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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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-16T11:28:47-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PRICEWATERHOUSECOOPERS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SEAPORT BLVDAddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02210ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020222140EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% ROBIN KILFEATHER-MACKEYInCareOfNm
Business Name ControlMARYBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRobin Kilfeather-MackeyPersonNm
Person TitleCFOPersonTitleTxt
Signature2015-05-13SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonPaul TanisPreparerPersonNm
PTINP01441612PTIN
Phone6175305000PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJames Weinstein DO MSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,103,321,593GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.dartmouth-hitchcock.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1889FormationYr
Legal Domicile StateNHLegalDomicileStateCd
Activity Or MissionAdvancing Health Through Research, Education, Clinical Practice, Community Partnerships, providing each person the best care in the right place, at the right time, every timeActivityOrMissionDesc
Voting Members Governing Body20VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee5780TotalEmployeeCnt
Total Volunteers480TotalVolunteersCnt
Total Gross UBI$4,012,573TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$502,506NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$20,984,972PYContributionsGrantsAmt
CY Contributions Grants$5,075,715CYContributionsGrantsAmt
PY Program Service Revenue$892,093,711PYProgramServiceRevenueAmt
CY Program Service Revenue$908,783,191CYProgramServiceRevenueAmt
PY Investment Income$17,100,684PYInvestmentIncomeAmt
CY Investment Income$17,620,625CYInvestmentIncomeAmt
PY Other Revenue$57,253,892PYOtherRevenueAmt
CY Other Revenue$47,796,806CYOtherRevenueAmt
PY Total Revenue$987,433,259PYTotalRevenueAmt
CY Total Revenue$979,276,337CYTotalRevenueAmt
PY Grants And Similar Paid$5,272,967PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,947,820CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$576,706,269PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$602,661,971CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$2,159,116CYTotalFundraisingExpenseAmt
PY Other Expenses$354,233,094PYOtherExpensesAmt
CY Other Expenses$377,996,999CYOtherExpensesAmt
PY Total Expenses$936,212,330PYTotalExpensesAmt
CY Total Expenses$982,606,790CYTotalExpensesAmt
PY Revenues Less Expenses$51,220,929PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$3,330,453CYRevenuesLessExpensesAmt
Total Assets BOY$1,331,158,473TotalAssetsBOYAmt
Total Assets EOY$1,294,964,551TotalAssetsEOYAmt
Total Liabilities BOY$689,440,250TotalLiabilitiesBOYAmt
Total Liabilities EOY$696,007,861TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$641,718,223NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$598,956,690NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$795,956,490ExpenseAmt
Grant$1,947,820GrantAmt
Revenue$925,032,743RevenueAmt
DescMary 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

