2016-05-16T11:28:46-05:00 2015-06-30 PRICEWATERHOUSECOOPERS LLC 101 SEAPORT BLVD BOSTON MA 02210 990 2014-07-01 222715483 Dartmouth-Hitchcock Medical Center % TINA NAIMIE DART 6036531155 One Medical Center Drive Lebanon NH 037560001 Tina E Naimie Treasurer 2016-05-13 Paul Tanis P01441612 6175305000 2014 2016-08-17 19:52:53Z Tina Naimie ONE MEDICAL CENTER DRIVE Lebanon NH 03756 6514585 false X www.dhmc.org X 1983 NH Provides health care admin & planning to supported orgs, advance & strengthen activities such as regl programs, education, research,gov't & public relations,fundraising & other svcs 7 2 0 7 0 0 1670403 704413 5157588 5656140 2175 75 121171 123423 6951337 6484051 1655446 704931 0 0 0 0 0 0 5285779 5301045 5780457 6956491 6485388 -5154 -1337 4050300 4117599 673536 742210 3376764 3375389 X DARTMOUTH-HITCHCOCK MEDICAL CENTER'S MISSION IS TO OFFER ADMINISTRATIVE, PLANNING, AND OTHER SERVICES DESIGNED TO PROMOTE, ADVANCE, AND STRENGTHEN THE INTERDEPENDENT AND SYNERGISTIC ACTIVITIES OF THE INDEPENDENT SUPPORTED ORGANIZATIONS IN THE AREAS OF HEALTHCARE, EDUCATION AND RESEARCH, GOVERNMENT AND PUBLIC RELATIONS, CHARITABLE FUNDRAISING AND OTHER RESOURCE DEVELOPMENT ACTIVITIES NOT INCONSISTENT WITH THE PURPOSES OF THE SUPPORTED ORGANIZATIONS. false false 1199609 704931 5779563 Promotion of multidisciplinary and regional health care programs, education and research, government and public relations, charitable fundraising and other resource development activities. 1199609 true true false false false false false false false false true false false false true false false true false false false false false false false false false true false true false false false false false false false false true false false false false true true true false false true 0 0 0 false false false false false false false false false false X 7 2 true false false false true true false true true false false true true true true true true true true false NH X TINA NAIMIE 6036531155 ONE MEDICAL CENTER DRIVE LEBANON NH 037560001 X Peter M Fahey Trustee end 12/31/14 0.01 0.0 X 0 0 0 Wayne G Granquist Vice Chair/Trustee 0.01 0.0 X X 0 0 0 Alan C Keiller Trustee 0.01 0.0 X 0 0 0 James N Weinstein DO MS Trustee Secretary/D-H CEO 0.01 61.0 X X 0 1229653 225752 William W Wyman Trustee end 12/31/14 0.01 0.0 X 0 0 0 William W Helman IV Trustee End 9/30/2014 0.01 2.0 X 0 0 0 Wiley Souba MD ScD Ex-Off Eff 7/1/14 0.01 42.0 X 0 992084 34570 Deborah Amdur MSW Trustee 0.01 40.0 X 0 159231 41397 Philip J Hanlon PhD Trustee 0.01 40.0 X 0 871795 31328 Duane A Compton PhD Trustee Eff 7/15/14 0.01 42.3 X 0 331883 37999 Tina E Naimie CPA Treasurer/VP Corp Finance D-H 1.5 40.0 X 0 222873 25900 Anne Page CPA Frmer Treasurer/VP Reg Finance 0.0 0.0 X 0 253870 22913 0 4061389 419859 0 true true false Trustees of Dartmouth College 1 Rope Ferry Road HANOVER NH 03755 Devlpmnt and Fundrsg 5285779 1 704413 30534 704413 ASSESSMENTS TO MEMBERS FOR SERVICES 900099 5656140 5656140 5656140 123 123 0 0 0 0 0 30486 30534 -48 -48 -48 0 0 0 REIM OF PROP TAXES BY SUPPORTED ORGS 900099 123423 123423 123423 6484051 5779563 75 X 704931 704931 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4544884 4544884 0 105605 105605 87228 87228 0 424552 424552 80769 80769 0 42741 42741 0 0 0 15950 15950 PROPERTY TAXES 478728 478728 6485388 1199609 0 5285779 0 0 719818 845432 0 0 410341 350267 0 0 0 0 0 0 0 0 85708 87985 3204415 529236 2675179 2675179 0 0 0 0 0 0 0 0 159254 158736 4050300 4117599 670523 739320 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3013 2890 673536 742210 X 3217510 3216653 159254 158736 0 0 3376764 3375389 4050300 4117599 X -1337 -38 X false true X false true true X X X 4 MARY HITCHCOCK MEMORIAL HOSPITAL 020222140 3 true 16008 0 DARTMOUTH-HITCHCOCK CLINIC 222519596 9 true 7192 0 TRUSTEES OF DARTMOUTH COLLEGE 020222111 2 true 341707 0 VETERANS AFFAIRS MEDICAL CENTER 741612229 6 true 0 0 4 364907 0 true false false false false true false false false false false false false false false true false Support to other organizations Form 990, Schedule A, Part IV, Line 2 As stated in DHMC's bylaws, the organization also supports the Veterans Affair Medical Center (VAMC), a governmental agency located in White River Junction, VT. There were no financial transactions between the VAMC and DHMC during FY15. Form 990, Schedule A, Part