2015-05-15T10:37:27-05:00 2014-06-30 PRICEWATERHOUSECOOPERS LLP 125 HIGH STREET BOSTON MA 02110 990 2013-07-01 222519596 DARTMOUTH-HITCHCOCK CLINIC % ROBIN KILFEATHER-MACKEY DART 6036505000 ONE MEDICAL CENTER DRIVE Suite LEBANON NH 03756 Robin Kilfeather-Mackey CFO 2015-05-12 Gwen Spencer P00641463 2013 2016-02-25 16:41:14Z James Weinstein DO MS One Medical Center Drive Lebanon NH 03756 400508542 false X www.dartmouth-hitchcock.org X 1983 NH Advancing Health Through Research, Education, Clinical Practice, Community Partnerships, providing each person the best care in the right place, at the right time, every time 21 16 4504 525 111475 -1097 0 12 312867125 306275720 86264 903545 93249217 90486684 406202606 397665961 2646503 2318322 0 0 253764588 258490412 0 0 863601 131081080 135664091 387492171 396472825 18710435 1193136 228949164 233852895 376500812 372810439 -147551648 -138957544 X We advance health through research, education, clinical practice, and community partnerships, providing each person the best care, in the right place, at the right time, every time. false false 317464655 2358532 393264283 Dartmouth-Hitchcock Clinic (the Clinic) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. The Clinic and subsidiaries, a multispecialty physician practice group which operates clinics throughout New Hampshire and Vermont, provides, among other things, medical services to patients, medical education and research. Health care services in 2014 resulted in approx. 665,319 office visits recorded by Clinic personnel. The promotion of health through the medical practice activities of the Clinic provides the basis for the organization's tax exempt activities. The Clinic operates as an integral component of Dartmouth-Hitchcock Medical Center (DHMC), a New Hampshire nonprofit corporation organized for the exploration and coordination of matters of mutual interest among its members: the Clinic, Mary Hitchcock Memorial Hospital (the Hospital), Geisel School of Medicine (GSM), a component of Dartmouth College, and the Veterans Affairs Medical Center in White River Junction, Vermont. The Clinic provides the physician staff to the Hospital and the sophistication essential for the development of the Hospital as the largest and only teaching hospital in New Hampshire and the designation by the federal government as a Rural Referral Center for Northern New England. The shared mission of the Clinic and Hospital is to advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. 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 Hospital, the Clinic provides high quality, cost effective, comprehensive, and integrated health care to individuals, families, and the communities it serves regardless of a patient's ability to pay. The Clinic actively supports community-based health care and promotes the coordination of services among health care providers and social services organizations. The Clinic also seeks to work collaboratively with other area health care providers to improve the health status of the region. As a key element in its work to improve population health and move to new payment models, Dartmouth-Hitchcock (D-H) is participating in a number of shared risk/shared savings programs, including the Pioneer ACO program initiated by the Centers for Medicare and Medicaid (CMS). Unlike the traditional fee for service structure, shared risk/savings programs tie rewards to the achievement of quality and cost goals. In 2014, the D-H Pioneer ACO (now called allwell) added three health systems as participants, bringing the number of covered Medicare patients to 47,000. At the end its first year, allwell was one of only 13 participating ACOs to meet all quality and safety metrics and show significant cost reductions, while providing coordinated, patient-centered care to the assigned Medicare population. Participation also continues to expand for OneCare Vermont, an ACO established by D-HH with Fletcher Allen Health Care, Vermont's academic medical center, that includes all 14 of the state's hospitals, hundreds of primary care physicians and specialists, two federally qualified health centers, and several rural health clinics, to coordinate the health care of approximately 42,000 of Vermont's 118,000 Medicare beneficiaries (40 percent of the Hospital and Clinic patients are from Vermont). D-HH continues to be a member of the Mayo Clinic Care Network, a non-ownership affiliation. This arrangement allows D-H physicians to partner with colleagues from Mayo for second opinions and consultations, thus bringing the expertise of both organizations to individual patient care. Much of the consultation is done via telemedicine, another expanding initiative of D-H. The program is intended to strengthen our ability to serve patients in our region with the highest-quality care, close to home. It also allows the Hospital and Clinic to get care to patients in emergency situations quickly and to partner with local health organizations in the delivery of care, something that is particularly important in our rural area. Regionally, as part of its work to create a sustainable health system, D-HH continues to build collaborations with other providers and to look for ways to make care more affordable and convenient for patients and