2015-05-11T12:19:17-05:00 2014-06-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2013-07-01 020354549 The Cheshire Medical Center CHES 6033545400 580 Court Street Keene NH 03431 Robert Cochrane Chief Financial Officer 6033545400 2015-05-07 1 Timothy R Hepburn CPA P00182393 8002447444 2015-05-07 2013 2016-03-07 17:11:31Z Arthur Nichols 580 Court Street Keene NH 03431 159837202 0 X www.cheshire-med.com X 1980 NH Community health care organization serving as a regional referral center 18 17 1134 184 164157 -105765 721869 695254 153224890 155615611 1408537 1601362 3637600 1924975 158992896 159837202 0 0 0 0 61842012 60554893 0 0 0 94352388 98088979 156194400 158643872 2798496 1193330 136587126 137587316 68373250 65004098 68213876 72583218 X The Cheshire Medical Center is a community health care organization serving as a regional referral center for Keene and the surrounding service area. It is fully committed to meeting the health care needs of these communities and providing access to quality health care services and programs. As a non-profit corporation, the Cheshire Medical Center acknowledges its commitment to provide services to the community. These services arise primarily from the four following general service categories. 1) Subsidization of government-sponsored healthcare programs - principally Medicare and Medicaid. 2) Sponsorship and/or subsidization of health-related community services and educational programs. 3) Provision of healthcare at no charge or reduced charge, according to financial need. 4) Provision of 24-hour emergency room services, without regard for ability to pay. The Cheshire Medical Center, as a matter of policy and practice has provided, and will continue to provide, a significant contributi 0 0 140535098 0 157407983 The primary purpose of the Cheshire Medical Center is to ensure access to quality health care services to all residents of the Monadnock Region. The Organization's charitable mission is enhanced through the operation of a joint operating partnership agreement with the Hitchcock Clinic. The purpose of the Joint Operating Partnership Agreement is to provide a more extensive and effective health care delivery system to the communities in the Monadnock Region by establishing joint planning and decision making processes, integrating health care services and establishing mechanisms for the reinvestment of resources to improve community health. The financial results of the joint operating partnership are reported annually on Form 1065, US Partnership Return of Income. 140535098 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 178 0 1 1134 1 1 1 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NH X Mary Sherwin Controller 6033545488 580 Court Street Keene NH 03431 X Ed Bergeron Trustee 1.00 1.00 X 0 0 0 Judith Boule MD Medical Staff President 1.00 1.00 X 0 0 0 H Roger Hansen Trustee 1.00 1.00 X 0 0 0 Steve Horton Trustee 1.00 1.00 X 0 0 0 Nathalie Houder Trustee 1.00 1.00 X 0 0 0 Larry Jaeger Trustee 1.00 1.00 X 0 0 0 Judy Kalich Trustee 1.00 1.00 X 0 0 0 Michael Kapiloff Trustee 1.00 1.00 X 0 0 0 Mary Ann Kristiansen Trustee 1.00 1.00 X 0 0 0 Geof Molina Trustee 1.00 1.00 X 4185 0 0 Michael Newbold Trustee (ending Oct 2013) 1.00 1.00 X 0 0 0 Walter Rohr Trustee 1.00 1.00 X 0 0 0 Katherine Snow Trustee 1.00 1.00 X 0 0 0 Sylvia McBeth Chair 2.00 1.00 X X 0 0 0 Gregg Tewksbury Vice Chair 1.00 1.00 X X 0 0 0 Robert Mucha Treasurer 1.00 1.00 X X 0 0 0 Mary Louise Caffrey Secretary 1.00 1.00 X X 0 0 0 Jay Kahn At-Large 1.00 1.00 X X 0 0 0 Arthur Nichols President/CEO 50.00 2.00 X X 564336 0 57678 Jill Batty CFO (ending December 2013) 50.00 2.00 X 268911 0 47478 Robert Cochrane CFO (beginning June 2014) 50.00 2.00 X 0 0 0 Cindi Coughlin CNO 52.00 0.00 X 186187 0 37965 Paul Pezone VP Facilities & Support Services 52.00 0.00 X 179442 0 31688 Erli Chen Physicist 50.00 0.00 X 230034 0 34334 Larry Miller Chief CRNA 50.00 0.00 X 197789 0 33350 Julie Green VP, Human Resources 50.00 0.00 X 174026 0 40472 Kristin Rossi CRNA 50.00 0.00 X 145692 0 25211 Denis Fortier Pharmacy Director 50.00 0.00 X 149774 0 32278 2100376 0 340454 27 0 1 0 Quest Diagnostics 5763 Collection Center Drive Chicago IL 60693 Lab Diagnostic Services 777019 New England Medical Transcription Inc PO Box 430 Woolwich ME 04579 Transcription Services 608167 Allscripts LLC 24630 Network Place Chicago