MARY HITCHCOCK MEMORIAL HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- MARY HITCHCOCK MEMORIAL HOSPITAL (EIN 02-0222140)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-16
- IRS object ID
- 201641379349304619
- Schema version
- 2014v6.0
- 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 K
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-16T11:28:47-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRICEWATERHOUSECOOPERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SEAPORT BLVD | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222140 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mary Hitchcock Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ROBIN KILFEATHER-MACKEY | InCareOfNm |
| Business Name Control | MARY | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robin Kilfeather-Mackey | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2015-05-13 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Paul Tanis | PreparerPersonNm |
| PTIN | P01441612 | PTIN |
| Phone | 6175305000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James Weinstein DO MS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,103,321,593 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.dartmouth-hitchcock.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1889 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | 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 | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 5780 | TotalEmployeeCnt |
| Total Volunteers | 480 | TotalVolunteersCnt |
| Total Gross UBI | $4,012,573 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $502,506 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $20,984,972 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,075,715 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $892,093,711 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $908,783,191 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17,100,684 | PYInvestmentIncomeAmt |
| CY Investment Income | $17,620,625 | CYInvestmentIncomeAmt |
| PY Other Revenue | $57,253,892 | PYOtherRevenueAmt |
| CY Other Revenue | $47,796,806 | CYOtherRevenueAmt |
| PY Total Revenue | $987,433,259 | PYTotalRevenueAmt |
| CY Total Revenue | $979,276,337 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,272,967 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,947,820 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $576,706,269 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $602,661,971 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,159,116 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $354,233,094 | PYOtherExpensesAmt |
| CY Other Expenses | $377,996,999 | CYOtherExpensesAmt |
| PY Total Expenses | $936,212,330 | PYTotalExpensesAmt |
| CY Total Expenses | $982,606,790 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $51,220,929 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,330,453 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,331,158,473 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,294,964,551 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $689,440,250 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $696,007,861 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $641,718,223 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $598,956,690 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $795,956,490 | ExpenseAmt |
| Grant | $1,947,820 | GrantAmt |
| Revenue | $925,032,743 | RevenueAmt |
| Desc | Mary Hitchcock Memorial Hospital (the Hospital), is an acute and tertiary care teaching hospital located in Lebanon, New Hampshire. The Hospital 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. The Hospital provides a broad range of patient services and health related community services, consistent with its role as a community hospital, a major teaching hospital and a tertiary care referral hospital. These include a full range of services in both acute and critical medicine, surgery, psychiatry and rehabilitation for infants, children and adults. During FY 2015 the Hospital provided 127,558 acute patient days of inpatient service and had 26,317 total acute care discharges, while the Hospital's emergency room was open to the public 24 hours per day, 7 days per week and had 31,477 discharges. The Hospital 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 Hospital, Dartmouth-Hitchcock Clinic (the Clinic), 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 Hospital and Clinic 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. Its strategic operating plan lays out a path to creating a "sustainable health system to improve the lives of the people and communities we serve, for generations to come." The focus of this work, across the Dartmouth-Hitchcock organization, i.e. all Hospital and Clinic sites, is in three main areas: Improving Population Health; Delivering Value Based Care; and Developing and Implementing New Payment Models. Consistent with this mission and in partnership with the Clinic, the Hospital 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 Hospital actively supports community-based health care and promotes the coordination of services among health care providers and social services organizations. The Hospital also seeks to work collaboratively with other area health care providers to improve the health status of the region. Effective with fiscal year 2000, the Hospital and the Clinic began filing 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 Dartmouth-Hitchcock's web site (www.dartmouth-hitchcock.org). 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, 2015 the Hospital provided financial assistance to 10,988 patients in the amount of $27,052,265, as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2015 was $10,531,447. The Hospital also routinely provides services to Medicaid patients at reimbursement levels that are below the cost of the care provided. The 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 partnering with the Healthy Eating Active Living NH initiative, the Women's Health Resource Center, 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 Hospital also provides a significant amount of uncompensated care to its patients reported as provision for bad debts, which is not included in the amounts reported above. During the years ended June 30, 2015, the Hospital reported a provision for bad debts of approximately $9,436,007. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $43,249,817 | ExpenseAmt |
| Revenue | $24,839,995 | RevenueAmt |
| Desc | As a component of New Hampshire's only integrated academic medical center, the Hospital provides significant support for academic and research programs through its support of The Geisel School of Medicine at Dartmouth (GSM), the Hospital 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 Hospital provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to the Clinic 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $839,206,307 | 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 | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | 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 | Yes (true) | 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 | Yes (true) | 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 | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | 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 | 1046 | IRPDocumentCnt |
| IRP Document W2 G | 3 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 5780 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | Yes (true) | ForeignFinancialAccountInd |
| Foreign Country | BD | ForeignCountryCd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| 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 | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | 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 | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| 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 | ROBIN KILFEATHER-MACKEY | PersonNm |
| Phone | 6036505634 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (66 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Jennie L Norman | ||||||||||
| Trustee/Board Sec End 12/31/14 | 1.5 | 2.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Hugh C Smith MD | ||||||||||
| Trustee End 12/31/14 | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Vincent S Conti MHA | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Anne-Lee Verville | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Barbara Couch MS | ||||||||||
| Trustee/Board Sec Eff 1/1/15 | 0.75 | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Wiley Souba MD ScD | ||||||||||
| Trustee/Ex-Officio End 6/30/14 | 0.75 | 1.26 | Yes (X) | $0 | $0 | $0 | ||||
| William J Conaty | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| William W Helman IV | ||||||||||
| Trustee End 9/30/14 | 0.75 | 1.26 | Yes (X) | $0 | $0 | $0 | ||||
| Robert A Oden Jr PhD | ||||||||||
| Trustee/Board Chair | 1.5 | 2.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| James N Weinstein DO MS | ||||||||||
| Trustee Ex-Officio/CEO | 38.0 | 23.01 | Yes (X) | Yes (X) | $0 | $1,229,653 | $225,752 | |||
| Michael J Goran MD | ||||||||||
| Trustee End 12/31/14 | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Denis A Cortese MD | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Matthew B Dunne | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Senator Judd A Gregg | ||||||||||
| Trustee | 0.75 | 0.75 | Yes (X) | $0 | $0 | $0 | ||||
| Laura K Landy MBA | ||||||||||
| Trustee | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Paul P Danos PhD | ||||||||||
| Trustee/Brd Treasurer | 1.5 | 2.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Barbara C Jobst MD | ||||||||||
| Trustee | 0.75 | 0.75 | Yes (X) | $0 | $0 | $0 | ||||
| Troyen Brennan MD MPH | ||||||||||
| Trustee Eff 4/1/15 | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| R William Burgess Jr MBA | ||||||||||
| Trustee Eff 1/1/15 | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Duane A Compton PhD | ||||||||||
| Trustee/Ex-Officio Eff 7/15/14 | 0.75 | 1.56 | Yes (X) | $0 | $0 | $0 | ||||
| M Brooke Herndon MD MS | ||||||||||
| Trustee Eff 3/20/15 | 0.75 | 0.75 | Yes (X) | $0 | $0 | $0 | ||||
| Charles G Plimpton MBA | ||||||||||
| Trustee Eff 4/1/15 | 0.75 | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| Richard J Powell MD | ||||||||||
| Trustee Eff 7/1/15 | 28.0 | 12.8 | Yes (X) | $0 | $449,269 | $145,523 | ||||
| Richard Rothstein MD | ||||||||||
| Trustee Eff 7/1/15 | 28.0 | 12.0 | Yes (X) | $0 | $536,148 | $159,867 | ||||
| Steven A Paris MD | ||||||||||
| Trustee Eff 7/1/15 | 28.0 | 12.51 | Yes (X) | $0 | $357,571 | $117,329 | ||||
| Robin Kilfeather-Mackey CPA | ||||||||||
| Chief Financial Officer | 37.0 | 24.01 | Yes (X) | $0 | $520,432 | $214,698 | ||||
| Daniel Jantzen CPA | ||||||||||
| Chief Operating Officer | 41.0 | 20.0 | Yes (X) | $604,478 | $0 | $210,934 | ||||
| Stephen Leblanc | ||||||||||
| Exec VP Strtgy & Ntwrk Rltns | 15.0 | 45.01 | Yes (X) | $0 | $602,197 | $269,589 | ||||
| Vincent Fusca III | ||||||||||
| Chief of Staff | 28.0 | 12.0 | Yes (X) | $308,695 | $0 | $22,752 | ||||
| Edward Merrens MD | ||||||||||
| Chief Medical Officer | 28.0 | 12.0 | Yes (X) | $0 | $386,917 | $94,435 | ||||
| George Blike MD | ||||||||||
| Chief Quality & Value Officer | 28.0 | 12.0 | Yes (X) | $0 | $447,955 | $263,509 | ||||
| Darlene A Saler | ||||||||||
| Actg Chf Nrsg Ofr End 9/27/14 | 41.0 | 19.0 | Yes (X) | $170,680 | $0 | $117,273 | ||||
