.0 28.0 X 575548 0 112602 Jeffrey OBrien MHA Key Emp/VP Clinical Ops 12.0 29.0 X 0 316013 42316 John Kacavas JD Chief Legal Officer 12.0 29.0 X 0 540763 39936 Peter D Solberg MD Chf Medical Information Ofcr 12.0 28.0 X 375458 0 47473 Karen Clements RN BSN MSB FACHE Chief Nursing Officer 12.0 28.0 X 0 364122 29270 Thomas J Siepka Chief Pharm Offcr end 4/17/18 12.0 28.0 X 0 308821 22578 Aimee M Giglio Chief HR Officer eff 2/13/18 12.0 29.0 X 0 296410 33977 Sandra Wong MD SVP Svc Ln & Chair of Surgery 12.0 28.0 X 714002 0 29956 Staci Hermann PharmD MS Int Chief Pharm Off eff 4/8/18 12.0 28.0 X 0 170079 14645 Simon Hillier Interm Dept Chair Anesths 12.0 28.0 X 512380 0 43349 Nathan Simmons MD Physician 12.0 28.0 X 1132567 0 55804 Daniel Stewart MD Physician 12.0 28.0 X 1077581 0 43058 Jock McCullough MD Staff Physician 12.0 28.0 X 844855 0 40603 David Bauer MD Staff Physician 12.0 28.0 X 962620 0 12384 Lixia Ellis MD Physcian 12.0 28.0 X 797200 0 30931 Robin Kilfeather-Mackey CPA Former CFO 0.0 0.0 X 313945 0 0 Richard I Rothstein MD Dept Chair/Srvc ln ldr - med 0.0 0.0 X 559912 0 77875 Darlene A Saler MBA RN Fmr Actg Chf Nrsg Ofr 12.0 28.0 X 0 121330 71702 John Birkmeyer MD Former CCO/EVP Entprs Sp 18.0 43.0 X 488625 0 0 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 12.0 28.0 X 0 377488 39937 Mary Oseid MHCDS Fmr Key Emp/VP Ambulatory Care 12.0 29.0 X 259438 0 362997 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 0.0 41.0 X 274101 0 42542 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 12.0 29.01 X 0 252623 21010 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 12.0 29.0 X 0 244771 40257 Vincent Fusca III Former Chief of Staff 12.0 29.0 X 0 151957 7742 John S Malanowski MILR Former Chief HR Officer 18.0 42.0 X 0 603227 28569 Thomas Dodds MD Fmr Key Emp/Dept Chr Anesth 12.0 28.0 X 269748 0 142174 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 12.0 28.0 X 496818 0 165100 Edward Catherwood MD MS Fmr Key Emp/Ctr Dir Hrt/Vsc 12.0 28.0 X 328372 0 58389 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 12.0 28.0 X 243090 0 72123 Robert Greene MD MHCDS FACP Former Key Employee 12.0 28.0 X 480016 0 14826 19592944 4710755 3448685 1378 true true false See Schedule O 0 0 NET PATIENT SERVICE REVENUE 621110 364143295 364143295 364143295 45174 -435 45609 0 0 835579 64774 172514 2669 663065 62105 725170 725170 455687 486800 -31113 31113 -41109 0 0 0 0 0 0 0 0 0 CONTRACTED REVENUE 621110 90420883 90074355 346528 CAFETERIA INCOME 621110 346528 346528 ALLOCATED OTHER REVENUE 621110 211380 211380 90978791 455923543 454429030 346093 1076198 X 793822 793822 593366 593366 0 0 5018718 1629240 3320819 68659 4244803 4244803 221636201 193116203 28519998 13469979 11736671 1733308 26053068 22700577 3352491 15058465 13120752 1937713 0 722803 55972 666831 247500 247500 11850 11850 0 0 35352604 30065557 5287047 1210252 34199 1176053 5130357 3968955 1161402 5614345 4156396 1457949 0 6920958 6920958 1564088 879721 684367 0 55670 55207 463 5116902 511690 4605212 0 3120744 926553 2194191 2843710 2096850 746860 MEDICAL SUPPLIES 84473616 84348395 125221 EQUIP REPAIR & MAINT 6412323 4505253 1907070 ACADEMIC,GME,TEACHING & SPT 2386432 1866948 519484 RECRUITMENT COSTS 514542 448331 66211 699139 684670 14026 443 449266257 385216286 63980869 69102 55 0 0 0 0 0 52054237 47522818 668482 186474 0 0 3269198 2960814 133134 428577 0 0 128900640 106531144 24783842 22369496 1363837 328561 0 1191079 1048709 855304 0 0 135792058 142685037 219113552 218528160 130418290 188056385 0 0 0 0 48731217 0 0 0 0 0 10424542 10390823 0 0 254910668 225603579 444484717 424050787 X -226770843 -206950402 401219 429316 998459 998459 -225371165 -205522627 219113552 218528160 X 6657286 93245 13098007 X X false true X true true true