IL 606731246 Electronic Health Record Technology 531306 Dartmouth Hitchcock One Medical Center Drive Lebanon NH 03755 Lab Diagnostic Services 483942 NH Imaging 1 Pillsbury Street Concord NH 033013570 Imaging Services 295391 23 285039 410215 695254 Patient Services 621300 152776118 152776118 Pharmacy and Drugs 446110 1353313 1353313 Food Services 722210 915822 915822 Miscellaneous Health S 621300 384619 384619 Contract Revenue 621300 61570 61570 124169 124169 155615611 577302 577302 992506 31554 0 0 992506 31554 1024060 31554 992506 Meaningful Use Income 621300 1254406 1254406 Childcare Center 624410 611388 447231 164157 Rebates and Discounts 621300 36435 36435 22746 22746 1924975 159837202 157407983 164157 1569808 X 1373685 1120927 252758 41602919 33947982 7654937 3019955 2464283 555672 11425008 9711257 1713751 3133326 2556794 576532 249809 249809 58538 58538 23479149 22074209 1404940 202456 202456 1222108 997240 224868 204951 167240 37711 5754065 4695317 1058748 264427 215772 48655 1106220 902676 203544 8573237 6995761 1577476 579674 473014 106660 Med Supplies, Drugs, et 24162621 24162621 Bad Debt Expense 11397403 11397403 JOA Gainshare 6803000 5551248 1251752 PILOT and MET 5310750 5310750 8720571 7588148 1132423 158643872 140535098 18108774 0 25492399 26344653 12586580 13248900 2273489 2338661 2418354 2646392 184625683 117563666 68647654 67062017 16743372 20014572 7573024 6784375 136587126 137587316 9996974 12675495 9825 34853 30888852 30131888 617362 424044 26860237 21737818 68373250 65004098 X 64611817 68092699 3602059 4490519 68213876 72583218 136587126 137587316 X 1193330 1277560 1898452 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21694 0 0 0 21694 0 Part II-B, Line 1: A portion of American Hospital Association and NH Hospital Association dues are available for lobbying. During 2013, the amounts available for lobbying were $6,485 and $15,479, respectively. 3602059 272723 929038 316300 4487520 3055274 234785 688499 376499 3602059 2634569 154965 484487 218747 3055274 2445561 168756 299947 279695 2634569 1479480 164317 1124611 322848 2445561 0.00000 0.00000 1.00000 0 0 69632 69632 80971321 45478438 35492883 100278185 72085228 28192957 3306545 3306545 67062017 Pooled Investments 19069725 F Funded Depreciation Account 944847 F 20014572 Pension Liability 12491225 Amount Payable to Third Party 30000 Due to Related Party 9216593 21737818 X 159845817 1277560 1277560 158568257 1268945 1268945 159837202 157374927 0 157374927 1268945 1268945 158643872 Part V, Line 4: Income from the endowments is used to support the Organization's programs. Part X, Line 2: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Code, and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management has evaluated the Medical Center's tax positions and concluded the Medical Center has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying financial statements. With few exceptions, the Medical Center is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2011. Part XI, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 1,268,945. Part XII, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 1,268,945. Part VI, Line 1a The accumulated depreciation is presented in accordance with the audited financial statements. Land improvements are included on line 1b and the value of land only is presented on line 1a. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments In Investment Entities Domiciled In Foreign Jurisdictions 3577113 0 0 0 0 0 0 3577113 0 3577113 1 0 1 1 0 0 Schedule F, Part IV, line 3: The Cheshire Medical Center did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Schedule F, Part IV, line 4: The Cheshire Medical Center meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Hospital. 1 1 1 X 225.000000000000 1 X 1 1 0 1 1 1690 2169025 0 2169025 0.01470 14621680 7373951 7247729 0.04920 0 1690 16790705 7373951 9416754 0.06390 27 15535 1105012 64559 1040453 0.00710 6 499 375749 0 375749 0.00260 2 191 1174976 0 1174976 0.00800 1 57 131497 0 131497 0.00090 6 463 206879 530 206349 0.00140 42 16745 2994113 65089 2929024 0.02000 42 18435 19784818 7439040 12345778 0.08390 1 19485 115848 0 115848 0.00080 3 4439 82712 48500 34212 0.00020 1 28493 0 28493 0.00020 4 329571 42000 287571 0.00200 9 23924 556624 90500 466124 0.00320 1 4513372 1128000 48378742 52539314 -4160572 X 1 1 1 1 Cheshire Medical Center 580 Court Street Keene NH 03431 00014 X X X The Cheshire Medical Center 1 1 X X X X X X X X 13 1 0 1 X X X X X X X X X X 1 0 1 1 225.