| John S Malanowski MILR | ||||||||||
| Chief HR Officer | 41.0 | 19.0 | Yes (X) | $446,455 | $0 | $54,754 | ||||
| Clifford J Belden MD | ||||||||||
| CHF CLNCL OFCR END 6/22/15 | 28.0 | 12.0 | Yes (X) | $0 | $710,709 | $55,414 | ||||
| Terrence P Carroll PHD | ||||||||||
| Chief Innovation Officer | 28.0 | 12.0 | Yes (X) | $641,630 | $0 | $53,393 | ||||
| John Birkmeyer MD | ||||||||||
| Chf Clncl Offr/EVP Entprs Sup | 37.0 | 23.0 | Yes (X) | $0 | $261,699 | $34,858 | ||||
| Gay Landstrom PhD RN NEA-BC | ||||||||||
| Chf Nursing Offr Eff 9/28/14 | 41.0 | 19.0 | Yes (X) | $281,442 | $0 | $27,901 | ||||
| Kimberly Troland JD | ||||||||||
| General Counsel End 4/19/15 | 37.0 | 23.0 | Yes (X) | $248,343 | $0 | $34,246 | ||||
| Robert Greene MD MHCDS FACP | ||||||||||
| Chf Popul Mgmt Ofr Eff 7/28/14 | 41.0 | 19.0 | Yes (X) | $0 | $374,106 | $27,231 | ||||
| John Kacavas JD | ||||||||||
| General Counsel Eff 4/20/15 | 41.0 | 19.0 | Yes (X) | $0 | $0 | $0 | ||||
| Christine Schon | ||||||||||
| V.P Comm. Grp. Pract. Ops | 28.0 | 12.01 | $0 | $227,406 | $58,292 | Yes (X) | ||||
| Gail Dahlstrom | ||||||||||
| V.P. Facilities Mgmt | 41.0 | 19.0 | $230,720 | $0 | $102,141 | Yes (X) | ||||
| Tina Naimie CPA | ||||||||||
| VP Corporate Finance | 28.0 | 13.5 | $222,873 | $0 | $25,900 | Yes (X) | ||||
| Wendy Fielding | ||||||||||
| VP Financial Planning | 28.0 | 12.0 | $220,559 | $0 | $57,824 | Yes (X) | ||||
| Wendy Wells MD | ||||||||||
| Dept. Chair Pathology | 28.0 | 12.0 | $0 | $430,798 | $168,546 | Yes (X) | ||||
| Jocelyn Chertoff MD MS | ||||||||||
| Dept Chair Diagnost Radiology | 28.0 | 12.0 | $0 | $513,849 | $204,718 | Yes (X) | ||||
| Douglas Merrill | ||||||||||
| Center Director Periop Svs | 28.0 | 12.0 | $0 | $558,557 | $55,489 | Yes (X) | ||||
| Stephen Boyce | ||||||||||
| VP Ambulatory Care | 28.0 | 12.0 | $0 | $196,780 | $60,119 | Yes (X) | ||||
| Bruce King | ||||||||||
| Pres & CEO New London Hosp | 0.0 | 50.0 | $351,565 | $0 | $183,662 | Yes (X) | ||||
| Roderic Young | ||||||||||
| VP Communications & Marketing | 28.0 | 12.0 | $301,316 | $0 | $45,714 | Yes (X) | ||||
| Martin Purcell | ||||||||||
| VP IS Operations | 28.0 | 12.0 | $309,514 | $0 | $130,615 | Yes (X) | ||||
| Susan Reeves | ||||||||||
| VP Colby Sawyer Nursing | 28.0 | 8.0 | $317,485 | $0 | $129,187 | Yes (X) | ||||
| Elwood Leonard | ||||||||||
| VP Development | 28.0 | 12.0 | $303,342 | $0 | $57,286 | Yes (X) | ||||
| Carl Dematteo MD | ||||||||||
| Fmr Chf Ql Compl Ofr/Physician | 28.0 | 12.0 | $0 | $114,301 | $2,381 | Yes (X) | ||||
| Linda Von Reyn | ||||||||||
| Fmr Chf Nursng Officer | 41.0 | 19.0 | $230,017 | $0 | $104,641 | Yes (X) | ||||
| John Butterly MD | ||||||||||
| Fmr Offr/Exec VP Med Affairs | 8.0 | 32.0 | $0 | $552,569 | $72,826 | Yes (X) | ||||
| Lawrence Dacey MD | ||||||||||
| Former CMO/ Phys | 26.7 | 13.3 | $0 | $132,136 | $242,566 | Yes (X) | ||||
| Alan Weston | ||||||||||
| Fmr Chief HR Officer | 41.0 | 19.0 | $295,536 | $0 | $0 | Yes (X) | ||||
| Jeanine Arden-Ornt | ||||||||||
| Fmr General Counsel | 37.0 | 24.0 | $361,457 | $0 | $42,717 | Yes (X) | ||||
| Thomas Colacchio MD | ||||||||||
| Former Officer/Phys | 28.0 | 13.0 | $0 | $1,067,539 | $130,947 | Yes (X) | ||||
| Mary Oseid | ||||||||||
| Fmr Key Emp/VP Enterprise Svcs | 28.0 | 12.0 | $0 | $374,245 | $240,234 | Yes (X) | ||||
| Barbara Walters DO MBA | ||||||||||
| Fmr Key Emp/Med Dir Acct Care | 22.0 | 10.0 | $0 | $329,833 | $21,631 | Yes (X) | ||||
| Mary Kay Boudewyns | ||||||||||
| Fmr Key Emp/Adm Dir Rev Mgmt | 28.0 | 12.0 | $213,992 | $0 | $129,667 | Yes (X) | ||||
| Thomas Dodds MD | ||||||||||
| Former Key Emp/Dept Chr Anesth | 28.0 | 12.0 | $0 | $535,557 | $231,969 | Yes (X) | ||||
| Edward Catherwood MD MS | ||||||||||
| Former Key Emp/Ctr Dir Hrt/Vsc | 28.0 | 12.0 | $0 | $443,720 | $148,473 | Yes (X) | ||||
| Jeffrey OBrien | ||||||||||
| Fmr Key Emp/VP Oncology | 28.0 | 12.0 | $276,051 | $0 | $41,966 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,336,150 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $11,353,946 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $4,818,969 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 324 | 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 |
|---|---|---|---|---|---|
| TRUSTEES OF DARTMOUTH COLLEGE | |||||
| 37 DEWEY FIELD | HANOVER | NH | 03755 | ADMIN & DIR SUPPORT | $31,647,452 |
| Cross Country Staffing | |||||
| PO Box 404674 | ATLANTA | GA | 303844674 | Staffing Services | $10,053,381 |
| Accretive Health | |||||
| 401 N Michigan Ave Ste 2700 | CHICAGO | IL | 60611 | REVENUE MGMT | $8,304,381 |
| Towers Watson Delaware Inc | |||||
| 800 Boylston St | BOSTON | MA | 02199 | Employee Benefits | $3,713,533 |
| Turner Construction | |||||
| Two Seaport Lane | BOSTON | MA | 02210 | Construction Svcs | $45,504,496 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 95 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,932,320 | GovernmentGrantsAmt |
| All Other Contributions | $1,143,395 | AllOtherContributionsAmt |
| Noncash Contributions | $682,435 | NoncashContributionsAmt |
| Total Contributions | $5,075,715 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $902,108,753 | $901,494,418 | $614,335 |
| RESEARCH RELATED ACTIVITIES | 621110 | $6,674,438 | $6,674,438 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $908,783,191 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,805,488 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $214,519 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,590,969 | 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 | $1,145,093 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $608,907 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $536,186 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $536,186 | TotalRevenueColumnAmt |
| Exclusion | $536,186 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $135,708,724 | SecuritiesAmt |
| Other | $542,762 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $123,272,564 | SecuritiesAmt |
| Other | $163,785 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $12,436,160 | SecuritiesAmt |
| Other | $378,977 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,815,137 | TotalRevenueColumnAmt |
| Exclusion | $12,815,137 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
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 | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| PHARMACY INCOME | 621110 | $21,795,010 | $21,636,817 | $158,193 | |
| CAFETERIA INCOME | 621110 | $2,987,354 | $2,987,354 | ||
| OTHER ALLOCATED INCOME | 611710 | $22,478,256 | $19,452,730 | $3,025,526 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $47,260,620 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $979,276,337 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $949,258,403 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,012,573 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,929,646 | 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 | $1,162,906 | TotalAmt |
| Program Services | $1,162,906 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $784,914 | TotalAmt |
| Program Services | $784,914 | 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 | $10,367,083 | TotalAmt |
| Program Services | $2,574,405 | ProgramServicesAmt |
| Management And General | $7,610,905 | ManagementAndGeneralAmt |
| Fundraising | $181,773 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,948,969 | TotalAmt |
| Program Services | $4,948,969 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $453,106,031 | TotalAmt |
| Program Services | $375,993,776 | ProgramServicesAmt |
| Management And General | $77,107,156 | ManagementAndGeneralAmt |
| Fundraising | $5,099 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,428,081 | TotalAmt |
| Program Services | $32,824,049 | ProgramServicesAmt |
| Management And General | $6,604,022 | ManagementAndGeneralAmt |
| Fundraising | $10 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,172,879 | TotalAmt |
| Program Services | $52,515,141 | ProgramServicesAmt |
| Management And General | $10,657,721 | ManagementAndGeneralAmt |
| Fundraising | $17 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,638,928 | TotalAmt |
| Program Services | $26,339,545 | ProgramServicesAmt |
| Management And General | $5,299,375 | ManagementAndGeneralAmt |
| Fundraising | $8 | 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 | $2,080,956 | TotalAmt |
| Program Services | $62,447 | ProgramServicesAmt |
| Management And General | $2,018,509 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $490,727 | TotalAmt |
| Management And General | $490,727 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,400 | TotalAmt |
| Program Services | $41,400 | 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 | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,550,137 | TotalAmt |
| Program Services | $47,011,686 | ProgramServicesAmt |
| Management And General | $10,538,451 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,961,146 | TotalAmt |
| Program Services | $20,381 | ProgramServicesAmt |
| Management And General | $2,940,765 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,172,318 | TotalAmt |
| Program Services | $4,824,887 | ProgramServicesAmt |
| Management And General | $2,347,362 | ManagementAndGeneralAmt |
| Fundraising | $69 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,938,656 | TotalAmt |
| Program Services | $7,065,404 | ProgramServicesAmt |
| Management And General | $873,252 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,623,761 | TotalAmt |
| Program Services | $12,078,931 | ProgramServicesAmt |
| Management And General | $1,544,830 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,535,387 | TotalAmt |
| Program Services | $1,650,551 | ProgramServicesAmt |
| Management And General | $1,884,836 | ManagementAndGeneralAmt |
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 | $70,881 | TotalAmt |
| Program Services | $69,123 | ProgramServicesAmt |
| Management And General | $1,758 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,212,880 | TotalAmt |
| Program Services | $11,759,463 | ProgramServicesAmt |
| Management And General | $1,453,417 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,956,680 | TotalAmt |
| Program Services | $35,558,959 | ProgramServicesAmt |
| Management And General | $4,397,721 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,518,309 | TotalAmt |
| Program Services | $3,518,309 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $139,005,955 | $138,922,282 | $83,673 |
| MEDICAID ENHANCEMENT TAX | $45,839,294 | $45,839,294 | |
| EQUIPMENT RENTAL & MAINT | $11,928,207 | $10,616,104 | $1,312,103 |
| ACDM, GME, TEACHING,& SUP | $5,876,806 | $5,876,806 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,193,499 | TotalAmt |
| Program Services | $17,146,575 | ProgramServicesAmt |
| Management And General | $4,074,784 | ManagementAndGeneralAmt |
| Fundraising | $1,972,140 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $982,606,790 | TotalAmt |
| Program Services | $839,206,307 | ProgramServicesAmt |
| Management And General | $141,241,367 | ManagementAndGeneralAmt |
| Fundraising | $2,159,116 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,761 | BOYAmt |
| EOY | $115,693 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,744,859 | BOYAmt |
| EOY | $10,175,102 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,452,357 | BOYAmt |
| EOY | $125,676,961 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,160 | BOYAmt |