FieldValueIRS element (for citing)
Expense$43,249,817ExpenseAmt
Revenue$24,839,995RevenueAmt
DescAs 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
FieldValueIRS element (for citing)
Total Program Service Expenses$839,206,307TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficeYes (true)ForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1046IRPDocumentCnt
IRP Document W2 G3IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee5780EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountYes (true)ForeignFinancialAccountInd
Foreign CountryBDForeignCountryCd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members20GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldNHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonROBIN KILFEATHER-MACKEYPersonNm
Phone6036505634PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (66 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Jennie L Norman
Trustee/Board Sec End 12/31/141.52.5Yes (X)Yes (X)$0$0$0
Hugh C Smith MD
Trustee End 12/31/140.751.25Yes (X)$0$0$0
Vincent S Conti MHA
Trustee0.751.25Yes (X)$0$0$0
Anne-Lee Verville
Trustee0.751.25Yes (X)$0$0$0
Barbara Couch MS
Trustee/Board Sec Eff 1/1/150.751.25Yes (X)Yes (X)$0$0$0
Wiley Souba MD ScD
Trustee/Ex-Officio End 6/30/140.751.26Yes (X)$0$0$0
William J Conaty
Trustee0.751.25Yes (X)$0$0$0
William W Helman IV
Trustee End 9/30/140.751.26Yes (X)$0$0$0
Robert A Oden Jr PhD
Trustee/Board Chair1.52.5Yes (X)Yes (X)$0$0$0
James N Weinstein DO MS
Trustee Ex-Officio/CEO38.023.01Yes (X)Yes (X)$0$1,229,653$225,752
Michael J Goran MD
Trustee End 12/31/140.751.25Yes (X)$0$0$0
Denis A Cortese MD
Trustee0.751.25Yes (X)$0$0$0
Matthew B Dunne
Trustee0.751.25Yes (X)$0$0$0
Senator Judd A Gregg
Trustee0.750.75Yes (X)$0$0$0
Laura K Landy MBA
Trustee0.751.25Yes (X)$0$0$0
Paul P Danos PhD
Trustee/Brd Treasurer1.52.5Yes (X)Yes (X)$0$0$0
Barbara C Jobst MD
Trustee0.750.75Yes (X)$0$0$0
Troyen Brennan MD MPH
Trustee Eff 4/1/150.751.25Yes (X)$0$0$0
R William Burgess Jr MBA
Trustee Eff 1/1/150.751.25Yes (X)$0$0$0
Duane A Compton PhD
Trustee/Ex-Officio Eff 7/15/140.751.56Yes (X)$0$0$0
M Brooke Herndon MD MS
Trustee Eff 3/20/150.750.75Yes (X)$0$0$0
Charles G Plimpton MBA
Trustee Eff 4/1/150.751.25Yes (X)$0$0$0
Richard J Powell MD
Trustee Eff 7/1/1528.012.8Yes (X)$0$449,269$145,523
Richard Rothstein MD
Trustee Eff 7/1/1528.012.0Yes (X)$0$536,148$159,867
Steven A Paris MD
Trustee Eff 7/1/1528.012.51Yes (X)$0$357,571$117,329
Robin Kilfeather-Mackey CPA
Chief Financial Officer37.024.01Yes (X)$0$520,432$214,698
Daniel Jantzen CPA
Chief Operating Officer41.020.0Yes (X)$604,478$0$210,934
Stephen Leblanc
Exec VP Strtgy & Ntwrk Rltns15.045.01Yes (X)$0$602,197$269,589
Vincent Fusca III
Chief of Staff28.012.0Yes (X)$308,695$0$22,752
Edward Merrens MD
Chief Medical Officer28.012.0Yes (X)$0$386,917$94,435
George Blike MD
Chief Quality & Value Officer28.012.0Yes (X)$0$447,955$263,509
Darlene A Saler
Actg Chf Nrsg Ofr End 9/27/1441.019.0Yes (X)$170,680$0$117,273
John S Malanowski MILR
Chief HR Officer41.019.0Yes (X)$446,455$0$54,754
Clifford J Belden MD
CHF CLNCL OFCR END 6/22/1528.012.0Yes (X)$0$710,709$55,414
Terrence P Carroll PHD
Chief Innovation Officer28.012.0Yes (X)$641,630$0$53,393
John Birkmeyer MD
Chf Clncl Offr/EVP Entprs Sup37.023.0Yes (X)$0$261,699$34,858
Gay Landstrom PhD RN NEA-BC
Chf Nursing Offr Eff 9/28/1441.019.0Yes (X)$281,442$0$27,901
Kimberly Troland JD
General Counsel End 4/19/1537.023.0Yes (X)$248,343$0$34,246
Robert Greene MD MHCDS FACP
Chf Popul Mgmt Ofr Eff 7/28/1441.019.0Yes (X)$0$374,106$27,231
John Kacavas JD
General Counsel Eff 4/20/1541.019.0Yes (X)$0$0$0
Christine Schon
V.P Comm. Grp. Pract. Ops28.012.01$0$227,406$58,292Yes (X)
Gail Dahlstrom
V.P. Facilities Mgmt41.019.0$230,720$0$102,141Yes (X)
Tina Naimie CPA
VP Corporate Finance28.013.5$222,873$0$25,900Yes (X)
Wendy Fielding
VP Financial Planning28.012.0$220,559$0$57,824Yes (X)
Wendy Wells MD
Dept. Chair Pathology28.012.0$0$430,798$168,546Yes (X)
Jocelyn Chertoff MD MS
Dept Chair Diagnost Radiology28.012.0$0$513,849$204,718Yes (X)
Douglas Merrill
Center Director Periop Svs28.012.0$0$558,557$55,489Yes (X)
Stephen Boyce
VP Ambulatory Care28.012.0$0$196,780$60,119Yes (X)
Bruce King
Pres & CEO New London Hosp0.050.0$351,565$0$183,662Yes (X)
Roderic Young
VP Communications & Marketing28.012.0$301,316$0$45,714Yes (X)
Martin Purcell
VP IS Operations28.012.0$309,514$0$130,615Yes (X)
Susan Reeves
VP Colby Sawyer Nursing28.08.0$317,485$0$129,187Yes (X)
Elwood Leonard
VP Development28.012.0$303,342$0$57,286Yes (X)
Carl Dematteo MD
Fmr Chf Ql Compl Ofr/Physician28.012.0$0$114,301$2,381Yes (X)
Linda Von Reyn
Fmr Chf Nursng Officer41.019.0$230,017$0$104,641Yes (X)
John Butterly MD
Fmr Offr/Exec VP Med Affairs8.032.0$0$552,569$72,826Yes (X)
Lawrence Dacey MD
Former CMO/ Phys26.713.3$0$132,136$242,566Yes (X)
Alan Weston
Fmr Chief HR Officer41.019.0$295,536$0$0Yes (X)
Jeanine Arden-Ornt
Fmr General Counsel37.024.0$361,457$0$42,717Yes (X)
Thomas Colacchio MD
Former Officer/Phys28.013.0$0$1,067,539$130,947Yes (X)
Mary Oseid
Fmr Key Emp/VP Enterprise Svcs28.012.0$0$374,245$240,234Yes (X)
Barbara Walters DO MBA
Fmr Key Emp/Med Dir Acct Care22.010.0$0$329,833$21,631Yes (X)
Mary Kay Boudewyns
Fmr Key Emp/Adm Dir Rev Mgmt28.012.0$213,992$0$129,667Yes (X)
Thomas Dodds MD
Former Key Emp/Dept Chr Anesth28.012.0$0$535,557$231,969Yes (X)
Edward Catherwood MD MS
Former Key Emp/Ctr Dir Hrt/Vsc28.012.0$0$443,720$148,473Yes (X)
Jeffrey OBrien
Fmr Key Emp/VP Oncology28.012.0$276,051$0$41,966Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$6,336,150TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$11,353,946TotReportableCompRltdOrgAmt
Total Other Compensation$4,818,969TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K324IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
TRUSTEES OF DARTMOUTH COLLEGE
37 DEWEY FIELDHANOVERNH03755ADMIN & DIR SUPPORT$31,647,452
Cross Country Staffing
PO Box 404674ATLANTAGA303844674Staffing Services$10,053,381
Accretive Health
401 N Michigan Ave Ste 2700CHICAGOIL60611REVENUE MGMT$8,304,381
Towers Watson Delaware Inc
800 Boylston StBOSTONMA02199Employee Benefits$3,713,533
Turner Construction
Two Seaport LaneBOSTONMA02210Construction Svcs$45,504,496
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K95CntrctRcvdGreaterThan100KCnt
Government Grants$3,932,320GovernmentGrantsAmt
All Other Contributions$1,143,395AllOtherContributionsAmt
Noncash Contributions$682,435NoncashContributionsAmt
Total Contributions$5,075,715TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE621110$902,108,753$901,494,418$614,335
RESEARCH RELATED ACTIVITIES621110$6,674,438$6,674,438
FieldValueIRS element (for citing)
Total Program Service Revenue$908,783,191TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,805,488TotalRevenueColumnAmt
Unrelated Business Revenue$214,519UnrelatedBusinessRevenueAmt
Exclusion$4,590,969ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,145,093RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$608,907RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$536,186RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$536,186TotalRevenueColumnAmt
Exclusion$536,186ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$135,708,724SecuritiesAmt
Other$542,762OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$123,272,564SecuritiesAmt
Other$163,785OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$12,436,160SecuritiesAmt
Other$378,977OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,815,137TotalRevenueColumnAmt
Exclusion$12,815,137ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
PHARMACY INCOME621110$21,795,010$21,636,817$158,193
CAFETERIA INCOME621110$2,987,354$2,987,354
OTHER ALLOCATED INCOME611710$22,478,256$19,452,730$3,025,526
FieldValueIRS element (for citing)
Other Revenue Total$47,260,620OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$979,276,337TotalRevenueColumnAmt
Related Or Exempt Func Income$949,258,403RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$4,012,573UnrelatedBusinessRevenueAmt
Exclusion$20,929,646ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,162,906TotalAmt
Program Services$1,162,906ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$784,914TotalAmt
Program Services$784,914ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$10,367,083TotalAmt
Program Services$2,574,405ProgramServicesAmt
Management And General$7,610,905ManagementAndGeneralAmt
Fundraising$181,773FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$4,948,969TotalAmt
Program Services$4,948,969ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$453,106,031TotalAmt
Program Services$375,993,776ProgramServicesAmt
Management And General$77,107,156ManagementAndGeneralAmt
Fundraising$5,099FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$39,428,081TotalAmt
Program Services$32,824,049ProgramServicesAmt
Management And General$6,604,022ManagementAndGeneralAmt
Fundraising$10FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$63,172,879TotalAmt
Program Services$52,515,141ProgramServicesAmt
Management And General$10,657,721ManagementAndGeneralAmt
Fundraising$17FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$31,638,928TotalAmt
Program Services$26,339,545ProgramServicesAmt
Management And General$5,299,375ManagementAndGeneralAmt
Fundraising$8FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,080,956TotalAmt
Program Services$62,447ProgramServicesAmt
Management And General$2,018,509ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$490,727TotalAmt
Management And General$490,727ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$41,400TotalAmt
Program Services$41,400ProgramServicesAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$57,550,137TotalAmt
Program Services$47,011,686ProgramServicesAmt
Management And General$10,538,451ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,961,146TotalAmt
Program Services$20,381ProgramServicesAmt
Management And General$2,940,765ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$7,172,318TotalAmt
Program Services$4,824,887ProgramServicesAmt
Management And General$2,347,362ManagementAndGeneralAmt
Fundraising$69FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$7,938,656TotalAmt
Program Services$7,065,404ProgramServicesAmt
Management And General$873,252ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$13,623,761TotalAmt
Program Services$12,078,931ProgramServicesAmt
Management And General$1,544,830ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$3,535,387TotalAmt
Program Services$1,650,551ProgramServicesAmt
Management And General$1,884,836ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$70,881TotalAmt
Program Services$69,123ProgramServicesAmt
Management And General$1,758ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$13,212,880TotalAmt
Program Services$11,759,463ProgramServicesAmt
Management And General$1,453,417ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$39,956,680TotalAmt
Program Services$35,558,959ProgramServicesAmt
Management And General$4,397,721ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,518,309TotalAmt
Program Services$3,518,309ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement 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