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 The Cheshire Medical Center Part V, Section B, Line 3: Needs were prioritized based on data collected from several current assessment processes. Prioritization was completed by the Community Health Needs Assessment Leadership Team. Several hundred people participated in forums and surveys to identify community needs. The Cheshire Medical Center Part V, Section B, Line 6i: A variety of community health improvement initiatives are underway. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 11,397,403. Part II, Community Building Activities: The Medical Center has been actively engaged since the spring of 2006 in Healthy Monadnock (HM) 2020: to make Keene and the surrounding region the healthiest in the nation by the year 2020. HM2020 promotes broad-based community health messaging and other environmental strategies for prevention and wellness. The "champions program" engages individuals and organizations to take steps to improve health at a personal and institutional level. The Medical Center provides staffing, office space and overall leadership for this initiative. As of June 30, 2014 there were 2,468 individual champions, 86 organizational champions, and 19 school champions. The organization is a founding member of the Council for Health Communities which has been in existence for over 15 years and has developed a variety of prevention, transportation, referral, and health promotion programs. Part III, Line 2: At cost bad debt expense of $4,513,372 is 39.6% of the bad debt reported on The Cheshire Medical Center's Audited Financial Statements, which totals $11,397,403. Part III, Line 3: The Cheshire Medical Center management estimates that approximately 25% of bad debt expense (approximately 5 times the region's poverty rate) is an appropriate estimation of patients who would have been eligible for the organization's financial assistance program but did not apply. This estimation is based on the recognition that the financial assistance program is available to residents with incomes of up to three times the federally defined poverty income levels and the assumption that patients who choose not to pay their bills are more likely to fall within the lower income levels. For 2013, the estimated amount of bad debt expense (at cost) attributable to patients who would have been eligible for financial assistance is $1,128,000. Part III, Line 4: Information related to the bad debt expense can be found in Footnote 2, page 9 of The Cheshire Medical Center's Audited Financial Statements, "Accounts Receivable and the Allowance for Doubtful Accounts." Part III, Line 8: This shortfall should be considered community benefit because we are the only hospital/medical center in Cheshire County, New Hampshire and we are designated by CMS as a Medicare Dependent Hospital (MDH) due to greater than 60% of our average daily census being comprised of Medicare Patients. Our presence in the community allows the residents of Cheshire County, especially the elderly population, to receive comprehensive hospital and medical services close to home. Part III, Line 9b: Systems are in place to capture financial assistance accounts prior to a bill going to the patient. Part VI, Line 2: In 2013, a Community Health Needs Assessment (CHNA) was completed with an implementation strategy identified for community benefit activities for the next three years. The 2013 CHNA report summarizes the work of the CHNA Leadership Team and the efforts of other local collaborative groups to assess the needs of our region. Several community partners recently completed community needs assessments, including Healthy Monadnock 2020. The results were used to strengthen and support the needs assessment process. Four community needs were prioritized above the other identified needs: - Behavioral health services: increasing the effectiveness of local services- Urgent care: timely and economical access to services instead of emergency room care - Transportation: increase access to public/private transportation particularly in rural towns- Improved coordination and communication between services: improving linkages between clinical services, faith-based organizations, and