| EOY | $313,922 | 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 | $1,092,351 | BOYAmt |
| EOY | $806,671 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,174,352 | BOYAmt |
| EOY | $15,427,916 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,055,419 | BOYAmt |
| EOY | $7,906,477 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $963,834,764 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $536,521,721 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $407,066,625 | BOYAmt |
| EOY | $427,313,043 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $280,390,609 | BOYAmt |
| EOY | $325,346,264 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,518,264 | BOYAmt |
| EOY | $254,702,840 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,385,931 | BOYAmt |
| EOY | $8,808,343 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,645,785 | BOYAmt |
| EOY | $118,371,319 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,331,158,473 | BOYAmt |
| EOY | $1,294,964,551 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,803,858 | BOYAmt |
| EOY | $125,289,886 | 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 | $412,543 | BOYAmt |
| EOY | $465,950 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $343,068,534 | BOYAmt |
| EOY | $335,292,116 | 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 | $148,038,569 | BOYAmt |
| EOY | $147,351,381 | 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 | $74,116,746 | BOYAmt |
| EOY | $87,608,528 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $689,440,250 | BOYAmt |
| EOY | $696,007,861 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,516,650 | BOYAmt |
| EOY | $519,605,834 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,291,018 | BOYAmt |
| EOY | $50,053,367 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,910,555 | BOYAmt |
| EOY | $29,297,489 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $641,718,223 | BOYAmt |
| EOY | $598,956,690 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,331,158,473 | BOYAmt |
| EOY | $1,294,964,551 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,330,453 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$17,816,000 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$21,615,080 | 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
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | Yes (true) | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $165,290 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $73,062 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $238,352 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LOBBYING ACTIVITY EXPLANATION | FORM 990, SCHEDULE C, PART II B, LINES 1B & 1G MARY HITCHCOCK MEMORIAL HOSPITAL 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, MARY HITCHCOCK MEMORIAL HOSPITAL, THROUGH ITS EMPLOYEES AND THE USE OF CONSULTANTS, CONTACTS GOVERNMENT OFFICIALS AND LEGISLATORS. THIS CONTACT IS FOR THE PURPOSE OF PROPOSING LEGISLATION OR EXPRESSING AN OPINION ON CHANGES IN LEGISLATION THAT AFFECT THE HOSPITAL AND ITS ABILITY TO CARRY OUT ITS MISSION. THE ACTIVITIES INCLUDE SENDING LETTERS TO, CALLING, AND MEETING WITH GOVERNMENT OFFICIALS AND LEGISLATORS. FOR THE FISCAL YEAR ENDED JUNE 30, 2015, MARY HITCHCOCK MEMORIAL HOSPITAL INCURRED $165,290 IN CONJUCTION WITH THESE ACTIVITIES. |
| Form 990 Schedule C, Part II B, Line 1I | MHMH pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. |
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 | $74,609,411 | BeginningYearBalanceAmt |
| Contributions | $208,107 | ContributionsAmt |
| Investment Earnings Or Losses | -$516,882 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,580,301 | OtherExpendituresAmt |
| End Year Balance | $72,720,335 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $54,935,134 | BeginningYearBalanceAmt |
| Contributions | $17,029,356 | ContributionsAmt |
| Investment Earnings Or Losses | $3,029,123 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $16,800 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,648,675 | OtherExpendituresAmt |
| End Year Balance | $73,328,138 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $57,050,185 | BeginningYearBalanceAmt |
| Contributions | $188,155 | ContributionsAmt |
| Investment Earnings Or Losses | -$357,053 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,322 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,940,831 | OtherExpendituresAmt |
| End Year Balance | $54,935,134 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $54,023,225 | BeginningYearBalanceAmt |
| Contributions | $30,717 | ContributionsAmt |
| Investment Earnings Or Losses | $3,834,255 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $15,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $823,012 | OtherExpendituresAmt |
| End Year Balance | $57,050,185 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $54,110,647 | BeginningYearBalanceAmt |
| Contributions | $398,541 | ContributionsAmt |
| Investment Earnings Or Losses | $842,732 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,328,695 | OtherExpendituresAmt |
| End Year Balance | $54,023,225 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.29622 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.52720 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.17658 | 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 | $40,738,341 | OtherCostOrOtherBasisAmt |
| Book Value | $40,738,341 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $484,087,239 | OtherCostOrOtherBasisAmt |
| Depreciation | $270,348,317 | DepreciationAmt |
| Book Value | $213,738,922 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,130,597 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,615,129 | DepreciationAmt |
| Book Value | $515,468 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $390,849,622 | OtherCostOrOtherBasisAmt |
| Depreciation | $262,558,275 | DepreciationAmt |
| Book Value | $128,291,347 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,028,965 | OtherCostOrOtherBasisAmt |
| Book Value | $44,028,965 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $427,313,043 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp (4 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| FIXED INCOME | $92,652,896 | F |
| PRIVATE EQUITIES | $30,475,622 | F |
| HEDGE FUNDS | $49,689,467 | F |
| OTHER INVESTMENTS | $81,884,855 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $254,702,840 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INVESTMENT IN CAPTIVE | $2,878,669 |
| DUE FROM AFFILIATES | $77,503,062 |
| BOND ISSUANCE COSTS | $2,992,348 |
| OTHER MISC ASSETS | $20,002,257 |
| CAPITAL LEASE RECEIVABLE | $14,994,983 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $118,371,319 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY SETTLEMENTS | $26,960,967 |
| ACCRUED POST RETMNT PENS & MED | $52,436,110 |
| INTEREST RATE SWAP | $8,211,451 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $87,608,528 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Intended use 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 the following mission-related programs: healthcare services, research, charity care, and health education. 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. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (27 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Specific Services ProvidedSpecificServicesProvidedTxt | Region Total ExpendituresRegionTotalExpendituresAmt | EmployeeEmployeeCnt |
|---|---|---|---|---|
| East Asia and the Pacific | Program Services | Educational Travel Exp | $241 | |
| Europe (Including Iceland and Greenland) | Program Services | Dues | $310 | |
| Europe (Including Iceland and Greenland) | Program Services | Honorarium Payments | $1,370 | |
| Europe (Including Iceland and Greenland) | Program Services | Software | $8,207 | |
| Europe (Including Iceland and Greenland) | Program Services | Insurance | $103,500 | |
| Europe (Including Iceland and Greenland) | Program Services | Travel | $26,428 | |
| Europe (Including Iceland and Greenland) | Program Services | Publications | $2,908 | |
| North America | Program Services | Honorarium Payments | $815 | |
| North America | Program Services | License | $1,570 | |
| North America | Program Services | Software | $5,765 | |
| North America | Program Services | Office Equipment | $113,320 | |
| North America | Program Services | Travel | $32,283 | |
| North America | Program Services | Services | $23,294 | |
| North America | Program Services | Publications | $752 | |
| North America | Program Services | Waste | $70 | |
| North America | Program Services | Studies Book | $3,450 | |
| North America | Program Services | Outdoor Lighting | $405 | |
| North America | Program Services | Activities Supplies | $185 | |
| Middle East and North Africa | Program Services | Software | $9,522 | |
| South America | Program Services | Travel | $646 | |
| Central America and the Caribbean | Program Services | Travel | $5,383 | |
| South America | Program Services | Medical Services | $16,406 | 6 |
| South Asia | Program Services | Medical Services | $1,105 | 1 |
| East Asia and the Pacific | Program Services | Medical Services | $9,083 | 2 |
| Central America and the Caribbean | Program Services | Medical Services | $3,425 | 3 |
| Sub-Saharan Africa | Program Services | Medical Services | $494,063 | 7 |
| Central America and the Caribbean | Investments | Inv in Ins Captive | $2,878,669 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Continutation Total Employee | 19 | ContinutationTotalEmployeeCnt |
| Total Employee | 19 | TotalEmployeeCnt |
| Subtotal Spent | $324,688 | SubtotalSpentAmt |
| Continuation Spent | $3,418,487 | ContinuationSpentAmt |
| Total Spent | $3,743,175 | TotalSpentAmt |
| Transfer To Foreign Corp | Yes (true) | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (true) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | Yes (true) | PassiveForeignInvestmestCoInd |
| Foreign Partnership | Yes (true) | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