X 12 0 0 0 0 12 306275720 323150656 358769170 355759149 364143295 1708097990 0 0 0 306275732 323150656 358769170 355759149 364143295 1708098002 0 0 0 1708098002 3644660 2741634 1411061 735442 770344 9303141 0 3644660 2741634 1411061 735442 770344 9303141 103904 230170 -172489 346528 508113 75358696 61525638 83083146 90978791 310946271 309920392 401354890 421936039 439405248 456238958 2028855527 0.84190 0.88420 0.00458 0.00436 X false true false false false false true 76966 false true 36130 113096 false Lobbying activity explanation FORM 990, SCHEDULE C, PART II-B, LINES 1B & 1G Dartmouth-Hitchcock Clinic employs two full time staff whose duties include lobbying. Typical expenses associated with the lobbying activities include staff salary, travel, membership fees and dues. From time to time, Dartmouth-Hitchcock Clinic, through its employees and the use of consultants, contacts government officials and legislators. This contact is for the purpose of proposing legislation or expressing an opinion on changes in legislation that affect the Clinic and its ability to carry out its mission. The typical activities may include sending letters to, calling, and meeting with government officials and legislators. For the fiscal year ended June 30, 2018, Dartmouth-Hitchcock Clinic incurred $76,966 in conjunction with these activities. Form 990, Schedule C, Part II-B, Line 1I DHC pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. 1284444 1105 55436 1340985 1214414 72236 2206 1284444 1128967 102466 -10712 6307 1214414 1113436 16985 1454 1128967 1000483 112492 461 1113436 0.00000 0.74460 0.25540 false false 2505032 7215859 9720891 2493173 72493046 62540868 12445351 27567760 27402726 165034 16625770 16587550 38220 22369496 INVESTMENT IN CAPTIVE - HAMDEN 54324028 DHC 457(B) PLAN ASSETS 71093826 DUE FROM AFFILIATE 17267183 142685037 0 INTEREST RATE SWAP 0 ACCRUED POST RETIRMNT PENSION 163743965 RESERVES FOR INSUR. RLTD LOSS 57858867 ESTIMATED THIRD PARTY SETTLEME 4000747 225603579 INTENDED USE OF ENDOWMENT FUNDS FORM 990, SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH-HITCHCOCK CLINIC. ASC 740 (FIN 48) Footnote Form 990, Schedule D, Part X No ASC 740 (Fin 48) footnote was included in the audited financial statements as there were no material uncertain tax positions at or since adoption. true North America Program Services Advertising 4460 North America Program Services Honorariums 158 Europe (Including Iceland and Greenland) Program Services Honorariums 105 Sub-Saharan Africa 6 Program Services Medical Services 51820 Central America and the Caribbean 5 Program Services Medical Services 11064 South Asia 4 Program Services Medical Services 79570 Europe (Including Iceland and Greenland) Program Services Software 45408 North America Program Services Software 110612 East Asia and the Pacific Program Services Software 213 South Asia Program Services Travel 935 Central America and the Caribbean Program Services Travel 5172 North America Program Services Travel 23832 Europe (Including Iceland and Greenland) Program Services Travel 22878 Middle East and North Africa Program Services Travel 653 South America Program Services Travel 456 East Asia and the Pacific Program Services Tavel 1626 Sub-Saharan Africa Program Services Travel 1571 Central America and the Caribbean Investments Investment in Captive 54324028 15 15 360533 54324028 54684561 true false true true true false true Advance Transit PO Box 1027 Wilder VT 05088 222558708 501(C)(3) 32748 FMV Transportn Subsidy American Cancer Society 2 Commerce Dr Bedford NH 03110 131788491 501(c)(3) 6750 FMV Program Support Good Neighbor Health Clinic 70 N MAIN ST WHITE RIVER JCT VT 05001 030346949 501(c)(3) 19500 FMV Program Support Grafton County Senior Citizens