FieldValueIRS element (for citing)
Total$23,193,499TotalAmt
Program Services$17,146,575ProgramServicesAmt
Management And General$4,074,784ManagementAndGeneralAmt
Fundraising$1,972,140FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$982,606,790TotalAmt
Program Services$839,206,307ProgramServicesAmt
Management And General$141,241,367ManagementAndGeneralAmt
Fundraising$2,159,116FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$193,761BOYAmt
EOY$115,693EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$44,744,859BOYAmt
EOY$10,175,102EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,000,000BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$145,452,357BOYAmt
EOY$125,676,961EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$438,160BOYAmt
EOY$313,922EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,092,351BOYAmt
EOY$806,671EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$14,174,352BOYAmt
EOY$15,427,916EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$8,055,419BOYAmt
EOY$7,906,477EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$963,834,764LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$536,521,721LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$407,066,625BOYAmt
EOY$427,313,043EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$280,390,609BOYAmt
EOY$325,346,264EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$331,518,264BOYAmt
EOY$254,702,840EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$4,385,931BOYAmt
EOY$8,808,343EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$88,645,785BOYAmt
EOY$118,371,319EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,331,158,473BOYAmt
EOY$1,294,964,551EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$123,803,858BOYAmt
EOY$125,289,886EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$412,543BOYAmt
EOY$465,950EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$343,068,534BOYAmt
EOY$335,292,116EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$148,038,569BOYAmt
EOY$147,351,381EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$74,116,746BOYAmt
EOY$87,608,528EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$689,440,250BOYAmt
EOY$696,007,861EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$555,516,650BOYAmt
EOY$519,605,834EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$57,291,018BOYAmt
EOY$50,053,367EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$28,910,555BOYAmt
EOY$29,297,489EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$641,718,223BOYAmt
EOY$598,956,690EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,331,158,473BOYAmt
EOY$1,294,964,551EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$3,330,453ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$17,816,000NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$21,615,080OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementYes (true)PaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (true)DirectContactLegislatorsInd
Direct Contact Legislators$165,290DirectContactLegislatorsAmt
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$73,062OtherActivitiesAmt
Total Lobbying Expenditures$238,352TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
LOBBYING ACTIVITY EXPLANATIONFORM 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 1IMHMH 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