informal support networkIn addition to these priorities, the implementation strategy also provides an overview of other CMC/DHK community benefit activities that are aligned with our mission or considered necessary to support ongoing efforts from previously identified community needs. The community health needs identified in the 2013 CHNA provide the basis for the development of the Implementation Strategy. Cheshire Medical Center provides staff for the Healthy Monadnock (HM) 2020 initiative and funds the community assessment process through an evaluation partnership contract with Antioch New England University. On November 10, 2011 community members attended Summit II and reviewed 31 core implementation strategies. The (HM 2020) Healthiest community Advisory Board, comprised of 30 community representatives, provides ongoing oversight of the implementation of the strategies and community planning process.The Cheshire Medical Center/Dartmouth Hitchcock Keene Community Advisory Committee reviewed and commented on the community benefit report. The 2013 CHNA, Implementation Strategy and Community Benefit report is available to the public on the Cheshire Medical Center website: www.cheshire-med.org. Part VI, Line 3: CMC is committed to providing medically necessary care to patients regardless of their ability to pay for services. Non-emergent patients sign a financial responsibility statement upon admission to certify recognition of their responsibility for payment of their bills. However, there will be instances where the patient, due to the lack of funds or third party coverage, will not be able to meet this obligation. CMC notifies patients of their potential to obtain assistance through the registration and billing processes. Upon registration, patients without insurance are offered the opportunity to apply for financial assistance. In addition, receptionists and clinicians in all areas are educated to refer patients to the financial assistance process in the event patients express concerns with their ability to pay for services. The application information is posted on the intranet and brochures describing the program are readily available to patients. There are signs posted in Registration and throughout the facility informing patients about financial assistance. Patients are informed of the program availability on any invoices they receive and individuals who attempt to collect patient balances are also trained to refer patients to the financial assistance process. The financial assistance application process is comprehensive and evaluates a patient's eligibility for a variety of federal, state, and local government programs in addition to CMC's internally funded financial assistance program. Part VI, Line 4: The Medical Center is the only hospital in its primary service area ("PSA"). Management defines its PSA as the City of Keene and 19 geographically proximate communities. Towns and cities included in the PSA include Alstead, Chesterfield, Fitzwilliam, Gilsum, Harrisville/ Chesham, Keene, Marlborough, Marlow, Nelson/Munsonville, Richmond, Roxbury, Stoddard, Sullivan, Surry, Swanzey, Troy, Walpole, Westmoreland and Winchester, all located in Cheshire County. According to the US Census Bureau, 2013 population estimates:- Medical Center's PSA represented approximately 5.79% of New Hampshire's population. - The PSA's total population is 76,610 with 23,419 residing in Keene, the largest community in the service area. - The median age of residents in Cheshire County is 42.1 with: - 14,468 or 19% less than 18 years of age - 49,424 or 64% between the ages of 18-64 - 12,718 or 17% over the age of 64 - Poverty rate for Cheshire County was 10.6% as compared to 8.4% for the State of New Hampshire. The median household income is $56,062 compared to the State average of $64,925. According to the US Bureau of Labor Statistics, August 2014, the State and Cheshire County unemployment rate was 4.4%. Part VI, Line 5: The Medical Center plays an active role in promoting community health and offers educational programs including classes and workshops. The 2013 year programs offered a variety of chronic disease and wellness topics such as nutrition, diabetes, end of life issues, alternative medicine options, air pollution, mobility issues, and gardening. In addition, the Medical Center offers several community