Council PO Box 433 LEBANON NH 03766 237248316 501(c)(3) 7200 FMV Program Support Riverbend Community Mental Health 3 N State St Concord NH 03301 020264383 501(c)(3) 7500 FMV Program Support Foundation for Healthy Communities 125 AIRPORT RD CONCORD NH 03301 020275078 501(c)(3) 163678 FMV Program Support Southeast Vermont Transit 45 Mill St Wilmington VT 05363 030353976 501(c)(3) 9000 FMV Program Support Upper Valley Haven 713 Hartford Ave Hartford VT 05001 030277908 501(c)(3) 11906 FMV Program Support Windsor Hospital Corporation 289 County Rd Windsor VT 05089 030183721 501(c)(3) 12000 FMV Program Support Granite United Way 22 Concord St Fl 2 Manchester NH 03101 026006033 501(c)(3) 6000 FMV Program Support Ottauquechee Health Foundation PO Box 784 Woodstock VT 05091 030197766 501(c)(3) 10533 FMV Program Support Manchester Community Health Center 145 Hollis Street Manchester NH 03101 020458174 501(c)(3) 15000 FMV Program Support Public Helath Council of the Upper Valley 1 Court St Suite 378 Waltham MA 02451 752991608 501(c)(3) 6000 FMV Program Support TLC Family Resource Center PO Box 1098 Claremont NH 03743 522439830 501(c)(3) 10200 FMV Program Support American Heart Association PO Box 50075 Prescott AZ 863045075 135613797 501(c)(3) 7950 FMV Program Supplies The Family Place 319 US Route 5 South Norwich VT 05055 751590896 501(c)(3) 5700 FMV Program Support Easter Seals Veterans Count 555 Auburn Street Manchester NH 03103 272867988 501(c)(3) 6000 FMV Program Supplies Granite State Fit Kids 2300 Southwood Drive Nashua NH 03063 020519379 501(c)(3) 5310 FMV Program Support Vital Communities 195 N Main St White River Junct VT 05001 030355283 501(c)(3) 5288 FMV NH Charitable Foundation 37 Pleasant Street Concord NH 03301 026005625 501(c)(3) 18000 FMV Southwestern Vermont Healthcare Foundation 100 Hospital Drive Bennington VT 05201 453362785 501(c)(3) 7500 FMV National Academy of Applied Sciences Keck Center Rm 805 500th St NW Washington DC 20001 530196932 501(c)(3) 22500 FMV New London Hospital 273 County Road New London NH 03257 020222171 501(c)(3) 7500 FMV Alice Peck Day 10 Alice Peck Drive Lebanon NH 03766 020222791 501(c)(3) 7500 FMV St Joseph's Hospital 172 Kinsley St Nashua NH 03060 020222215 501(c)(3) 7500 FMV Cheshire Medical Center 580-590 Court Street Keene NH 03431 020354549 501(c)(3) 43500 FMV Albert Schweitzer Foundation 25 Larkspur Ln White River Junct VT 05001 131982786 501(c)(3) 6600 FMV The Granite YMCA 117 Market Street Manchester NH 03101 020222248 501(c)(3) 5850 FMV Southwestern Community Services Inc PO Box 603 Keene NH 03431 026013808 501(c)(3) 6000 FMV 29 D-H Tuition Reimbursement Program 431 327480 FMV Awards and Educational Assistance 64 225070 FMV Patient Assistance 840 40817 FMV Description of Organization's Procedures for Monitoring the Use of Grants Form 990, Schedule I, Part I, Line 1 Each award established by Dartmouth-Hitchcock Clinic has written guidelines and procedures. Award payments are processed in accordance with the specific terms of each award. The Dartmouth Institute Scholarships (TDI) are paid directly to Dartmouth College on behalf of the individuals receiving the award. The coordinators of the program(s) are responsible for assuring that all terms are met, including proper documentation of expenses with receipts. X X X X true true false false false false false false false James N Weinstein DO MS Trstee Ex-Off/CEO end 7/2/17 1575236 0 750000 0 848271 0 97679 0 15458 0 3286644 0 0 0 Robin Kilfeather-Mackey CPA Former CFO 0 0 0 0 313945 0 0 0 0 0 313945 0 0 0 Daniel P Jantzen CPA CFO 0 638681 0 0 0 80406 0 122242 0 16644 0 857973 0 0 Stephen LeBlanc Chief Administrative Officer 637177 0 0 0 153222 0 200238 0 21738 0 1012375 0 0 0 Nathan Simmons MD Physician 