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$74,609,411BeginningYearBalanceAmt
Contributions$208,107ContributionsAmt
Investment Earnings Or Losses-$516,882InvestmentEarningsOrLossesAmt
Other Expenditures$1,580,301OtherExpendituresAmt
End Year Balance$72,720,335EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,935,134BeginningYearBalanceAmt
Contributions$17,029,356ContributionsAmt
Investment Earnings Or Losses$3,029,123InvestmentEarningsOrLossesAmt
Grants Or Scholarships$16,800GrantsOrScholarshipsAmt
Other Expenditures$1,648,675OtherExpendituresAmt
End Year Balance$73,328,138EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$57,050,185BeginningYearBalanceAmt
Contributions$188,155ContributionsAmt
Investment Earnings Or Losses-$357,053InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,322GrantsOrScholarshipsAmt
Other Expenditures$1,940,831OtherExpendituresAmt
End Year Balance$54,935,134EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,023,225BeginningYearBalanceAmt
Contributions$30,717ContributionsAmt
Investment Earnings Or Losses$3,834,255InvestmentEarningsOrLossesAmt
Grants Or Scholarships$15,000GrantsOrScholarshipsAmt
Other Expenditures$823,012OtherExpendituresAmt
End Year Balance$57,050,185EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,110,647BeginningYearBalanceAmt
Contributions$398,541ContributionsAmt
Investment Earnings Or Losses$842,732InvestmentEarningsOrLossesAmt
Other Expenditures$1,328,695OtherExpendituresAmt
End Year Balance$54,023,225EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.29622BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.52720PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.17658TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$40,738,341OtherCostOrOtherBasisAmt
Book Value$40,738,341BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$484,087,239OtherCostOrOtherBasisAmt
Depreciation$270,348,317DepreciationAmt
Book Value$213,738,922BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,130,597OtherCostOrOtherBasisAmt
Depreciation$3,615,129DepreciationAmt
Book Value$515,468BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$390,849,622OtherCostOrOtherBasisAmt
Depreciation$262,558,275DepreciationAmt
Book Value$128,291,347BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$44,028,965OtherCostOrOtherBasisAmt
Book Value$44,028,965BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$427,313,043TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
FIXED INCOME$92,652,896F
PRIVATE EQUITIES$30,475,622F
HEDGE FUNDS$49,689,467F
OTHER INVESTMENTS$81,884,855F
FieldValueIRS element (for citing)
Total Book Value Securities$254,702,840TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook 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
FieldValueIRS element (for citing)
Total Book Value Other Assets$118,371,319TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
THIRD PARTY SETTLEMENTS$26,960,967
ACCRUED POST RETMNT PENS & MED$52,436,110
INTEREST RATE SWAP$8,211,451
FieldValueIRS element (for citing)
Total Liability$87,608,528TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceIntended use of Endowment FundsFormAndLineReferenceDesc
ExplanationForm 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)