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 | $10,504,394 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,504,394 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $163,787,802 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $61,489,942 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $102,297,860 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10410 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $174,292,196 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $61,489,942 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $112,802,254 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11480 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,616,956 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,828,448 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,788,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $41,697,435 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,258,261 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,439,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,790,076 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $273,855 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,516,221 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,607,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,594 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,586,322 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,650,468 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,650,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $54,362,851 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,382,158 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $39,980,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $228,655,047 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,872,100 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $152,782,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15570 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,350 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,350 | NetCommunityBenefitExpnsAmt |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $638,873 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $477,970 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $160,903 | NetCommunityBenefitExpnsAmt |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,788 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $49,788 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,594 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,594 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $713,605 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $477,970 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $235,635 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,436,077 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $269,468,394 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $295,037,671 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$25,569,277 | 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 | Mary Hitchcock Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.dartmouth-hitchcock.org | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Childrens Hospital | Yes (X) | ChildrensHospitalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Research Facility | Yes (X) | ResearchFacilityInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Psych Unit and Transplant Unit Cancer Center | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mary Hitchcock Memorial Hospital | 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 |
| CHNA Conducted | 12 | 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 | Please see Section C, Supplemental Info | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | Please see Section C, Supplemental Info | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Section C, Supplemental Info | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Section C, Supplemental Info | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Sect. C, Spplmntl Info | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| None Made | Yes (X) | NoneMadeInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Sch H, Part V, Section B Line 3 | Input From Representatives of Community Served by the Hospital Facility D-H is actively engaged in the development of an active Upper Valley Regional Public Health Advisory Council (35+ community representatives) and broader ReThink Health Initiatives (100+ community representatives). Members of these two community health advisory groups have had the opportunity to review and comment on drafts of Dartmouth-Hitchock's Community Health Improvement Plan. The plan document has also been circulated to public health officials in Vermont for their comment. In addition, Dartmouth-Hitchcock representatives serve on numerous boards, task forces, municipal health leadership and planning teams, and other community health leadership entities in order to ensure that we both participate in and better understand the needs of our community. Form 990, Schedule H, Part V, Section B Line 6A CHNA Conducted With One Or More Other Hospital Facilities During 2012, MHMH partnered with Alice Peck Day Memorial Hospital and Mount Ascutney Hospital and Health Care. Form 990, Schedule H, Part V, Section B Line 6B CHNA Conducted With One Or More Organizations Other Than Hospital Facilities In 2012, in addition to other hospitals, the assessment was completed in partnership with Granite State United Way. Form 990, Schedule H, Part V, Section B Line 7a Community Health Needs Assessment The Community Health Needs Assessment can be found online at http://www.dartmouth-hitchcock.org/about_dh/community_benefits_program.htm l Form 990, Schedule H, Part V, Section B Line 7c & 7d Community Health Needs Assessment The Needs Assessment was distributed to non-profit organizations throughout the region including the United Way. It is also available from the Organization upon request. Form 990, Schedule H, Part V, Section B Line 10a Community Health Needs Assessment Implementation Strategy The Community Health Needs Assessment Implementation Strategy can be found online at http://www.dartmouth-hitchcock.org/about_dh/community_benefits_program.htm l Form 990, Schedule H, Part V, Section B Line 11 Community Health Needs Identified Based upon the most recent community benefits report, MHMH is increasing community benefits spending to address identified community needs, particularly, oral health, needs of older adults, substance misuse prevention, and obesity/nutrition/physical activity. In FY 2015, Mary Hitchcock Memorial Hospital's (MHMH) Community Health Improvement strategies were consistent with the intentions identified in our Community Health Improvement Plan to address identified community health needs by: a) increase investment; b) maintain similar levels of investments for services and initiatives already provided by MHMH; or c) limit investment in areas where other community organizations already provide leadership and services to address the need, or where the identified need is significantly outside the mission/services/scope of MHMH. Mary Hitchcock Memorial Hospital's Community Health Improvement Plan is a 3-year document identifying anticipated investments and activities that it will take to address needs identified in the most recent Upper Valley Community Health Needs Assessment (CHNA). In four cases, items identified in the CHNA were not adddressed by MHMH: 1) the need for more affordable housing; 2) the need for more livable wage jobs; 3) the need to reduce rural isolation; and 4) the need for improved quality of education. These needs are outside the traditional mission/services/scope of the hospital; the region looks to other entities, such as Granite United Way, Twin Pines Housing Trust, Lebanon Housing Authority; Vital Communities; and others, for leadership to address these needs. In these cases, MHMH's response may include: a) minimal investment of time, leadership, and expertise, such as serving on community committees; b) making cash investments in the lead organization or addressing smaller aspects of the identified need as part of a collaboration with community organizations, such as cash support for the Upper Valley Housing Coalition and investing in an on-site employment training program for young adults with developmental disabilities; or c) investing in the issue, but in a way that may not meet criteria for inclusion as a Community Benefit, such as investing significantly in regional jobs training activities that help individuals move to higher paying, stable jobs at Dartmouth-Hitchcock or developing pediatric clinic-community approaches to improving care for children with asthma. While these efforts address an identified community need, the cost of these efforts cannot be separated from MHMH's business model or standard of clinical care, thus do not qualify as Community Benefits. Additionally, leadership to address two community needs: cancer prevention; and prevention of unintentional injuries, is led primarily by teams who are employed by the Geisel School of Medicine at Dartmouth College. In many cases, while leadership for these efforts are provided by staff who have dual appointments to both the Geisel School of Medicine and MHMH, the cost accounting for these efforts occurs through the Geisel School, so MHMH does not claim leadership in these areas of community health improvement. In both cases, however, MHMH does provide cash support to the Geisel School of Medicine teams who do this work in our Hospital Service Area and throughout New Hampshire and Vermont. Form 990, Schedule H, Part V, Section B Line 13B Discounted Care by income level other than FPG Patients whose family income exceeds 300% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of D-H. Form 990, Schedule H, Part V, Section B Line 13G Residency In order to receive financial assistance, an individual must be a resident of NH or VT, or a non-resident who experiences a medical emergency. Form 990, Schedule H, Part V, Section B Line 13H Uninsured Discount Policy D-H has a separate Uninsured Discount Policy that outlines how the discount is calculated annually and is applied prior to billing any uninsured patient. This assures a patient is not billed at an amount greater than the amount generally billed to patients with insurance. This is referenced as a link in the Financial Assistance Policy. |
| Form 990, Schedule H, Part V, Section B Line 16 A-C | The financial assistance policy can be found at: http://www.dartmouth-hitchcock.org/documents/dh_financial_assistance_polic y.pdf The financial assistance application can be found at: http://www.dartmouth-hitchcock.org/documents/DH-NHHAN_Application_SR_WEB.p df The plain language financial assistance summary can be found at: http://www.dartmouth-hitchcock.org/documents/financial_services_brochure-1 2152015.pdf Form 990, Schedule H, Part V, Section B Line 16i Financial Assistance Policy availability within the Community MHMH financial assistance policy is posted on MHMH's website, including the verbatim policy and a shorter, more patient-friendly version. MHMH provides the patient friendly brochure version of the policy to all uninsured patients who enter the health system. MHMH continues to notify patients on the back of the billing statement about financial assistance being available to them. Additionally, MHMH posts information about the policy in public areas throughout the facilities including admission offices. MHMH has also made additional changes internally to increase awareness of the policy, including adding information to the back of the patient's statement about financial assistance available to them, posting information about the policy in public areas throughout the facilities, and ensuring financial assistance policy brochures are available in patient areas. MHMH Screens 100% of uninsured inpatient and same-day patients prior to admission. As part of this process, MHMH checks all state and federal programs to see if individuals are eligible for assistance. Patients are also screened to determine qualification for financial assistance and the application is provided and/or completed at this time. Form 990, Schedule H, Part V, Section B Line 22B Maximum charges to financial assistance policy-eligible individuals for emergency or medically-necessary care MHMH uses the average of the three highest commerical payer discounts and applies this as a discount for all uninsured patients. The discount rate is 43%. Form 990, Schedule H, Part V, Section D Facility information The Hospital has a Cancer Treatment Center located in Saint Johnsbury, Vermont. This location is registered under the same license as the Organization's main Campus located in Lebanon, New Hampshire. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Schedule H, Part I, Line 3c | Other factors used in determining eligibility other than FPG Guidelines D-H uses the FPG guidelines in determining the initial level of financial assistance provided. In addition, D-H allows for catastrophic assistance consideration based on a calculation of 10% of two years income plus 10% of amount over sheltered assets. If the projected or current selfpay balance is greater than this calculation, the Selfpay balance is reduced to the sum of 10% of two years income plus 10% of assets. Each household is allowed certain sheltered assets which are not used when calculating household income or assets. Savings is sheltered up to 100% of FPL based on family size, equity in primary residence up to $200,000 up to 55 and $250,000 for aged 55 and older, and a retirement shelter of up to $ 100,000 in retirement assets as long as it is employer based contributions if working or IRA if self-employed. If a patient is retired, prior retirement accounts would be included as a sheltered asset. Form 990, Schedule H, Part I, Line 6a Community Benefits Report Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic (Collectively referred to as Dartmouth-Hitchcock (D-H)) share common board members and operate under an affiliation agreement. D-H performs a joint Community Health Needs Assessment (CHNA) and files a consolidated Community Benefits report with the state of New Hampshire. For purposes of IRS Form Schedule H, only Hospital numbers were used. All amounts relating to DHC were excluded. The New Hampshire Community Benefits Report filed for fiscal year 2015, DHC and MHMH combined, totaled $184,854,551. |