1066453 0 0 0 66114 0 33390 0 22414 0 1188371 0 0 0 Mary Oseid MHCDS Fmr Key Emp/VP Ambulatory Care 258929 0 0 0 509 0 343760 0 19237 0 622435 0 0 0 Christine Schon MPA Fmr Key Emp/Adm VP Prmry Care 264798 0 0 0 9303 0 26040 0 16502 0 316643 0 0 0 Richard I Rothstein MD Dept Chair/Srvc ln ldr - med 553552 0 0 0 6360 0 60872 0 17003 0 637787 0 0 0 Tina Naimie CPA MHCDS Fmr Key Emp/VP Corp Finance 0 252087 0 0 0 536 0 19147 0 1863 0 273633 0 0 Wendy Fielding MBA Fmr Key Emp/VP Finance Plnning 0 244357 0 0 0 414 0 18692 0 21565 0 285028 0 0 Vincent Fusca III Former Chief of Staff 0 107871 0 0 0 44086 0 7554 0 188 0 159699 0 0 Edward Merrens MD Chief Clinical Officer 637949 0 0 0 34114 0 53885 0 12331 0 738279 0 0 0 George Blike MD Chief Quality & Value Officer 437202 0 0 0 42452 0 333250 0 21748 0 834652 0 0 0 Daniel Stewart MD Physician 1005631 0 0 0 71950 0 20640 0 22418 0 1120639 0 0 0 Darlene A Saler MBA RN Fmr Actg Chf Nrsg Ofr 0 86130 0 0 0 35200 0 67401 0 4301 0 193032 0 0 John S Malanowski MILR Former Chief HR Officer 0 197472 0 0 0 405755 0 23958 0 4611 0 631796 0 0 Thomas Dodds MD Fmr Key Emp/Dept Chr Anesth 244818 0 0 0 24930 0 122566 0 19608 0 411922 0 0 0 Wendy Wells MD Fmr Key Emp/Dpt Chr Pathology 468879 0 0 0 27939 0 142696 0 22404 0 661918 0 0 0 Jocelyn Chertoff MD VP Srvc Ln/Dpt Chr Dgnstc Rad 539060 0 0 0 36488 0 103286 0 9316 0 688150 0 0 0 Edward Catherwood MD MS Fmr Key Emp/Ctr Dir Hrt/Vsc 263816 0 0 0 64556 0 48821 0 9568 0 386761 0 0 0 Steven Boyce Fmr Key Emp/Adm. VP Med Spclts 224093 0 0 0 18997 0 50582 0 21541 0 315213 0 0 0 Jeffrey OBrien MHA Key Emp/VP Clinical Ops 0 311569 0 0 0 4444 0 20640 0 21676 0 358329 0 0 M Brooke Herndon MD Trustee/physician end 12/31/17 208018 0 0 0 774 43701 0 19474 0 271967 0 0 0 John Birkmeyer MD Former CCO/EVP Entprs Sp 0 0 0 0 488625 0 0 0 0 0 488625 0 0 0 Kimberly Troland JD Fmr Intrm GC/Deputy Gen Cnsl 0 367482 0 0 0 10006 0 20640 0 19297 0 417425 0 0 John Kacavas JD Chief Legal Officer 0 522566 0 0 0 18197 0 20640 0 19296 0 580699 0 0 Jeffrey A Cohen MD Trustee/VP Service Line 411216 0 0 0 26560 0 65523 0 22589 0 525888 0 0 0 Timothy D Scherer MD Trustee end 7/1/17/Physician 504115 0 0 0 15662 0 61745 0 19967 0 601489 0 0 0 Brian C Spence MD MHCDS Trustee/Physician 433472 0 0 0 28482 0 27374 0 22104 0 511432 0 0 0 Maria Padin MD Chief Medical Officer 386729 0 0 0 12780 0 253282 0 22404 0 675195 0 0 0 Peter D Solberg MD Chf Medical Information Ofcr 363669 0 0 0 11789 0 25541 0 21932 0 422931 0 0 0 Karen Clements RN BSN MSB FAC Chief Nursing Officer 0 363113 0 0 0 1009 0 20640 0 8630 0 393392 0 0 Thomas J Siepka Chief Pharm Offcr end 4/17/18 0 305051 0 0 0 3770 0 20640 0 1938 0 331399 0 0 Kari M Rosenkranz MD Trustee/Physician 523082 0 0 0 22649 0 20640 0 9315 0 575686 0 0 0 Aimee M Giglio Chief HR Officer eff 2/13/18 0 275256 0 0 0 21154 0 12384 0 21593 0 330387 0 0 Sowmya Viswanathan MD Chief ACO Officer end 12/2/17 319775 0 0 0 42351 0 20640 0 18317 0 401083 0 0 0 Jock McCullough MD Staff Physician 789261 0 0 0 55594 0 20640 0 19963 0 885458 0 0 0 Susan A Reeves EdD RN Chief Nursing Executive 0 196911 0 0 0 999 0 17640 0 11069 0 226619 0 0 Sandra Wong MD SVP Svc Ln & Chair of Surgery 673002 0 0 0 41000 0 20640 0 9316 0 743958 0 0 0 Cherie Holmes MD Trustee eff 3/15/18 405322 0 0 0 17185 0 135097 0 9320 0 566924 0 0 0 Joanne M Conroy MD Ttee eff 8/7/17 Ex-Officio CEO 352889 0 50000 0 9984 0 6750 0 0 0 419623 0 0 0 Staci Hermann PharmD MS Int Chief Pharm Off eff 4/8/18 0 165356 0 0 0 4723 0 6404 0 8241 0 184724 0 0 Simon Hillier Interm Dept Chair Anesths 481165 0 0 0 31215 0 26040 0 17309 0 555729 0 0 0 David Bauer MD Staff Physician 937129 0 0 0 25491 0 12384 0 0 0 975004 0 0 0 Robert Greene MD MHCDS FACP Former Key Employee 89688 0 0 