RegionRegionTxtType Of Activities ConductedTypeOfActivitiesConductedTxtSpecific Services ProvidedSpecificServicesProvidedTxtRegion Total ExpendituresRegionTotalExpendituresAmtEmployeeEmployeeCnt
East Asia and the PacificProgram ServicesEducational Travel Exp$241
Europe (Including Iceland and Greenland)Program ServicesDues$310
Europe (Including Iceland and Greenland)Program ServicesHonorarium Payments$1,370
Europe (Including Iceland and Greenland)Program ServicesSoftware$8,207
Europe (Including Iceland and Greenland)Program ServicesInsurance$103,500
Europe (Including Iceland and Greenland)Program ServicesTravel$26,428
Europe (Including Iceland and Greenland)Program ServicesPublications$2,908
North AmericaProgram ServicesHonorarium Payments$815
North AmericaProgram ServicesLicense$1,570
North AmericaProgram ServicesSoftware$5,765
North AmericaProgram ServicesOffice Equipment$113,320
North AmericaProgram ServicesTravel$32,283
North AmericaProgram ServicesServices$23,294
North AmericaProgram ServicesPublications$752
North AmericaProgram ServicesWaste$70
North AmericaProgram ServicesStudies Book$3,450
North AmericaProgram ServicesOutdoor Lighting$405
North AmericaProgram ServicesActivities Supplies$185
Middle East and North AfricaProgram ServicesSoftware$9,522
South AmericaProgram ServicesTravel$646
Central America and the CaribbeanProgram ServicesTravel$5,383
South AmericaProgram ServicesMedical Services$16,4066
South AsiaProgram ServicesMedical Services$1,1051
East Asia and the PacificProgram ServicesMedical Services$9,0832
Central America and the CaribbeanProgram ServicesMedical Services$3,4253
Sub-Saharan AfricaProgram ServicesMedical Services$494,0637
Central America and the CaribbeanInvestmentsInv in Ins Captive$2,878,669
FieldValueIRS element (for citing)
Continutation Total Employee19ContinutationTotalEmployeeCnt
Total Employee19TotalEmployeeCnt
Subtotal Spent$324,688SubtotalSpentAmt
Continuation Spent$3,418,487ContinuationSpentAmt
Total Spent$3,743,175TotalSpentAmt
Transfer To Foreign CorpYes (true)TransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipYes (true)ForeignCorpOwnershipInd
Passive Foreign Investmest CoYes (true)PassiveForeignInvestmestCoInd
Foreign PartnershipYes (true)ForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other225.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,504,394TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,504,394NetCommunityBenefitExpnsAmt
Total Expense0.01070TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$163,787,802TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$61,489,942DirectOffsettingRevenueAmt
Net Community Benefit Expns$102,297,860NetCommunityBenefitExpnsAmt
Total Expense0.10410TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$174,292,196TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$61,489,942DirectOffsettingRevenueAmt
Net Community Benefit Expns$112,802,254NetCommunityBenefitExpnsAmt
Total Expense0.11480TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,616,956TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,828,448DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,788,508NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$41,697,435TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$12,258,261DirectOffsettingRevenueAmt
Net Community Benefit Expns$29,439,174NetCommunityBenefitExpnsAmt
Total Expense0.03000TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,790,076TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$273,855DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,516,221NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,607,916TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$21,594DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,586,322NetCommunityBenefitExpnsAmt
Total Expense0.00360TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,650,468TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,650,468NetCommunityBenefitExpnsAmt
Total Expense0.00370TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$54,362,851TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,382,158DirectOffsettingRevenueAmt
Net Community Benefit Expns$39,980,693NetCommunityBenefitExpnsAmt
Total Expense0.04090TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$228,655,047TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$75,872,100DirectOffsettingRevenueAmt
Net Community Benefit Expns$152,782,947NetCommunityBenefitExpnsAmt
Total Expense0.15570TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,350TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,350NetCommunityBenefitExpnsAmt

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$638,873TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$477,970DirectOffsettingRevenueAmt
Net Community Benefit Expns$160,903NetCommunityBenefitExpnsAmt

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$49,788TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$49,788NetCommunityBenefitExpnsAmt