| Form 990, Schedule H, Part I, Line 7 | Costing Methodology The costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, Ratio of Patient Care Cost-to-Charges. |
| Form 990, Schedule H, Part I, Line 7G | Subsidized health services related to physician clinics The Organization did not include any subsidized health service costs attributable to a physician clinic on Part I, line 7G. |
| Form 990, Schedule H, Part II | Community Building Activities Community Building activities include expenses related to coalitions that address rural emergency/trauma services, prevention of pediatric obesity, prevention of substance abuse, falls reduction for older adults, public health networks, prescription drug misuse, and low-income housing. These also include cash support and/or contributed in-kind support for the development and maintenance of housing for low-income families, regional economic development, and support for regional workforce development services. |
| Form 990, Schedule H, Part III, Section A Lines 2 and 3 | Bad Debt Expense The amounts reported on Part III, Section A, line 2 were derived from MHMH's audited financial statements (provision for bad debt). MHMH's Policy is to exert everything in the Organization's power to obtain sufficient and adequate information to determine eligibility for financial assistance. MHMH's discount for uninsured patients is currently 43% (before financial assistance is applied). As part of MHMH's Financial Assistance Policy, MHMH makes information available to patients for eligibility and how to apply for free or discounted care. If the patient does not respond to the hospital's attempts to complete the financial assistance package, these patients may be written off to bad debt. Prior to moving any balance to bad debt it is assessed for charity through the organization's presumptive charity process. If the patient balance meets the presumptive charity qualification, it is adjusted to financial assistance and therefore never charged to bad debt. |
| Form 990, Schedule H, Part III, Section A Line 4 | Audited financial Statement Disclosure for Charity Care and Provision for Bad Debt (Please note that MHMH files a combined audited financial statement with Dartmouth-Hitchcock Clinic and other Subsidiaries). MHMH provides care to patients who meet certain criteria under their financial assistance policies without charge or at amounts less than their established rates. Because MHMH does not anticipate collection of amounts determined to qualify as charity care, they are not reported as revenue. MHMH grants credit without collateral to patients. Most are local residents and are insured under third-party arrangements. Additions to the allowance for uncollectible accounts are made by means of the provision for bad 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 managements assessment of historical and expected net collections, business and economic conditions, trends in federal and state governmental healthcare coverage, and other collection indicators. |
| Form 990, Schedule H, Part III, Section B Line 8 | Medicare Shortfalls The costing methodology used to calculate the amounts reported as Medicare Shortfalls was derived from the Internal Revenue Service's Worksheet B as provided for Part III calculations. MHMH had revenues of $22,391,314 and costs of $31,023,274 for services not included on the Medicare Cost Report (Ambulance Services, Laboratory and other fees screens, and Medicare Part C & D services). MHMH incurred a net loss of $8,631,960 on the provision of these services. Because of the central role of the organization in serving the healthcare needs of its community and the demographic characteristics of the community served, it is likely that a portion of the Medicare shortfall should be considered community benefit expenditure. MHMH has not identified a specific amount of Medicare Shortfall that should be reported as such. |
| Form 990, Schedule H, Part III, Line 9b | Credit and Collection Policy MHMH has a Credit and Collection Policy that addresses the procedures for patients who choose not to make payment or work with MHMH to make payment arrangements for their bill. The Organization has a separate Financial Assistance Policy that addresses those patients who are unable to make payment. MHMH is a charitable health care organization who treats patients that come for medically necessary care, regardless of their financial status. MHMH offers financial assistance in the form of free or discounted care to those patients who have an inability to pay their bills. The Financial Assistance Policy outlines eligibility criteria for financial assistance; the method by which patients may apply for financial assistance; the basis for calculating amounts charged to patients eligible for financial assistance under this policy; D-H's measures to widely publicize the policy within the community served; and the limitation of charges for emergency or other medically necessary care. Patients can qualify for 25%, 50%, 75%, or 100% reduction based on Federal Poverty Levels as well as a catastrophic guideline of 10% of 2 year's income for those that may not qualify based on assets and income, but who have a bill beyond their means to pay. If a financial assistance policy eligible patient has a balance for which they are responsible after a financial assistance discount is applied, the standard collection practices are followed as outlined in the D-H Credit and Collections policy. Under the Credit and Collections Policy, Dartmouth-Hitchcock routinely attempts to collect the most current insurance information for a patient. For any unpaid balances, D-H will issue the billing statement and request payment in full within 30 days. Partial payments are accepted as long as minimum payment expectations are met as outlined in the budget plan procedure. Regulatory requirements mandate no account be transferred to a collection agency less than 120 days from the initial date of service. Balances move to collections when they are determined to be uncollectible and at that time they are moved to a collection agency and are considered in default. Collection agencies are allowed to report balances due D-H to credit reporting agencies 60 days after placement if there is no resolution of the balance reached during this period. D-H reserves the right to file a lien in liability cases for the interest of the hospital. |
| Form 990, Schedule H, Part VI, Line 2 | Needs Assessment Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic (Collectively referred to as Dartmouth-Hitchcock (D-H)) share common board members and operate under an affiliation agreement. D-H performs a joint Community Needs Assessment and files a consolidated Community Benefits report. Dartmouth-Hitchcock participates with other health care charitable trusts and community partners in each of our service areas to complete community health needs assessments. During 2012, MHMH partnered with Alice Peck Day Memorial Hospital, Mount Ascutney Hospital and Health Care, and Granite State United Way to conduct a Community Needs Assessment. The needs assessment included reviewing health data available throughout NH and VT Health Departments; Behavioral Risk Factor Surveillance Survey and youth Risk Behavior Surveys; focus groups with community members from lower-income neighborhoods; and electronic surveys of professional health and social service providers as well as community residents. This information was reviewed by a Steering Committee comprised of community leaders from the health care system, education, public health, and other social service organizations to develop a community needs assessment. The Steering Committee's work was reviewed at larger community gatherings in fall 2012 for further comments and feedback. In addition, MHMH reviewed related health data generated through www.CHNA.org as a comparative tool. MHMH monitors emerging health data on an ongoing basis as it is released by each state, schools, and other community entities. As part of the needs assessment, the Steering Committee reviewed: 1. Health, economic, and education data from sources including Youth Risk Behavior Surveys, the Behavioral Risk Factor Surveillance System, public health and hospital discharge data available in NH Health WRQS, census data, and reports from the New England Common Assessment Program. Additionally, it reviewed the 2011 NH State Health Profile and Upper Valley Regional Health Profile, quantitative and qualitative data from local sources (newspapers, regional planning offices, community forums) to identify concerns that emerged, intensified, or were the source of local attention since the last secondary data was collected. Emergent issues that are not well-reflected in secondary data but were reflected elsewhere include oral health needs (data from UV Smiles school-based oral health clinics), prescription drug misuse (data from the NH Governor's Commission on Alcohol and other Drug Abuse Prevention, Intervention, and Treatment), housing assessments (data from Upper Valley Lake Sunapee Regional Planning Commission), and reductions in availability of appropriate mental health services (news outlets and professional stakeholder interviews). 2. Opinion data from professional stakeholders using an online opinion poll of regional leaders in health, public health, education, municipal governments, public safety, and social service providers. 67 informed stakeholders responded to this survey. 3. Focus group data collected from 6 focus groups largely consisting of lower-income consumers of health/welfare services. 4. Opinion data from residents collected through community list-servs, individual interviews at human service organizations, and focus groups. These surveys were targeted primarily to economically stable households. 196 residents responded to surveys. Dartmouth-Hitchcock regularly monitors newly released health, economic, and education data from our service region to identify emerging regional needs and concerns, including FY 2013 Youth risk Behavior Surveys, the 2013 NH State Health Improvement Plan, NH's emerging state plans to address substance misuse, prescription drug misuse, obesity, and children's behavioral health. |