IV, Line 6 During fiscal year 2015, the board determined that based on organizational changes, fundraising services provided by DHMC in the past should be completed by the Health System's Parent Organization, Dartmouth-Hitchcock Health (D-HH). In order to better serve the health care system and new affiliations, the Development Function and services were moved to D-HH at the end of fiscal year 2015. As part of this transition, $340,023 was transferred to D-HH instead of the supported organizations. D-HH provided the funds transferred to the supported organizations of DHMC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2675179 2675179 355231 355231 174005 174005 2675179 0 ANNUITY LIABILITY 2890 2890 Schedule D, Part X, Line 2 Audited Financial Statement Footnote Regarding ASC 740 The organization's audited financial statements did not include a footnote relating to ASC 740 since there have been no changes since inception. true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 501(c)(3) 16008 FMV Gen support Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 501(c)(3) 341707 FMV Gen support Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 501(c)(3) 340023 FMV Gen Support Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 501(C)(3) 7192 FMV Gen Support 4 Schedule I, Part I, Question 2 The majority of the DHMC board members are nominated by the board members of the supported organizations. All assistance represents fundraising proceeds raised on the behalf of DHMC's supported organizations and is given for general and unrestricted operating use. true true false false false false false false false James N Weinstein DO MS Trustee Secretary/D-H CEO 0 1145559 0 0 0 84094 0 209341 0 16411 0 1455405 0 0 Wiley Souba MD ScD Ex-Off Eff 7/1/14 0 951344 0 0 0 40740 0 23400 0 11170 0 1026654 0 0 Tina E Naimie CPA Treasurer/VP Corp Finance D-H 0 222765 0 0 0 108 0 24097 0 1803 0 248773 0 0 Anne Page CPA Frmer Treasurer/VP Reg Finance 0 166690 0 0 0 87180 0 22913 0 0 0 276783 0 0 Deborah Amdur MSW Trustee 0 143724 0 4693 0 10814 0 7724 0 33673 0 200628 0 0 Philip J Hanlon PhD Trustee 0 855635 0 0 0 16160 0 23400 0 7928 0 903123 0 0 Duane A Compton PhD Trustee Eff 7/15/14 0 329221 0 0 0 2662 0 22672 0 15327 0 369882 0 0 Severance Payments Schedule J Part I, line 4a During FY15, Anne Page received severance payments from a related organization in the amount of $86,704. This amount is included on Schedule J, Part II, line B(iii). Part I Line 4B The following individual received the following amount from the Dartmouth-Hitchcock Supplemental Retirement Plan (see below for terms): James Weinstein $82,952 Terms of the Dartmouth-Hitchcock Supplemental Retirement Plan: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (which consists of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic), 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 Sections 401(a)(17) and/or IRC Section 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 contribution as a result of limitations imposed by IRC Sections 401(a)(17) and/or IRC Section 415. X 12 30534 FMV 0 false true true Third Party Solicitations Schedule M, Part I, Line 32b The organization utilizes a Joint Development Office (JDO) contract with the Trustees of Dartmouth College to assist with solicitation of donors and gifts. Contributions solicited by DHMC may be utilized by its supported organizations. Business Relationships Form 990, Part VI, Section A, Line 2 Dartmouth-Hitchcock Medical Center is part of the Dartmouth-Hitchcock Health System, which owns for-profit subisidiaries that provide services and support the mission of the organization. As a result, some officers of the Medical Center are also officers of for-profit entities. Organization Members Form 990 Part VI, Section A Line 6 & 7a DHMC has four Members, referred to as components: Dartmouth College/Geisel School of Medicine; Dartmouth-Hitchcock Clinic; Mary Hitchcock Memorial Hospital; and the Veterans Affairs Center. The components shall be represented, respectively, by the Dean of Geisel School of Medicine, President of the Clinic, President of the Hospital, and Director of the Veterans Affairs, all of whom shall be Ex-Officio. The College/Medical School, Clinic, and Hospital shall each be represented by two individuals (component trustees), nominated by their respective