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$14,594TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$14,594NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$713,605TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$477,970DirectOffsettingRevenueAmt
Net Community Benefit Expns$235,635NetCommunityBenefitExpnsAmt
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$9,436,077BadDebtExpenseAmt
Reimbursed By Medicare$269,468,394ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$295,037,671CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$25,569,277MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.dartmouth-hitchcock.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Childrens HospitalYes (X)ChildrensHospitalInd
Teaching HospitalYes (X)TeachingHospitalInd
Research FacilityYes (X)ResearchFacilityInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherPsych Unit and Transplant Unit Cancer CenterOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mary Hitchcock Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLPlease see Section C, Supplemental InfoOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt12ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLPlease see Section C, Supplemental InfoStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care225.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSee Section C, Supplemental InfoFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSee Section C, Supplemental InfoFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSee Sect. C, Spplmntl InfoFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
None MadeYes (X)NoneMadeInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Sch H, Part V, Section B Line 3Input 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-CThe 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 ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Schedule H, Part I, Line 3cOther 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 7Costing 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 7GSubsidized 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 IICommunity 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 3Bad 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 4Audited 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 8Medicare 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 9bCredit 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 2Needs 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 3Patient 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 5Promotion 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 6Affiliated 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 7State 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

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (14 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescPurpose Of GrantPurposeOfGrantTxt
Granite State United Way
46 South Main StConcordNH03301026006033501(c)(3)$18,630FMVProgram Support
David's House
461 Mount Support RdLebanonNH03766222593431501(C)(3)$22,770FMVProgram Support
Mascoma Valley Health Initiative
PO Box 2013CanaanNH03741752991608501(C)(3)$11,385FMVHlth Adv Cnsl Sppt S
The Trustees of Dartmouth College
1 Rope Ferry RoadHanoverNH03755020222111501(C)(3)$690,000FMVEduc and Prog Suppt
Advance Transit
PO Box 1027WilderVT05088222558708501(C)(3)$75,060FMVTransportn Subsidy
Upper Valley Transportation MGMT Assoc
195 No Main StWhite River JctVT05001030355283501(C)(3)$10,350FMVTransportn Subsidy
March of Dimes- NH Chapter
25 Lowell St Ste 304ManchesterNH03101131846366501(c)(3)$9,574FMVProgram Support
Southwestern VT Health Care
100 Hospital Dr BOX 41BenningtonVT05201030179435501(c)(3)$12,938FMVProgram Support
City Year NH Pledge
287 Columbus AvenueBostonMA02116222882549501(c)(3)$17,250FMVProgram Support
Indian Stream Health Center
2 Corliss Ln Rr2 Box 14ColebrookNH03576200999212501(c)(3)$34,500FMVProgram Sponsor
American Cancer Society
250 Williams Street NWAtlantaGA30303131788491501(c)(3)$11,644FMVProgram Support
American Heart Association
7272 Greenville AvenueDallasTX75231135613797501(c)(3)$7,763FMVProgram Support
Daniel Webster Council
571 Holt AveManchesterNH03109020222115501(c)(3)$5,693FMVProgram Support
University of NH School of Law
2 White StConcordNH03301020332032501(c)(3)$10,350FMVProgram Support
FieldValueIRS element (for citing)
Total501c3 Org14Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (10 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDesc
E. Hintze Nursing Awards2$1,894FMV
Levine Nursing Awards10$35,531FMV
Patterson Awards19$10,284FMV
The Trustees of Dartmouth College13$136,239FMV
Knox Awards13$22,120FMV
Prouty Awards39$24,277FMV
Daniels Awards9$6,167FMV
Waterman Awards4$13,315FMV
D-H Tuition Reimbursement Program604$507,494FMV
Varnum Nursing Awards43$27,593FMV

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceDescription of Organization's Procedures for Monitoring the Use of GrantsFormAndLineReferenceDesc
ExplanationForm 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

FieldValueIRS element (for citing)
First Class Or Charter TravelYes (X)FirstClassOrCharterTravelInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (44 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp 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 ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Supplemental Compensation InformationForm 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 PaymentsForm 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 ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
New Hampshire Health and Education Facilities Auth
A020279866644614Y072009-08-19$134,661,088CURRENT REFUND 2008 (A), (B), (C)falsefalsefalse
New Hampshire Health and Education Facilities Auth
B020279866644614G292010-06-16$73,647,839CONSTR. OF FACILITY AND EQUIP.falsefalsefalse
New Hampshire Health and Education Facilities Auth
C0202798660000000002011-08-31$38,119,624CURRENT REFUND 2001 (A)falsefalsefalse
New Hampshire Health and Education Facilities Auth
D0202798660000000002012-11-28$116,170,000CURRENT REFUND 2002falsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$65,950,000$0$134,841,419$0$0$0$2,273,111$0$0$0$132,387,977$02010Yes (true)falseYes (true)Yes (true)
B$0$0$73,666,926$0$3,766,049$0$1,168,560$0$0$68,732,317$0$02012falsefalseYes (true)Yes (true)
C$4,002,041$0$38,119,624$0$0$0$97,500$0$0$0$38,022,124$02011Yes (true)falseYes (true)Yes (true)
D$1,990,000$0$116,170,000$0$0$0$520,000$0$0$0$115,650,000$02013Yes (true)falseYes (true)Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
Afalsefalsefalsefalse0falsefalsefalseYes (true)
Bfalsefalsefalsefalse0falsefalsefalseYes (true)
C0
D0