| Form 990, Schedule H, Part VI, Line 3 | Patient Education of Eligibility for Assistance All uninsured inpatients, same day surgery, observation, and Emergency Department patients are pro-actively screened using an automated tool to identify potential qualification for other federal, state, and local programs. In addition, specific outpatient activities deemed to have a higher rate of need are screened as part of regular protocol. If a patient appears to be eligible, on-site Financial Counselors assist the patient in completing the appropriate paperwork/applications and provide instruction regarding how to complete the qualification process. In some cases a Financial Counselor will act on behalf of the patient, at their signed consent, in order to complete the application process (for example, in New Hampshire a patient must be physically present at the District Office). If a patient doesn't qualify for specific programs, they are also considered for financial assistance as part of their screening. For outpatient services that are not routinely screened, staff interacting with patients are instructed to provide either a financial assistance application or contact information for a Financial Counselor when a patient expresses their inability to make payment. Every application is screened for completed income and asset documentation. Applications are also screened to assure there are no other potential options of federal, state, or local programs. The website, patient statements, and financial brochures all include information about financial assistance and how to apply. Form 990, Schedule H, Part VI, Line 4 Community Information The Organization defines its service region as New Hampshire and eastern Vermont, with the largest presence in the Lebanon, New Hampshire region, site of Dartmouth-Hitchcock Medical Center which includes Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinics main Northern clinic. MHMH serves the general population with a wide range of services. In addition to general hospital populations, the Organization provides services to patients with highly-specialized needs that are not available elsewhere in New Hampshire. MHMH is the states only tertiary referral center, provides the states only comprehensive cancer center (Norris Cotton Cancer Center - NCCC), operates the only Level I Trauma Center in New Hampshire, operates the only comprehensive childrens hospital and accredited pediatric trauma center in New Hampshire (Childrens Hospital at Dartmouth CHaD), hosts the only Level IV neonatal intensive care nursery and one of two pediatric intensive care units in New Hampshire, and operates the only helicopter transport service in the state. As such, the service population is both the general public seeking primary health care services as well as residents with unique and highly-specialized health care needs. |
| Form 990, Schedule H, Part VI, Line 5 | Promotion of Community Health MHMH supports organizations and initiatives that further health by strengthening and developing key community capacities to address identified community health needs. This includes hosting or leading community partnerships to address substance misuse, reduce obestiy through community-level strategies; provide funding for children's oral health initiatives, and participation of our staff in other partnerships including the Outpatient Falls Prevention Task Force; the Transportation Management Association, and the Upper Valley Housing Authority. In addition, MHMH operates health education and support services such as a Women's Health Resource Center, the Aging Resource Center; and a Health Education Center. MHMH uses cash contributions, contracted services, and in-kind contribution of staff time and expertise, to support these strategies which improve community health. At MHMH's Lebanon, NH campus, the Hospital extends Professional Staff Privileges to qualified and appropriate physicians who are employees of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and Dartmouth College, who also hold a faculty appointment at Geisel School of Medicine. Mary-Hitchcockss Trustees annually set strategic priorities for the institution and approve operating and capital budgets which allocate surplus funds to improvements in patient care, medical education, research, as well as maintenance of a prudent reserve. Examples of these investments include the development of Mary Hitchcockss Patient Safety and Training Center, ongoing Quality and Patient Safety initiatives; purchases of new and emerging medical technologies, awards made to support translational research, and support for undergraduate medical education at Geisel School of Medicine. Of the 20 voting members of Mary Hitchcock Board of Trustees, 17 are neither contractors nor employees of MHMH. |
| Form 990, Schedule H, Part VI, Line 6 | Affiliated Health Care System Community Benefits are provided by the Dartmouth-Hitchcock health care system, which includes Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic, and other related organizations whose primary mission is health care. Mary Hitchcock Memorial Hospital (MHMH) in Lebanon is New Hampshires largest hospital. In Fiscal Year 2015 MHMH had 396 licensed inpatient beds. The Dartmouth-Hitchcock Clinic (DHC) is a multi-specialty physician practice with a network of providers across New Hampshire and Vermont. While DHCs main offices are located in Lebanon, the Clinic also has multi-specialty practices in Manchester, Nashua, Concord, and Keene, NH areas as well as Bennington, VT. In addition, the Clinic provides primary care in rural communities in Vermont and northern New Hampshire. MHMH, DHC, and the Geisel School of Medicine faculty and students make up the Dartmouth-Hitchcock (D-H) health care system. The Hospital and Clinic operate jointly through interlocking directorates, strategic planning and management and share identical missions. The Medical School, which works closely with the Hospital and Clinic, is focused on medical education and research. |
| Form 990, Schedule H, Part VI, Line 7 | State filing of Community Benefit Report MHMH files a Community Benefit Report with the State of New Hampshire jointly with Dartmouth-Hitchcock Clinic. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Granite State United Way | ||||||||
| 46 South Main St | Concord | NH | 03301 | 026006033 | 501(c)(3) | $18,630 | FMV | Program Support |
| David's House | ||||||||
| 461 Mount Support Rd | Lebanon | NH | 03766 | 222593431 | 501(C)(3) | $22,770 | FMV | Program Support |
| Mascoma Valley Health Initiative | ||||||||
| PO Box 2013 | Canaan | NH | 03741 | 752991608 | 501(C)(3) | $11,385 | FMV | Hlth Adv Cnsl Sppt S |
| The Trustees of Dartmouth College | ||||||||
| 1 Rope Ferry Road | Hanover | NH | 03755 | 020222111 | 501(C)(3) | $690,000 | FMV | Educ and Prog Suppt |
| Advance Transit | ||||||||
| PO Box 1027 | Wilder | VT | 05088 | 222558708 | 501(C)(3) | $75,060 | FMV | Transportn Subsidy |
| Upper Valley Transportation MGMT Assoc | ||||||||
| 195 No Main St | White River Jct | VT | 05001 | 030355283 | 501(C)(3) | $10,350 | FMV | Transportn Subsidy |
| March of Dimes- NH Chapter | ||||||||
| 25 Lowell St Ste 304 | Manchester | NH | 03101 | 131846366 | 501(c)(3) | $9,574 | FMV | Program Support |
| Southwestern VT Health Care | ||||||||
| 100 Hospital Dr BOX 41 | Bennington | VT | 05201 | 030179435 | 501(c)(3) | $12,938 | FMV | Program Support |
| City Year NH Pledge | ||||||||
| 287 Columbus Avenue | Boston | MA | 02116 | 222882549 | 501(c)(3) | $17,250 | FMV | Program Support |
| Indian Stream Health Center | ||||||||
| 2 Corliss Ln Rr2 Box 14 | Colebrook | NH | 03576 | 200999212 | 501(c)(3) | $34,500 | FMV | Program Sponsor |
| American Cancer Society | ||||||||
| 250 Williams Street NW | Atlanta | GA | 30303 | 131788491 | 501(c)(3) | $11,644 | FMV | Program Support |
| American Heart Association | ||||||||
| 7272 Greenville Avenue | Dallas | TX | 75231 | 135613797 | 501(c)(3) | $7,763 | FMV | Program Support |
| Daniel Webster Council | ||||||||
| 571 Holt Ave | Manchester | NH | 03109 | 020222115 | 501(c)(3) | $5,693 | FMV | Program Support |
| University of NH School of Law | ||||||||
| 2 White St | Concord | NH | 03301 | 020332032 | 501(c)(3) | $10,350 | FMV | Program Support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 14 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (10 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc |
|---|---|---|---|
| E. Hintze Nursing Awards | 2 | $1,894 | FMV |
| Levine Nursing Awards | 10 | $35,531 | FMV |
| Patterson Awards | 19 | $10,284 | FMV |
| The Trustees of Dartmouth College | 13 | $136,239 | FMV |
| Knox Awards | 13 | $22,120 | FMV |
| Prouty Awards | 39 | $24,277 | FMV |
| Daniels Awards | 9 | $6,167 | FMV |
| Waterman Awards | 4 | $13,315 | FMV |
| D-H Tuition Reimbursement Program | 604 | $507,494 | FMV |
| Varnum Nursing Awards | 43 | $27,593 | FMV |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Description of Organization's Procedures for Monitoring the Use of Grants | FormAndLineReferenceDesc |
| Explanation | Form 990, Schedule I, Part I, Line 1 Each award established by Mary Hitchcock Memorial Hospital (Levine Nursing Awards, Knox Nursing Award, Patterson, Varnum, Hintze, and Prouty) has written established guidelines and procedures. Award payments are processed in accordance with the specific terms of each of the awards noted above. The Dartmouth Institute Scholarships (TDI) are paid directly to the College on the 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| 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 | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (44 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Carl Dematteo MD | ||||||||||||||
| Fmr Chf Ql Compl Ofr/Physician | $0 | $112,103 | $0 | $0 | $0 | $2,198 | $0 | $1,080 | $0 | $1,301 | $0 | $116,682 | $0 | $0 |
| Robin Kilfeather-Mackey CPA | ||||||||||||||
| Chief Financial Officer | $0 | $500,806 | $0 | $0 | $0 | $19,626 | $0 | $194,123 | $0 | $20,575 | $0 | $735,130 | $0 | $0 |
| Linda Von Reyn | ||||||||||||||
| Fmr Chf Nursng Officer | $133,716 | $0 | $0 | $0 | $96,301 | $0 | $99,057 | $0 | $5,584 | $0 | $334,658 | $0 | $0 | $0 |
| Daniel Jantzen CPA | ||||||||||||||
| Chief Operating Officer | $515,042 | $0 | $0 | $0 | $89,436 | $0 | $190,359 | $0 | $20,575 | $0 | $815,412 | $0 | $0 | $0 |
| Stephen Leblanc | ||||||||||||||
| Exec VP Strtgy & Ntwrk Rltns | $0 | $478,894 | $0 | $0 | $0 | $123,303 | $0 | $249,014 | $0 | $20,575 | $0 | $871,786 | $0 | $0 |
| John Butterly MD | ||||||||||||||
| Fmr Offr/Exec VP Med Affairs | $0 | $498,440 | $0 | $0 | $0 | $54,129 | $0 | $72,826 | $0 | $0 | $0 | $625,395 | $0 | $0 |
| Lawrence Dacey MD | ||||||||||||||
| Former CMO/ Phys | $0 | $82,044 | $0 | $9,000 | $0 | $41,092 | $0 | $230,712 | $0 | $11,854 | $0 | $374,702 | $0 | $0 |
| Alan Weston | ||||||||||||||
| Fmr Chief HR Officer | $0 | $0 | $0 | $0 | $295,536 | $0 | $0 | $0 | $0 | $0 | $295,536 | $0 | $0 | $0 |
| Bruce King | ||||||||||||||
| Pres & CEO New London Hosp | $313,800 | $0 | $0 | $0 | $37,765 | $0 | $163,148 | $0 | $20,514 | $0 | $535,227 | $0 | $0 | $0 |
| Mary Oseid | ||||||||||||||
| Fmr Key Emp/VP Enterprise Svcs | $0 | $365,364 | $0 | $0 | $0 | $8,881 | $0 | $228,572 | $0 | $11,662 | $0 | $614,479 | $0 | $0 |
| Christine Schon | ||||||||||||||