programs including: Cheshire Smiles, a school-based dental health program for children in grades K-3, provides screening, prevention and restorative dental care for children in Cheshire County schools. Cheshire Medical Center/Dartmouth-Hitchcock Keene also works in partnership with other community health and human service organizations to meet the dental health needs of underserved populations such as the chronically mentally ill, pregnant women who cannot afford dental care, children identified through the school based Cheshire Smiles Program, and others. The Medical Center sponsors patient visits at Dental Health Works, a public/private program serving underserved residents of Cheshire County. The Medical Center also provides leadership and support to the Dental Public Health Task Force, a coalition of dental staff, hospital staff and concerned citizen addressing the oral health needs of adults. The Cheshire Coalition for Tobacco Free Communities addresses the use of tobacco products by people who live and work in the communities served by CMC/DHK. The Coalition is comprised of hospital staff, healthcare providers, community members and representatives of schools and colleges, law enforcement, clergy and the general public. The group meets monthly working to engage schools and the greater community with tobacco prevention initiatives which include retailer education and enforcement of tobacco laws. The Coordinator, a CMC/DHK employee, actively engages in anti-tobacco activities in our local community and coordinates with state agencies and organizations.The Medication Assistance Program addresses the critical need for programs to help low income people afford medications. The Medication Assistance Program at the Medical Center was initiated in March, 1999. It was the first hospital-based program of its kind in the State of New Hampshire and was the first recipient of the New Hampshire Medication Bridge Award. The Medication Assistance Program provides free or reduced cost medications for acute illnesses and improves access to medications vital to continued good health for patients who require medication on an ongoing basis and who cannot afford it. In FY 2014 the program supplied 2,318 prescriptions to 401 individuals valued at $1.6 million.AFHY is a community coalition focused on childhood obesity. Through AFHY, CMC/DHK works closely with community health providers, Keene State College, Antioch University New England, Keene Parks and Recreation Center, and area schools to address the epidemic of childhood obesity. In FY 2014 AFHY supported efforts in several schools, after school programs, and non-profit organizations to implement the 5-2-1-0 message via policy change and educational activities. AFHY implemented the community based Family BeFit program through collaboration with the Keene Family YMCA and Keene State College Dietetic Internship Program.Cheshire County HEAL (CC HEAL) engages Organization Champions to adopt healthy eating, active living initiatives that promote and support worksite wellness. Our local program is focused on three sectors: food service industry, worksites, and before and after school programs. We are working with each sector to identify needs and implement best practice programs and community education to help promote good nutrition and enhance physical activity. The Turn a New Leaf program (TANL) is New Hampshire's first county-wide healthy dining initiative. TANL is a (healthy eating) program that was designed to create healthy eating environments within Cheshire County by assisting participating venues who adopt, highlight, identify and promote healthier menu/food items by using a consistent, credible and easily recognized nutritional guidance for consumers. Additionally, three other hospitals in the state have implemented the TANL program (DH-Lebanon, Littleton Hospital and DH-Nashua). The Worksite Wellness Program engages worksites to assess, plan and implement programs, policy, systems and environmental changes (PPSE) that support healthy eating, active living and other best practice interventions that can enhance health outcomes. As of June 30, 2014 there are eleven participating restaurants and twenty-two worksites. Senior Passport is a program for area residents aged 60 years and above. It encompasses low cost complete evening and weekend meals; free