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1TxtGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsIndTerm Of HedgeTermOfHedgePctSuperintegrated HedgeSuperintegratedHedgeIndHedge TerminatedHedgeTerminatedInd
0
AfalsefalseYes (true)falsefalsefalsefalse0falseYes (true)
0
BfalsefalsefalseYes (true)falsefalsefalse0falseYes (true)
Morgan Stanley
CfalseYes (true)falsefalseYes (true)Yes (true)false0falseYes (true)29.8Yes (true)false
0
DfalseYes (true)falsefalsefalsefalsefalse0falseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)
CYes (true)
DYes (true)

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart 1, Column F, Additional Information:FormAndLineReferenceDesc
ExplanationLine 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 6/17/2015ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1NH Health and Ed Facilities AuthBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN020279866BondIssuerEIN
CUSIP000000000CUSIPNum
Bond Issued2014-08-13BondIssuedDt
Issue Price$41,242,990IssuePriceAmt
PurposeRefund Portion of 2009 Issued DatePurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$0RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$41,242,990TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$352,990IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$40,890,000OtherSpentProceedsAmt
Unspent$0UnspentAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0PrivateBusUseByOthersPct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)

Relationship With OrgRelationshipWithOrgTxtLoan PurposeLoanPurposeTxtLoan From OrganizationLoanFromOrganizationIndOriginal PrincipalOriginalPrincipalAmtBalance DueBalanceDueAmtDefaultDefaultIndBoard Or Committee ApprovalBoardOrCommitteeApprovalIndWritten AgreementWrittenAgreementInd
DANIEL JANTZEN
OfficerSPLIT DOLLAR LIFEYes (X)$108,765$108,765falseYes (true)Yes (true)
Deborah Jantzen
Family MemberSplit Dollar LifeYes (X)$53,425$53,425falseYes (true)Yes (true)
FieldValueIRS element (for citing)
Total Balance Due$162,190TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Hypertherm
Trustee Barbara Couch$484,000See Part Vfalse
Vincent Fusca III
Officer Fusca II$112,979Family member employed by MHMHfalse
Garth Dunkel
Officer Fusca II$17,662Family member employed by MHMHfalse
Christopher Weston
Officer Alan Weston$30,044Family member employed by DHCfalse
Linda Billings
Former KE Mary Oseid$103,824Family member employed by MHMHfalse
Richard Alfred Powell
Trustee Powell$59,234Family member employed by MHMHfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceForm 990, Schedule L Part IVFormAndLineReferenceDesc
ExplanationName 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

FieldValueIRS element (for citing)
Works Of ArtWorksOfArtGrp
Art Historical TreasuresArtHistoricalTreasuresGrp
Art Fractional InterestArtFractionalInterestGrp
Books And PublicationsBooksAndPublicationsGrp
Clothing And Household GoodsClothingAndHouseholdGoodsGrp
Cars And Other VehiclesCarsAndOtherVehiclesGrp
Boats And PlanesBoatsAndPlanesGrp
Intellectual PropertyIntellectualPropertyGrp

Securities Publicly Traded SecuritiesPubliclyTradedGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution24ContributionCnt
Noncash Contributions Rpt F990$682,435NoncashContributionsRptF990Amt
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Securities Closely Held StockSecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust IntrstsSecurPrtnrshpTrustIntrstsGrp
Securities MiscellaneousSecuritiesMiscellaneousGrp
Qualified Contrib Hist StructQualifiedContribHistStructGrp
Qualified Contrib OtherQualifiedContribOtherGrp
Real Estate ResidentialRealEstateResidentialGrp
Real Estate CommercialRealEstateCommercialGrp
Real Estate OtherRealEstateOtherGrp
CollectiblesCollectiblesGrp
Food InventoryFoodInventoryGrp
Drugs And Medical SuppliesDrugsAndMedicalSuppliesGrp
TaxidermyTaxidermyGrp
Historical ArtifactsHistoricalArtifactsGrp
Scientific SpecimensScientificSpecimensGrp
Archaeological ArtifactsArchaeologicalArtifactsGrp
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (true)ReviewProcessUnusualNCGiftsInd
Third Parties UsedYes (true)ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule M, Part I, Column BFormAndLineReferenceDesc
ExplanationThe 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 ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Business relationshipsForm 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 990Form 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 PolicyForm 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 UNDERTAKENForm 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 UndertakenForm 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 PublicForm 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 ReportingForm 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 AuditForm 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/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
NEW ENGLAND ALLIANCE FOR HEALTH LLC
ONE MEDICAL CENTER DRIVELEBANONNH03756264232401HLTH IMPROVMTNH$4,726$1,729,900MHMH
D-H Specialty Services LLC
One Medical Center DriveLebanonNH03756460876427Shd Svgs PrgmNH$0$0MHMH