| V.P Comm. Grp. Pract. Ops | $0 | $223,696 | $0 | $0 | $0 | $3,710 | $0 | $42,762 | $0 | $15,530 | $0 | $285,698 | $0 | $0 |
| Gail Dahlstrom | ||||||||||||||
| V.P. Facilities Mgmt | $226,090 | $0 | $0 | $0 | $4,630 | $0 | $86,615 | $0 | $15,526 | $0 | $332,861 | $0 | $0 | $0 |
| James N Weinstein DO MS | ||||||||||||||
| Trustee Ex-Officio/CEO | $0 | $1,145,559 | $0 | $0 | $0 | $84,094 | $0 | $209,341 | $0 | $16,411 | $0 | $1,455,405 | $0 | $0 |
| Tina Naimie CPA | ||||||||||||||
| VP Corporate Finance | $222,765 | $0 | $0 | $0 | $108 | $0 | $24,097 | $0 | $1,803 | $0 | $248,773 | $0 | $0 | $0 |
| Wendy Fielding | ||||||||||||||
| VP Financial Planning | $220,289 | $0 | $0 | $0 | $270 | $0 | $37,462 | $0 | $20,362 | $0 | $278,383 | $0 | $0 | $0 |
| Barbara Walters DO MBA | ||||||||||||||
| Fmr Key Emp/Med Dir Acct Care | $0 | $286,993 | $0 | $0 | $0 | $42,840 | $0 | $21,631 | $0 | $0 | $0 | $351,464 | $0 | $0 |
| Jeanine Arden-Ornt | ||||||||||||||
| Fmr General Counsel | $340,566 | $0 | $0 | $0 | $20,891 | $0 | $38,457 | $0 | $4,260 | $0 | $404,174 | $0 | $0 | $0 |
| Vincent Fusca III | ||||||||||||||
| Chief of Staff | $306,308 | $0 | $0 | $0 | $2,387 | $0 | $21,284 | $0 | $1,468 | $0 | $331,447 | $0 | $0 | $0 |
| Mary Kay Boudewyns | ||||||||||||||
| Fmr Key Emp/Adm Dir Rev Mgmt | $206,293 | $0 | $0 | $0 | $7,699 | $0 | $121,696 | $0 | $7,971 | $0 | $343,659 | $0 | $0 | $0 |
| Edward Merrens MD | ||||||||||||||
| Chief Medical Officer | $0 | $368,912 | $0 | $0 | $0 | $18,005 | $0 | $73,184 | $0 | $21,251 | $0 | $481,352 | $0 | $0 |
| George Blike MD | ||||||||||||||
| Chief Quality & Value Officer | $0 | $402,600 | $0 | $0 | $0 | $45,355 | $0 | $242,258 | $0 | $21,251 | $0 | $711,464 | $0 | $0 |
| Thomas Colacchio MD | ||||||||||||||
| Former Officer/Phys | $0 | $648,749 | $0 | $0 | $0 | $418,790 | $0 | $116,627 | $0 | $14,320 | $0 | $1,198,486 | $0 | $0 |
| Darlene A Saler | ||||||||||||||
| Actg Chf Nrsg Ofr End 9/27/14 | $169,385 | $0 | $0 | $0 | $1,295 | $0 | $101,528 | $0 | $15,745 | $0 | $287,953 | $0 | $0 | $0 |
| John S Malanowski MILR | ||||||||||||||
| Chief HR Officer | $432,266 | $0 | $0 | $0 | $14,189 | $0 | $37,650 | $0 | $17,104 | $0 | $501,209 | $0 | $0 | $0 |
| Clifford J Belden MD | ||||||||||||||
| CHF CLNCL OFCR END 6/22/15 | $0 | $668,497 | $0 | $0 | $0 | $42,212 | $0 | $41,093 | $0 | $14,321 | $0 | $766,123 | $0 | $0 |
| Terrence P Carroll PHD | ||||||||||||||
| Chief Innovation Officer | $540,130 | $0 | $100,000 | $0 | $1,500 | $0 | $37,650 | $0 | $15,743 | $0 | $695,023 | $0 | $0 | $0 |
| Roderic Young | ||||||||||||||
| VP Communications & Marketing | $296,109 | $0 | $100 | $0 | $5,107 | $0 | $27,634 | $0 | $18,080 | $0 | $347,030 | $0 | $0 | $0 |
| Martin Purcell | ||||||||||||||
| VP IS Operations | $267,978 | $0 | $25,000 | $0 | $16,536 | $0 | $110,169 | $0 | $20,446 | $0 | $440,129 | $0 | $0 | $0 |
| Thomas Dodds MD | ||||||||||||||
| Former Key Emp/Dept Chr Anesth | $0 | $499,435 | $0 | $0 | $0 | $36,122 | $0 | $210,719 | $0 | $21,250 | $0 | $767,526 | $0 | $0 |
| Wendy Wells MD | ||||||||||||||
| Dept. Chair Pathology | $0 | $406,536 | $0 | $0 | $24,262 | $0 | $147,305 | $0 | $21,241 | $0 | $599,344 | $0 | $0 | |
| Jocelyn Chertoff MD MS | ||||||||||||||
| Dept Chair Diagnost Radiology | $0 | $454,304 | $0 | $28,500 | $0 | $31,045 | $0 | $183,467 | $0 | $21,251 | $0 | $718,567 | $0 | $0 |
| Edward Catherwood MD MS | ||||||||||||||
| Former Key Emp/Ctr Dir Hrt/Vsc | $0 | $440,464 | $0 | $0 | $0 | $3,256 | $0 | $132,062 | $0 | $16,411 | $0 | $592,193 | $0 | $0 |
| Douglas Merrill | ||||||||||||||
| Center Director Periop Svs | $0 | $297,465 | $0 | $0 | $0 | $261,092 | $0 | $42,850 | $0 | $12,639 | $0 | $614,046 | $0 | $0 |
| Stephen Boyce | ||||||||||||||
| VP Ambulatory Care | $0 | $190,631 | $0 | $0 | $0 | $6,149 | $0 | $39,913 | $0 | $20,206 | $0 | $256,899 | $0 | $0 |
| Jeffrey OBrien | ||||||||||||||
| Fmr Key Emp/VP Oncology | $273,570 | $0 | $0 | $0 | $2,481 | $0 | $21,530 | $0 | $20,436 | $0 | $318,017 | $0 | $0 | $0 |
| Susan Reeves | ||||||||||||||
| VP Colby Sawyer Nursing | $288,501 | $0 | $0 | $0 | $28,984 | $0 | $111,170 | $0 | $18,017 | $0 | $446,672 | $0 | $0 | $0 |
| Elwood Leonard | ||||||||||||||
| VP Development | $296,367 | $0 | $0 | $0 | $6,975 | $0 | $39,208 | $0 | $18,078 | $0 | $360,628 | $0 | $0 | $0 |
| Richard J Powell MD | ||||||||||||||
| Trustee Eff 7/1/15 | $0 | $368,104 | $0 | $55,633 | $0 | $25,532 | $0 | $124,282 | $0 | $21,241 | $0 | $594,792 | $0 | $0 |
| Richard Rothstein MD | ||||||||||||||
| Trustee Eff 7/1/15 | $0 | $529,679 | $0 | $0 | $0 | $6,469 | $0 | $143,455 | $0 | $16,412 | $0 | $696,015 | $0 | $0 |
| Steven A Paris MD | ||||||||||||||
| Trustee Eff 7/1/15 | $0 | $329,589 | $0 | $0 | $0 | $27,982 | $0 | $100,968 | $0 | $16,361 | $0 | $474,900 | $0 | $0 |
| John Birkmeyer MD | ||||||||||||||
| Chf Clncl Offr/EVP Entprs Sup | $0 | $211,596 | $0 | $0 | $0 | $50,103 | $0 | $30,458 | $0 | $4,400 | $0 | $296,557 | $0 | $0 |
| Gay Landstrom PhD RN NEA-BC | ||||||||||||||
| Chf Nursing Offr Eff 9/28/14 | $219,611 | $0 | $50,000 | $0 | $11,831 | $0 | $21,842 | $0 | $6,059 | $0 | $309,343 | $0 | $0 | $0 |
| Kimberly Troland JD | ||||||||||||||
| General Counsel End 4/19/15 | $248,150 | $0 | $0 | $0 | $193 | $0 | $16,308 | $0 | $17,938 | $0 | $282,589 | $0 | $0 | $0 |
| Robert Greene MD MHCDS FACP | ||||||||||||||
| Chf Popul Mgmt Ofr Eff 7/28/14 | $0 | $219,696 | $0 | $150,000 | $0 | $4,410 | $0 | $20,150 | $0 | $7,081 | $0 | $401,337 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Supplemental Compensation Information | Form 990, Schedule J, Part I - Line 1a FROM TIME TO TIME, THE ORGANIZATION PROVIDES CHARTERED TRAVEL SERVICES TO THE CEO. THE COST OF PROVIDING THE CHARTERED SERVICE HAS BEEN DEEMED A COST-EFFICIENT MANNER TO ALLOW THE OFFICER TO WORK WHILE TRAVELLING VERSUS THE TIME LOST DRIVING, ETC. THIS EXPENSE HAS BEEN DEEMEND AN ORDINARY AND NECESSARY BUSINESS EXPENSE AND NON-TAXABLE TO THE RECIPIENT. ALL REQUESTS ARE APPROVED BEFORE PAYMENT TO ENSURE COMPLIANCE WITH INTERNAL POLICIES. The Organization has in place a Management Self Development Plan (MSDP) designed to promote professional and personal development. The MSDP is capped at 2% of gross pay and may be utilized for expenses such as professional dues, meetings and seminars, tuition reimbursement, and other miscellaneous items that promote professional knowledge. The monies may also be used for up to a 50% reimbursement of the cost of a fitness/wellness program designed to maintain the health of management personnel. All expenses are submitted for approval before reimbursement. |
| Severance Payments | Form 990, Schedule J, Part I Line 4a The following listed individuals received Severance and/or change in control payments during calendar year 2014: During 2012, Thomas Colacchio transitioned from an officer role to a staff physician role. As part of this transition, Thomas Colacchio received a multi-year $320,000 change of control payment from Dartmouth-Hitchcock in 2014. The payment is included on Schedule J, Part II, Column (B)iii. During calendar year 2014, Former Chief Human Resource Officer Alan Weston received a one-time $295,536 severance payment from Dartmouth-Hitchcock. The payment is included on Schedule J, Part II, Column (B)iii. Supplemental Nonqualified Retirement Plan: 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)): James Weinstein $82,952 Robin Kilfeather-Mackey $19,090 Linda Von Reyn $95,981 Daniel Jantzen $73,637 Stephen Leblanc $121,249 John Butterly $47,038 Jeanine Arden Ornt $19,862 Edward Merrens $17,745 George Blike $44,957 Mary Oseid $8,881 Barbara Walters $41,835 Bruce King $10,185 Susan Reeves $5,717 Lawrence Dacey $40,914 Thomas Colacchio $98,790 Clifford Belden $42,160 Richard Rothstein $4,911 Thomas Dodds $35,378 Wendy Wells $22,757 Jocelyn Chertoff $30,301 Edward Catherwood $3,256 Douglass Merrill $38,160 Jeffrey OBrien $2,000 Martin Purcell $15,468 Roderic Young $5,107 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. MHMH sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable MHMH 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 dwindle as individuals retire/leave the organization. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| New Hampshire Health and Education Facilities Auth | ||||||||
| A | 020279866 | 644614Y07 | 2009-08-19 | $134,661,088 | CURRENT REFUND 2008 (A), (B), (C) | false | false | false |
| New Hampshire Health and Education Facilities Auth | ||||||||
| B | 020279866 | 644614G29 | 2010-06-16 | $73,647,839 | CONSTR. OF FACILITY AND EQUIP. | false | false | false |
| New Hampshire Health and Education Facilities Auth | ||||||||
| C | 020279866 | 000000000 | 2011-08-31 | $38,119,624 | CURRENT REFUND 2001 (A) | false | false | false |
| New Hampshire Health and Education Facilities Auth | ||||||||
| D | 020279866 | 000000000 | 2012-11-28 | $116,170,000 | CURRENT REFUND 2002 | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $65,950,000 | $0 | $134,841,419 | $0 | $0 | $0 | $2,273,111 | $0 | $0 | $0 | $132,387,977 | $0 | 2010 | Yes (true) | false | Yes (true) | Yes (true) |
| B | $0 | $0 | $73,666,926 | $0 | $3,766,049 | $0 | $1,168,560 | $0 | $0 | $68,732,317 | $0 | $0 | 2012 | false | false | Yes (true) | Yes (true) |
| C | $4,002,041 | $0 | $38,119,624 | $0 | $0 | $0 | $97,500 | $0 | $0 | $0 | $38,022,124 | $0 | 2011 | Yes (true) | false | Yes (true) | Yes (true) |
| D | $1,990,000 | $0 | $116,170,000 | $0 | $0 | $0 | $520,000 | $0 | $0 | $0 | $115,650,000 | $0 | 2013 | Yes (true) | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Remedial Action TakenRemedialActionTakenInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | 0 | false | false | false | Yes (true) |
| B | false | false | false | false | 0 | false | false | false | Yes (true) |
| C | 0 | ||||||||
| D | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Business Name Line1GICProviderName/BusinessNameLine1Txt | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | |||||||||||||
| A | false | false | Yes (true) | false | false | false | false | 0 | false | Yes (true) | |||
| 0 | |||||||||||||
| B | false | false | false | Yes (true) | false | false | false | 0 | false | Yes (true) | |||
| Morgan Stanley | |||||||||||||
| C | false | Yes (true) | false | false | Yes (true) | Yes (true) | false | 0 | false | Yes (true) | 29.8 | Yes (true) | false |
| 0 | |||||||||||||
| D | false | Yes (true) | false | false | false | false | false | 0 | false | Yes (true) | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (true) |
| B | Yes (true) |
| C | Yes (true) |
| D | Yes (true) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part 1, Column F, Additional Information: | FormAndLineReferenceDesc |
| Explanation | Line A: Current Refund 2008 (A), Issued 9/4/2008, Which Advance Refunded 1985 Current Refund 2008 (B), Issued 10/31/2008, Which Advance Refunded 1993 Current Refund 2008 (C), Issued 12/19/2008 Line C: Current Refund 2001(A), Issued 10/17/2001, Which Advance Refunded 1997 & 1994 Part II Line 11, Column A, C, & D The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow Part IV, Line 2C, Column B The rebate calculation was performed on 6/17/2015 | ExplanationTxt |
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 Auth | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 000000000 | CUSIPNum |
| Bond Issued | 2014-08-13 | BondIssuedDt |
| Issue Price | $41,242,990 | IssuePriceAmt |