health education programs oriented to seniors; exercise programs; and the Cheshire Walkers Program, a walking group that takes organized nature and historic walks. Seven walks are offered each spring and fall. Walks are led by a member of CMC/DHK and occur at a variety of locations throughout the region. During FY2014 3,769 meals were provided to program members and a total of 155 seniors attended the walking program. Greater Monadnock Public Health Network (GMPHN) is a community health and safety collaborative which works to enhance and improve public health-related services. The GMPHN is one of 13 public health networks in the state of New Hampshire. The GMPHN is housed by CMC/DHK and, in collaboration with Cheshire County, is financed with funds provided by the Centers for Disease Control and Prevention, under an agreement with the State of New Hampshire, Department of Health and Human Services, Division of Public Health Services. The GMPHN serves all of Cheshire County and the 10 western-most towns in Hillsborough County. The GMPHN strives to increase collaboration and planning across municipal boundaries and the health and safety sectors. It is made up of members of each of the coalition communities as well as representatives of regional organizations involved in providing for the public's health and safety. Included within the GMPHN, is the Greater Monadnock Medical Reserve Corps. Developed initially to build local capacity to address public health emergency response needs, the GMMRC also supports local initiatives to address pressing public health activities. Membership included doctors, nurses, EMT/paramedics, pharmacists, veterinarians, other public health professionals, and non-medical/public health members. As of June 30, 2014 the GMMRC has a membership of over 110 individuals.The total expenditures associated with these and other programs for the fiscal year ending 6/30/14 is $5,559,677. Part VI, Line 7, Reports Filed With States NH X 1 1 X X X X 0 0 0 0 0 0 0 1 0 Arthur Nichols President/CEO 455746 0 61210 0 47380 0 33015 0 24663 0 622014 0 0 0 Jill Batty CFO (ending December 2013) 222131 0 0 0 46780 0 22815 0 24663 0 316389 0 0 0 Cindi Coughlin CNO 153406 0 0 0 32781 0 19593 0 18372 0 224152 0 0 0 Paul Pezone VP Facilities & Support Services 140202 0 0 0 39240 0 14736 0 16952 0 211130 0 0 0 Erli Chen Physicist 186343 0 0 0 43691 0 20117 0 14217 0 264368 0 0 0 Larry Miller Chief CRNA 175299 0 0 0 22490 0 24555 0 8795 0 231139 0 0 0 Julie Green VP, Human Resources 127616 0 0 0 46410 0 21662 0 18810 0 214498 0 0 0 Kristin Rossi CRNA 123592 0 0 0 22100 0 14123 0 11088 0 170903 0 0 0 Denis Fortier Pharmacy Director 115830 0 0 0 33944 0 14743 0 17535 0 182052 0 0 0 Part I, Line 1a Cheshire Medical Center does not reimburse expenses for first class travel, housing allowance, health or social club dues, personal services, business use of personal residence, discretionary spending accounts, or provide tax indemnification or gross up payments. The Medical Center does reimburse Board members for companion travel to business related meetings under specific circumstances. All reimbursements are reported on Form 1099 issued to the Board member. One reimbursement was made in 2013 in the amount of $4,185. Part I, Line 7 Senior Management is eligible for incentive compensation at the discretion of the Board based on, but not directly related to, overall organizational financial performance and other discretionary measures. A NH Health & Education Facilities Authority 020279866 2012-11-15 29650000 Refund existing debt, acquisition of equipment 0 0 0 A 29650000 4777102 379754 554125 4777102 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 A 1 0 0 0 0 0 A 0 Schedule K Supplental Information Schedule K Part V: The medical center established written procedures to ensure that violations of federal tax requirements are timely identified and corrected October 2014. Bergeron Construction Firm hired by CMC for services 106975 Edward Bergeron, Trustee of Cheshire Medical Center, is an officer of Bergeron Construction, which performed carpentry for the Hospital during the fiscal year. 0 Jessica Horton Child of CMC Trustee 38547 Jessica Horton, who is employed in the Radiology Department of Cheshire Medical Center, is the child of Steve Horton, a Cheshire Medical Center Trustee. The 2013 W-2 compensation paid is in accordance with CMC's standard employment practices and policies. 