0 390328 0 7491 0 7335 0 494842 0 0 0 Lixia Ellis MD Physcian 797020 0 0 0 180 0 8100 0 22831 0 828131 0 0 0 Severance Payments Form 990, Schedule J, Part I line 4a THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2017: DURING CALENDAR YEAR 2017, FORMER INTERIM CHIEF NURSING OFFICER DARLENE SALER RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $34,830 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF CLINICAL OFFICER JOHN BIRKMEYER RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $488,625 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF HR OFFICER JOHN MALANOWSKI RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $376,352 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF FINANCIAL OFFICER ROBIN KILFEATHER-MACKEY RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $313,945 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF OF STAFF VINCENT FUSCA RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $30,770 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF ACO OFFICER SOWMYA VISWANATHAN RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $13,462 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (B)III. DURING CALENDAR YEAR 2017, FORMER CHIEF POPULATION MANAGEMENT OFFICER ROBERT GREENE RECEIVED SEVERANCE PAYMENTS MONTHLY TOTALING $334,519 FROM DARTMOUTH-HITCHCOCK. THESE PAYMENTS ARE 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)): BRIAN SPENCE $24,622 CHERIE HOLMES $15,997 DANIEL JANTZEN $54,632 DANIEL STEWART $71,681 DAVID BAUER $25,311 EDWARD MERRENS $33,700 GEORGE BLIKE $40,874 JAMES WEINSTEIN $95,986 JEFFREY COHEN $17,913 JEFFREY OBRIEN $2,426 JOCELYN CHERTOFF $35,300 JOCK MCCULLOUGH $53,500 JOHN KACAVAS $17,423 JOHN MALANOWSKI $29,038 KAREN CLEMENTS $595 KARI ROSENKRANZ $22,379 KIMBERLY TROLAND $9,871 MARIA PADIN $10,686 NATHAN SIMMONS $65,700 PETER SOLBERG $11,375 ROBERT GREENE $39,900 SANDRA WONG $41,000 SIMON HILLIER $26,167 STEPHEN LEBLANC $126,128 TIMOTHY SCHERER $15,537 THOMAS DODDS $23,742 THOMAS SIEPKA $3,500 VINCENT FUSCA $12,602 WENDY WELLS $26,109 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. Other Payments Form 990, Schedule J, Part II James Weinstein received a $750,000 bonus payment as part of a transition agreement. This amount is included on Schedule J, Column B(ii). James Weinstein received a $750,000 deferred compensation payment as part of an executive retention agreement. This amount is included on Schedule J, Column B(iii). DHC sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen in 1998 and therefore no further costs of the individual employee insurance premiums have been funded by the organization. The number of participants and dollar value continues to decline as individuals retire/leave the organization. retire/leave the organization. Note regarding compensation Schedule J, Part II Column B, parts I, II, and III represent actual amounts paid to employees by DHC and related organizations. These amounts are reported to employees on their annual W-2 forms as compensation. Columns C and D represent items earned, however, not paid directly to the employee as cash payments during the calendar year. Column C includes retirement benefits as well as any changes in pension actuarial value (if applicable) in a calendar year. Column D represents nontaxable benefits such as the cost of healthcare coverage provided by D-H on behalf of its employees. Stephen LeBlanc Officer Split Dollar Life X 54917 54917 false true true Mary Oseid Former Key EE Split Dollar Life X 36441 36441 false true true Richard Rothstein Officer Split Dollar Life X 95116 95116 false true true 186474 Karen Clements Key Employee 36628 Scholarship Master's Degree Program Roshini C Pinto-Powell Family Member of Trustee Richard Powell 264985 