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
DARTMOUTH-HITCHCOCK CLINIC
ONE MEDICAL CENTER DRIVELEBANONNH03756222519596PHYSICIAN SVCNH501(c)(3)9D-HHYes (true)
DARTMOUTH-HITCHCOCK MEDICAL CENTER
ONE MEDICAL CENTER DRIVELEBANONNH03756222715483SUPPORTNG ORGNH501(c)(3)11 TYPE INAYes (true)
DARTMOUTH - HITCHCOCK HEALTH
One Medical Center DriveLebanonNH03756264812335SUPPORTNG ORGNH501(C)(3)7NAfalse
HAMDEN RISK RETENTION GROUP INC
30 MAIN STREET STE 330BURLINGTONVT05401208530788Self InsVT501(c)(3)11 TYPE IDHCYes (true)
The Hitchcock Foundation
One Medical Center DriveLebanonNH03756020222139HLTHCRE RSRCHNH501(c)(3)7DHCYes (true)
EverWell Inc
One Medical Center DriveLebanonNH03756352506275Supportng OrgNH501(c)(3)11 Type INAYes (true)
The New London Hospital Association Inc
273 County RdNew LondonNH03257020222171HospitalNH501(c)(3)3D-HHYes (true)
Windsor Hospital Association
289 Country RoadWindsorVT05089030183721HospitalVT501(C)(3)3D-HHYes (true)
Cheshire Medical Center
580 Court StreetKeeneNH03431020354549HospitalNH501(C)(3)3D-HHYes (true)
Cheshire Health Foundation
580 Court StreetKeeneNH03431020202220SUPPORTNG ORGNH501(C)(3)11, TYPE IICMCYes (true)
Mt Ascutney Hosp Cmmty Hlth Found
289 Country RoadWindsorVT05089030300481FoundationVT501(c)(3)3WHAYes (true)
Historic Homes of Runnemede
289 County RoadWindsorVT05089237396147HealthcareVT501(c)(3)9WHAYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndUBI Code VUBICodeVAmtGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
D-H Mster Invst Prg
1 Med Ctr DrLEBANONNH03756020205863POOLED INVESTNHMHMHExcluded$22,766,096$524,681,801false$214,519Yes (true)0.93234
KEENE HLTH ALLIANCE
580 Court StKeeneNH03431300179297HealthcareNHNA
Obnet Services LLC
1 Med Ctr DrLebanonNH03756043746287Database ServNHNA
One Care VT ACOLLC
111 COLCHESTER AVEBurlingtonVT05401455399218Shared SavingVTNA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndEINEINAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPct
Charit Remndr Unitrusts (5)
One Medical Center DriveLebanonNH03756Chart. TrustNHMHMHTRUSTYes (true)
Pompanoosuc Investment Corp
1 Medical Ctr DrLebanonNH03756Real Est HldgNHDHCC CorporationYes (true)020352330
Hamden Assurance Co Ltd
Liab. InsuancDHCForeign CorpYes (true)98012140944 Church StHamiltonBDHM 12BD$0$2,878,6690.25800
Hitchcock Health Connect
1 Medical Ctr DrLebanonNH03756TelehealthDED-HHC CorpYes (true)800908979
Kearsarge Community Services Inc
273 County RoadNew LondonNH03257Real Est HldgNHNLHC CorpYes (true)020460136
New London Physician Group Inc
Physician GroNHNLHC CorpYes (true)020494420
New London Medical Center East
273 County RoadNew LondonNH03257Real Est HldgNHNLHC CorpYes (true)020480857
Keene Health Services
580 Court StreetKeeneNH03431Real Est HldgNHCMCC CorpYes (true)020374997
Keene Health Realty
580 Court StreetKeeneNH03431Real Est HldgNHCMCC CorpYes (true)020374998
Keene Health Enterprises
580 Court StreetKeeneNH03431Real Est HldgNHCMCC CorpYes (true)020374999
Cheshire Health Services
580 Court StKeeneNH03431HEALTHCARENHCMCC COPRYes (true)473379283
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (9 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Dartmouth-Hitchcock Clinic
JKLMN$29,325,261FMV
Dartmouth-Hitchcock Medical Center
M$2,135,230FMV
Hamden Risk Retention Group
O$5,373,734FMV
The Hitchcock Foundation
Q$15,573FMV
The Hitchcock Foundation
P$37,145FMV
The New London Hospital Association
Q$1,935,251FMV
Windsor Hospital Association
Q$1,410,072FMV
Cheshire Medical Center
Q$2,808,969FMV
The Hitchcock Foundation
C$99,071FMV