0 Form 990, Part VI, Section A, line 6 The sole member of The Cheshire Medical Center is The Cheshire Health Foundation. Form 990, Part VI, Section B, line 11 A copy of the Form 990 is made available for all Board members to review prior to filing. The Board has formally delegated review of the 990 to the Finance and Audit Committee. Committee members receive copies of the 990 and it is reviewed in a meeting prior to filing. Form 990, Part VI, Section B, line 12c Officer, Board Members and Key Employees annually disclose potential conflicts of interest and are required to recuse themselves from all Board activity related to all conflicts. Form 990, Part VI, Section B, line 15a Cheshire Medical Center/Dartmouth Hitchcock Keene has retained Yaffe & Company, Inc. to provide consultation to the Executive Committee of the Board of Trustees regarding executive compensation, benefits, and perquisites. Yaffe & Company, Inc. is a independent consulting firm with 35 years of service and provides services to not-for-profit hospitals and health systems. Further Yaffe & Company, Inc. has been engaged directly by the Board of Trustees of Cheshire Medical Center through its Executive Committee to only provide services to the board. An Executive Committee d/b/a Compensation Committee Charter and Compensation Philosophy (approved by the Board) documents the compensation review process and guidelines so as to provide an orderly structure for executive total compensation decisions. Annually, a multi-tiered approach using independent comparability data is utilized to gauge appropriate comparative market levels of compensation and benefits. An annual performance evaluation is based on subjective and objective criteria which flow from the strategic plan. By way of questionnaire, Board members participate in the performance review process and a summary report is shared with the CEO. Variable pay is awarded based on achievement of specific qualitative and quantitative goals. In conjunction with the Executive Committee, challenging and measurable goals are established for the Office of the President which provides an alignment between executive compensation and achievement of the hospital's strategic goals. Form 990, Part VI, Section C, line 19 The Organization makes governing documents, conflict of interest policy and financial statements available to members of the public upon request, through its annual report, and through state and federal filings. F990, Part VII: Compensation reported on Part VII is reported for the calendar year ending within the organization's tax year. Robert Cochrane's compensation will be included in the subsequent 990 filing. Form 990, Part IX, line 11g Contract Labor: Program service expenses 10,662,309. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,662,309. Physician/Medical Services: Program service expenses 5,181,298. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,181,298. Other Purchased Services: Program service expenses 2,650,787. Management and general expenses 597,727. Fundraising expenses 0. Total expenses 3,248,514. Data Processing Fees: Program service expenses 2,170,698. Management and general expenses 489,471. Fundraising expenses 0. Total expenses 2,660,169. Outside Lab Fees: Program service expenses 1,002,609. Management and general expenses 226,078. Fundraising expenses 0. Total expenses 1,228,687. Consulting: Program service expenses 406,508. Management and general expenses 91,664. Fundraising expenses 0. Total expenses 498,172. Form 990, Part XI, line 9: Pension Liability Adjustment 1,898,452. Form 990, Part XIII, Line 2c The audit process has not changed from the prior year. The Cheshire Health Foundation 580 Court Street Keene NH 03431 020202220 Management of Board designated, SPF, building, and endowment funds NH 501(C)(3) Line 11b, II 0 Keene Health Alliance 580 Court Street Keene NH 03431 300179297 Healthcare NH Related 4639000 0 1 0.50000 Keene Health Services 580 Court Street Keene NH 03431 020374997 Investments/Real Estate NH N/A C 0 Keene Health Realty 580 Court Street Keene NH 03431 020374998 Investments/Real Estate NH N/A C 0 Keene Health Enterprises 580 Court Street Keene NH 03431 020374999 Investments/Real Estate NH N/A C 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0