Boards of Trustees and elected by the DHMC Board. Such individuals should normally be trustees of the component boards, but is not a requirement. All members of the board, both elected and ex-officio, shall have voting rights. In addition, the DHMC board may elect as many as five Non-Component Trustees. IRS Form 990 Review Process Form 990 Part VI Section B Line 11B After preparation and review by internal tax staff and external tax consultants, the return is reviewed by the Treasurer. The final form 990 is shared electronically with the Trustees prior to filing. The trustees are provided an opportunity to review, ask questions, and recommend changes before filing of the return. Conflict of Interest Policy Form 990 Part VI Section B Line 12C The Dartmouth-Hitchcock Medical Center BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK, OFFICE OF POLICY SUPPORT, COMPLIANCE AND AUDIT SERVICES 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 COMPLIANCE AND AUDIT SERVICES 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 CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Compensation Review Form 990 Part VI Section B Line 15B The organization's treasurer and secretary are compensated by Mary Hitchcock Memorial Hospital (MHMH), a related and supported organization of DHMC. As part of their role at MHMH, their compensation is reviewed by external parties and MHMH's compensation committee. Availability of Documents Form 990 Part VI Section C Line 19 The Organization makes its audited financial statements, governing documents, and conflict of interest policy available upon request in hardcopy or electronic form. Reported Compensation Form 990 Part VII Section A, Line 1 The compensation paid by related organizations was for services provided to those related organizations and not the filing organization. Although the individuals worked the time listed as part of their board of trustee duties, they were not compensated with respect to those hours. The time/hours at the related organization varies by individual and organization, and would be the hours necessary to total to their respective full hours per week. Statement of Functional Expenses Form 990 Part IX Line 11G,Purchased Services The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as Purchased services represent reimbursement for services provided by the College to DHMC. Form 990 Part IX, Line 25, Fundraising Expenses The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as fundraising expenses represent costs incurred raising funds for the Organization as well as fundraising on the behalf of its supported members including Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. During fiscal year 2015, the total costs paid to Dartmouth College for these services were $5,285,779. Total fundraising revenue recognized by DHMC was $704,413. All additional fundraising revenue generated by DHMC on behalf of its supported organizations was recognized directly by the Supported Organizations in the amount of $32,636,215. A-133 Audit Form 990 Part XII, Question 3a DURING FISCAL YEAR 2015, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE MINIMUM THRESHHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133, THEREFORE REQUIRING AN AUDIT. DUE TO THE ISSUANCE OF THE COMBINED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING Dartmouth Hitchcock Medical Center. Statement Regarding Form 5471 Filing Requirements The Organizations's Form 5471 filing requirements have been or will be satisfied by Dartmouth-Hitchcock Clinic, One Medical Center Drive, Lebanon, New Hampshire, 03756, EIN: 22-2519596, the majority shareholder of Hamden Insurance Company Limited. Dartmouth-Hitchcock Clinic has filed the form 5471 and the applicable schedules with the IRS Service Center, Philadelphia, PA. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:4544884 Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Group NH 501(C)(3) 9 D-H Health true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(C)(3) 3 D-H Health true Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 Med. School NH 501(C)(3) 2 NA false Veterans Affairs Med & Regnl Office Cntr 215 North Main Street White River Jct VT 05001 741612229 Hospital VT N/A false false true false false false false false false true false true true false true true true false false