| Purpose | Refund Portion of 2009 Issued Date | 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 | $0 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $41,242,990 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $352,990 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $40,890,000 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| 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 | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| 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 | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | 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 | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| DANIEL JANTZEN | |||||||
| Officer | SPLIT DOLLAR LIFE | Yes (X) | $108,765 | $108,765 | false | Yes (true) | Yes (true) |
| Deborah Jantzen | |||||||
| Family Member | Split Dollar Life | Yes (X) | $53,425 | $53,425 | false | Yes (true) | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $162,190 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Hypertherm | |||
| Trustee Barbara Couch | $484,000 | See Part V | false |
| Vincent Fusca III | |||
| Officer Fusca II | $112,979 | Family member employed by MHMH | false |
| Garth Dunkel | |||
| Officer Fusca II | $17,662 | Family member employed by MHMH | false |
| Christopher Weston | |||
| Officer Alan Weston | $30,044 | Family member employed by DHC | false |
| Linda Billings | |||
| Former KE Mary Oseid | $103,824 | Family member employed by MHMH | false |
| Richard Alfred Powell | |||
| Trustee Powell | $59,234 | Family member employed by MHMH | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule L Part IV | FormAndLineReferenceDesc |
| Explanation | Name of Interested Person: Barbara Couch Relationship: Trustee Description of Transaction: Barbara Couch is a greater than 35% owner of Hypertherm, an entity that conducts business with MHMH. | ExplanationTxt |
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 | 24 | ContributionCnt |
| Noncash Contributions Rpt F990 | $682,435 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Fair Market Value | 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 | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (true) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule M, Part I, Column B | FormAndLineReferenceDesc |
| Explanation | The organization reported the number of contributions received in column (b). Use of related organizations to solicit noncash donations Line 32B The organization uses Dartmouth-Hitchcock Medical Center, a supporting Organization, for solicitation of contributions and annual fund activities. From time to time, the Hospital may receive non-cash contributions directly from its donors. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Business relationships | Form 990, Part VI, Section A, Line 2 Mary Hitchcock Memorial Hospital owns for-profit subsidiaries that provide services and support the mission of the organization. As a result, some officers of the Hospital also are officers of for-profit entities within the healthcare system. Description of classes of members, persons, and the nature of their rights Form 990, Part VI, Section A, Line 6 & 7a Dartmouth-Hitchcock Health (D-HH) is the sole corporate Member of Mary Hitchcock Memorial Hospital (MHMH). D-HH has specific authority and reserved powers, including the power to confirm the election of members of the MHMH's Board of Trustees and the power to approve significant governance, financial and operational decisions of MHMH'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 Hospital 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 MHMH's Board of Trustees, to appoint or remove a member of the Hospital's Board of Trustees, assess the Hospital a monetary amount for the payment of the expenses of D-HH, approve the Hospital's budget, approve the borrowings or dispositions of assets by the Hospital, 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 Hospital. |
| Process used by management and/or Governing Body to Review 990 | Form 990, Part VI, 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 Mary Hitchcock Memorial Hospital 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. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR UNDERTAKEN | Form 990, Part VI, Line 15a Although paid by a related organization, Dartmouth-Hitchcock Clinic, the Compensation for the President is evaluated by an independent third party firm for reasonableness and national data benchmarking. The 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 2014. |
| Offices & Positions for Which Process was Used & Year Undertaken | Form 990, Part VI, 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 2012. External benchmarking from an independent third party has been used for any Officer who was hired or received a compensation adjustment since the last process 2012. Compensation rates are determined by following the guidelines of the compensation committee charter and philosophy documents and/or a formal review by compensation committee members. |
| Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public | Form 990, Part VI, Line 19 MHMH'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 MHMH's and Dartmouth-Hitchcock Clinic'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, Hamden Risk Retention Group, and Everwell, Inc., and related hospitals: Mount Ascutney Hospital and Health Center, Cheshire Medical Center, and New London Hospital. 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-related changes: ($20,938,391) Unrealized Gain/Loss on Hedge and other ($676,689) Total changes in net assets: ($21,615,080) Audited Financial Statements Form 990 Part XII, Line 2d The organization's financial information is included in the audited financial statements of Dartmouth-Hitchcock Health and Subsidiaries, which consists of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, Mount Ascutney Hospital and Health Center, Cheshire Medical Center, New London Hospital, and subsidiaries. |
| A-133 Audit | Form 990 Part XII, Line 3A DURING FISCAL YEAR 2015, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE MINIMUM THRESHOLD 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 MARY HITCHCOCK MEMORIAL HOSPITAL. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| NEW ENGLAND ALLIANCE FOR HEALTH LLC | |||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 264232401 | HLTH IMPROVMT | NH | $4,726 | $1,729,900 | MHMH |
| D-H Specialty Services LLC | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 460876427 | Shd Svgs Prgm | NH | $0 | $0 | MHMH |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| DARTMOUTH-HITCHCOCK CLINIC | ||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 222519596 | PHYSICIAN SVC | NH | 501(c)(3) | 9 | D-HH | Yes (true) |
| DARTMOUTH-HITCHCOCK MEDICAL CENTER | ||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 222715483 | SUPPORTNG ORG | NH | 501(c)(3) | 11 TYPE I | NA | Yes (true) |
| DARTMOUTH - HITCHCOCK HEALTH | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 264812335 | SUPPORTNG ORG | NH | 501(C)(3) | 7 | NA | false |
| HAMDEN RISK RETENTION GROUP INC | ||||||||||
| 30 MAIN STREET STE 330 | BURLINGTON | VT | 05401 | 208530788 | Self Ins | VT | 501(c)(3) | 11 TYPE I | DHC | Yes (true) |
| The Hitchcock Foundation | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222139 | HLTHCRE RSRCH | NH | 501(c)(3) | 7 | DHC | Yes (true) |
| EverWell Inc | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 352506275 | Supportng Org | NH | 501(c)(3) | 11 Type I | NA | Yes (true) |
| The New London Hospital Association Inc | ||||||||||
| 273 County Rd | New London | NH | 03257 | 020222171 | Hospital | NH | 501(c)(3) | 3 | D-HH | Yes (true) |
| Windsor Hospital Association | ||||||||||
| 289 Country Road | Windsor | VT | 05089 | 030183721 | Hospital | VT | 501(C)(3) | 3 | D-HH | Yes (true) |
| Cheshire Medical Center | ||||||||||
| 580 Court Street | Keene | NH | 03431 | 020354549 | Hospital | NH | 501(C)(3) | 3 | D-HH | Yes (true) |
| Cheshire Health Foundation | ||||||||||
| 580 Court Street | Keene | NH | 03431 | 020202220 | SUPPORTNG ORG | NH | 501(C)(3) | 11, TYPE II | CMC | Yes (true) |
| Mt Ascutney Hosp Cmmty Hlth Found | ||||||||||
| 289 Country Road | Windsor | VT | 05089 | 030300481 | Foundation | VT | 501(c)(3) | 3 | WHA | Yes (true) |
| Historic Homes of Runnemede | ||||||||||
| 289 County Road | Windsor | VT | 05089 | 237396147 | Healthcare | VT | 501(c)(3) | 9 | WHA | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| D-H Mster Invst Prg | ||||||||||||||
| 1 Med Ctr Dr | LEBANON | NH | 03756 | 020205863 | POOLED INVEST | NH | MHMH | Excluded | $22,766,096 | $524,681,801 | false | $214,519 | Yes (true) | 0.93234 |
| KEENE HLTH ALLIANCE | ||||||||||||||
| 580 Court St | Keene | NH | 03431 | 300179297 | Healthcare | NH | NA | |||||||
| Obnet Services LLC | ||||||||||||||
| 1 Med Ctr Dr | Lebanon | NH | 03756 | 043746287 | Database Serv | NH | NA | |||||||
| One Care VT ACOLLC | ||||||||||||||
| 111 COLCHESTER AVE | Burlington | VT | 05401 | 455399218 | Shared Saving | VT | NA | |||||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | EINEIN | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Charit Remndr Unitrusts (5) | |||||||||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | Chart. Trust | NH | MHMH | TRUST | Yes (true) | |||||||||
| Pompanoosuc Investment Corp | |||||||||||||||||
| 1 Medical Ctr Dr | Lebanon | NH | 03756 | Real Est Hldg | NH | DHC | C Corporation | Yes (true) | 020352330 | ||||||||
| Hamden Assurance Co Ltd | |||||||||||||||||
| Liab. Insuanc | DHC | Foreign Corp | Yes (true) | 980121409 | 44 Church St | Hamilton | BD | HM 12 | BD | $0 | $2,878,669 | 0.25800 | |||||
| Hitchcock Health Connect | |||||||||||||||||
| 1 Medical Ctr Dr | Lebanon | NH | 03756 | Telehealth | DE | D-HH | C Corp | Yes (true) | 800908979 | ||||||||
| Kearsarge Community Services Inc | |||||||||||||||||
| 273 County Road | New London | NH | 03257 | Real Est Hldg | NH | NLH | C Corp | Yes (true) | 020460136 | ||||||||
| New London Physician Group Inc | |||||||||||||||||
| Physician Gro | NH | NLH | C Corp | Yes (true) | 020494420 | ||||||||||||
| New London Medical Center East | |||||||||||||||||
| 273 County Road | New London | NH | 03257 | Real Est Hldg | NH | NLH | C Corp | Yes (true) | 020480857 | ||||||||
| Keene Health Services | |||||||||||||||||
| 580 Court Street | Keene | NH | 03431 | Real Est Hldg | NH | CMC | C Corp | Yes (true) | 020374997 | ||||||||
| Keene Health Realty | |||||||||||||||||
| 580 Court Street | Keene | NH | 03431 | Real Est Hldg | NH | CMC | C Corp | Yes (true) | 020374998 | ||||||||
| Keene Health Enterprises | |||||||||||||||||
| 580 Court Street | Keene | NH | 03431 | Real Est Hldg | NH | CMC | C Corp | Yes (true) | 020374999 | ||||||||
| Cheshire Health Services | |||||||||||||||||
| 580 Court St | Keene | NH | 03431 | HEALTHCARE | NH | CMC | C COPR | Yes (true) | 473379283 | ||||||||
| 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 | false | 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 | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Dartmouth-Hitchcock Clinic | ||
| JKLMN | $29,325,261 | FMV |
| Dartmouth-Hitchcock Medical Center | ||
| M | $2,135,230 | FMV |
| Hamden Risk Retention Group | ||
| O | $5,373,734 | FMV |
| The Hitchcock Foundation | ||
| Q | $15,573 | FMV |
| The Hitchcock Foundation | ||
| P | $37,145 | FMV |
| The New London Hospital Association | ||
| Q | $1,935,251 | FMV |
| Windsor Hospital Association | ||
| Q | $1,410,072 | FMV |
| Cheshire Medical Center | ||
| Q | $2,808,969 | FMV |
| The Hitchcock Foundation | ||
| C | $99,071 | FMV |