Employment Compensation false Lynn Butterly Family Member of Former Officer John Butterly 364102 Employment Compensation false Amy Stansfield Family Member of Trustee Ed Stansfield 224479 Employment Compensation false Business Relationships FORM 990, PART VI, SECTION A, LINE 2 Trustees, officers and key employees also hold trustee, officer or key employee positions at Mary Hitchcock Memorial Hospital (MHMH), a related organization. Individuals who received related organization compensation (as reported in Part VII) are paid employees of MHMH. DARTMOUTH-HITCHCOCK CLINIC OWNS FOR-PROFIT SUBSIDIARIES THAT PROVIDE SERVICES AND SUPPORT THE MISSION OF THE ORGANIZATION. The following are current officers, directors, trustees, or key employees of DHC and officers of Hamden Assurance, LTD: - Daniel Jantzen - Edward Merrens - John Kacavas Description of classes of members, persons, and nature of rights Form 990, Part VI, Section A, Line 6 & 7a Dartmouth-Hitchcock Health (D-HH)is the sole corporate Member of Dartmouth-Hitchcock Clinic (DHC). D-HH has specific authority and reserved powers, including the power to confirm the election of members of DHC's Board of Trustees and the power to approve significant governance, financial and operational decisions of DHC's Trustees. Governance decisions reserved to or subject to approval by persons other than the governing body Form 990, Part VI, Section A, Line 7B In addition to reserved powers, Dartmouth-Hitchcock Health (D-HH) shall have the authority to take actions to establish, manage, and govern the System as an integrated health care delivery system in furtherance of the mission of the Clinic and other Organizations. These powers include but are not limited to items such as the ability to approve, disapprove, or modify all material governance, programmatic, and financial decisions of DHC's Board of Trustees, to appoint or remove a member of the Clinic's Board of Trustees, assess the Clinic a monetary amount for the payment of the expenses of D-HH, approve the Clinic's budget, approve the borrowings or dispositions of assets by the Clinic, approve key strategic relationships, approve the elimination or addition of any material health care service or program, and other authority to take action on behalf of the Clinic. Process used by management and/or Governing Body to Review 990 Form 990, Part VI, Section B, Line 11b THE FORMS 990 AND 990-T ARE REVIEWED BY THE DIRECTOR OF CORPORATE FINANCE, VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL 990 AND 990-T COMPLETE ELECTRONIC VERSION IS SENT OUT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS/RESPONSES PRIOR TO OFFICIAL FILING. Conflict of Interest Policy Form 990, Part VI, Section B, Line 12C The Dartmouth-Hitchcock Clinic 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, trustees, key employees and performs other procedures as considered necessary to report on compliance with the conflict of interest policy. The Department then reports to each board any potential conflicts for their review. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trusteees on an ongoing basis. In the event a conflict arises, the individual 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 Compensation for the CEO is evaluated by an independent third party firm for reasonableness and national data benchmarking. The Talent Development and Compensation Committee, along with Independent Trustees, approve the final compensation in consideration with the independent third party firm's recommendations and suggestions. This process was contemporaneously documented and last undertaken in 2017. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Section B, Line 15b Compensation for officers and key employees are evaluated by internal HR staff using national benchmarking data, along with ongoing evaluations by an independent third party firm for reasonableness, with the last formal process in 2017. External benchmarking from an independent third party has been used for any Officer who was hired or received a compensation adjustment since the last formal process. Compensation rates are determined by following the guidelines of the compensation committee charter and philosophy documents and a formal review by compensation committee members. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Section C, Line 19 DHC's governing documents are available through the New Hampshire Secretary of State. Certain financial information is disclosed through the Community Benefits Annual Report. The audited financial statements, governing documents, and conflict of interest policy are available upon request either in electronic or hardcopy form. Average Hours Per Week Form 990, Part VII, Section A, Line 1A Column B As part of Dartmouth-Hitchcock Clinic's and Mary Hitchcock Memorial Hospital's affiliation agreement, the two organizations share officers. As such, the average hours per week are allocated between the two organizations' 990's even though compensation reported in part VII is based on the entity issuing the W-2. In addition, certain officers spend time on Dartmouth-Hitchcock Health, the sole corporate member of both MHMH and DHC, along with three supporting organizations Dartmouth-Hitchcock Medical Center, Everwell, Inc., Hamden Risk Retention Group, and related entities: Alice Peck Day Memorial Hospital, Windsor Hospital Corporation (dba Mount Ascutney Hospital and Health Center), Mount Ascutney Hospital Community Health Foundation, Historic Homes of Runnemede, Cheshire Medical Center, Cheshire Health Foundation, Cheshire Health Services, The New London Hospital Association, VNA & Hospice of VT and NH, and The Hitchcock Foundation. Independent Contractors Form 990, Part VII, Section B Dartmouth-Hitchcock Clinic is part of the Dartmouth-Hitchcock (D-H) Healthcare System which includes DHC, Mary Hitchcock Memorial Hospital (MHMH) and subsidiaries. MHMH received authority from the Internal Revenue Service to act as DHC's Pay Agent and implemented this process at the beginning of fiscal year 2010. All expenses are paid directly by MHMH and reimbursed by DHC. MHMH manages all required IRS reporting in regards to 1099's for independent contractors. Statement of Functional Expenses Form 990, Part IX Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic operate under an affiliation agreement as directed by Dartmouth-Hitchcock Health, the sole Corporate Member of both entities. Due to the integrated operating structure, related mission, and close relationship of the two tax-exempt organizations, expenses are shared between the two entities. All expenses reported within this 990 are the organization's share of expenses as designated by the affiliation agreement. FINANCIAL STATEMENTS AND REPORTING Form 990 Part XI, Line 9 Other Changes in Net Assets Include: Pension and other charges $13,168,444 and net assets released from restriction ($70,437) Total $13,098,007 Audited Financial Statements Form 990, Part XII, Line 2c The organization's financial information is included in the consolidated audited financial statements of Dartmouth-Hitchcock Health and Subsidiaries, which consists of the following organizations and their related subsidiaries: Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, Mount Ascutney Hospital and Health Center, Cheshire Medical Center, The New London Hospital Association, Alice Peck Day Memorial Hospital, and VNA & Hospice of VT and NH. Circular A-133 Audit Requirement Form 990, Part XII, Line 3a DURING FISCAL YEAR 2018, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE $750,000 THRESHOLD SET FORTH IN THE OMB UNIFORM GUIDANCE, THEREFORE REQUIRING AN AUDIT. DUE TO THE ISSUANCE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF ALL ORGANIZATIONS. Renaissance Psychiatry of New England ONE MEDICAL CENTER DRIVE LEBANON NH 03756 813076466 PSYCH SVCS NH -25098 62502 D-HC Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) 3 D-HH true Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon NH 03756 222715483 SUPPORTNG ORG NH 501(c)(3) 12 TYPE I NA true The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 HLTHCRE RSRCH NH 501(c)(3) 7 DHC true Hamden Risk Retention Group Inc 30 Main Street Suite 330 Burlington VT 05401 208530788 SELF INS. VT 501(c)(3) 12 TYPE I DHC true Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 PARENT ORG NH 501(c)(3) 7 NA false The New London Hospital Association Inc 273 County Rd New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH true EverWell Inc One Medical Center Drive Lebanon NH 03756 352506275 Supportng Org NH 501(c)(3) 11 Type I NA true Windsor Hospital Corporation 289 County Road Windsor VT 05089 030183721 Hospital VT 501(C)(3) 3 D-HH true Cheshire Medical Center 580 Court Street Keene NH 03431 020354549 Hospital NH 501(C)(3) 3 D-HH true Cheshire Health Foundation 580 Court Street Keene NH 03431 020202220 SUPPORTNG ORG NH 501(C)(3) 12 TYPE I CMC true Mt Ascutney Hosp Cmmty Hlth Found 289 County Road Windsor VT 05089 030300481 Hospital VT 501(c)(3) 3 WHA true Historic Homes of Runnemede 289 County Road Windsor VT 05089 237396147 Healthcare VT 501(c)(3) 10 WHA true Cheshire Health Services 580 Court Street Keene NH 03431 473379283 HEALTHCARE NH 501(c)(3) 3 CMC true Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 Hospital NH 501(c)(3) 3 D-HH true VNA & Hospice of VT and NH 205 Billings Farm Road 5 Wilder VT 05088 036006494 Hospice VT 501(c)(3) 10 D-HH true D-H Mster Invst Prg 1 Med Ctr Dr Lebanon NH 03756 020505863 Pooled Invest NH NA Excluded 81524 1191082 false -435 false 0.00185 OneCare VT ACO LLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Related Pompanoosuc Investment Corporation One Medical Center Drive Lebanon NH 03756 020352330 Real Est Hldg NH DHC C CORP -127 75632 1.00000 true Hamden Assurance Company Limited 3 Gorham Road Hamilton BD 08 980121409 Liab Insur. BD DHC Foreign Corp 54324028 0.70200 true Hitchcock Health Connect ONE MEDICAL CENTER DRIVE Lebanon NH 03756 800908979 Telehealth DE D-HH C Corp true Kearsarge Community Services Inc 273 County Road New London NH 03257 020460136 Real Est Hldg NH NLH C Corp true New London Physician Group Inc 273 County Road New London NH 03257 020494420 Physician Gro NH NLH C Corp true New London Medical Center East 273 County Road New London NH 03257 020480857 Real Est Hldg NH NLH C Corp true Keene Health Services 580 Court Street Keene NH 03431 020374997 Real Est Hldg NH CMC C Corp true Keene Health Realty 580 Court Street Keene NH 03431 020374998 Real Est Hldg NH CMC C Corp true Keene Health Enterprises 580 Court Street Keene NH 03431 020374999 Real Est Hldg NH CMC C Corp true ImagineCare One Medical Center Drive Lebanon NH 03756 813105071 Sftwre tchnlg NH D-HH C Corp true false true false false true false false false true true true true true true true true true true Mary Hitchcock Memorial Hospital MNOPQ 55111967 FMV Hamden Risk Retention Group p 1806675 FMV Windsor Hospital Corporation Q 861304 FMV Cheshire Medical Center L 12850699 FMV Cheshire Medical Center Q 486804 FMV Alice Peck Day Memorial Hospital Q 416914 FMV Dartmouth-Hitchcock Health R 2492489 FMV The Hitchcock Foundation Q 478644 FMV The New London Hospital Association Q 941649 FMV The Hitchcock Foundation B 169366 FMV