families, while ensuring highest quality. New London Hospital in New Hampshire and Mt Ascutney Hospital and Health System in Vermont became formally affiliated with D-HH in 2014, and discussions are ongoing with other health systems in the two states. In keeping with its sustainable health strategy and mission to provide "the best care, in the right place, at the right time, every time", D-HH entered into an arrangement with CVS MinuteClinic to provide 24/7 urgent care at sites around New Hampshire. This new, lower cost option will allow individuals and families to easily access tests and treatments for illnesses and injuries that do not require the care of an academic medical center or that occur outside normal business hours. Nationally, Dartmouth-Hitchcock is a founding member, with Mayo Clinic, Intermountain Health Care, Denver Health, and The Dartmouth Institute for Health Policy and Clinical Practice, of the High Value Healthcare Collaborative (HVHC). The Collaborative currently comprises 18 health systems. Together, they have a patient base of more than 70 million. The goal of the Collaborative is to improve the quality of health care while lowering costs. Through data sharing and defining of best practices for 8 high-cost, high-variation conditions, the members are improving outcomes and already seeing cost savings. A $26 million grant from CMS is making it possible to integrate shared decision making - the Hospital was the first in the nation to create a Center for Shared Decision Making and integrate tools into clinical care - into the work of the Collaborative. Beyond that grant, however, the HVHC is self-funded by the member health systems. Effective with fiscal year 2000, the Clinic and the Hospital began filing an annual Community Benefit Report with the State of New Hampshire which outlines the community and charitable benefits they provide. The complete and updated Community Benefit Reports are available upon request or can be found on Dartmouth-Hitchcock's web site (www.dartmouth-hitchcock.org). The broad categories used in the Community Benefit Report to summarize these benefits are as follows: Financial assistance, formerly called charity care, represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended June 30, 2014, the Clinic provided financial assistance to 16,101 patients in the amount of $20,092,472 as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2014 was $6,495,896. The Clinic also routinely provides services to Medicaid patients at reimbursement levels that are below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the years ended June 30, 2014 was $22,631,075. Community health activities includes the cost or value of several different types of programs including the cost of community based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include Granite State Fit Kids health program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, and smoking prevention and cessation. This category also includes financial contributions and the contribution of time and services to community programs, hospitals and agencies. The Clinic also provides a significant amount of uncompensated care to its patients that is reported as provision for bad debts, which is not included in the amounts reported above. For the year ended June 30, 2014, the Clinic reported a provision for bad debts of approximately $20,581,584. 19829114 As a component of an integrated academic medical center, the Clinic provides significant support for academic and research programs through its support of The Geisel School of Medicine at Dartmouth (GSM). DHC provides support for Physicians' unpaid teaching time as part of its Community Benefit Initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, the Clinic provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to the Hospital and GSM. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across New Hampshire, Vermont, and beyond as well as uncompensated costs of academic and medical research activities. 337293769 true false false true false false false false false true true false false true true false false true false true true false false false false false false true true true true false false false false false true true false true true false false false false false true true true false false true 0 0 true 4504 true true true true BD false false false false false false false false X 21 16 false false false false true false true true true false false true true true true true true true true false NH X ROBIN KILFEATHER-MACKEY 6036505634 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 X Alan C Keiller Trustee/BD Treas End12/31/2013 0.75 1.26 X X 0 0 0 Jennie L Norman Trustee/Board Secretary 1.5 2.5 X X 0 0 0 Hugh C Smith MD Trustee 0.75 1.25 X 0 0 0 James N Weinstein DO MS Trustee Ex-Officio/CEO 17.0 44.01 X X 1010719 0 23574 Michael J Goran MD Trustee 0.75 1.25 X 0 0 0 Vincent S Conti Trustee 0.75 1.25 X 0 0 0 Barbara Couch Trustee 0.75 1.25 X 0 0 0 Anne-Lee Verville Trustee/BD Treas 1/1-2/5/14 0.75 1.25 X X 0 0 0 William Abdu MD MS Trustee End 12/31/2013 12.0 28.5 X 604908 0 23575 Wiley Souba MD ScD Trustee/Ex-Officio, Dean DMS 0.75 1.26 X 0 0 0 Richard S Shreve Trustee End 12/31/2013 0.75 1.25 X 0 0 0 William J Conaty Trustee 0.75 1.25 X 0 0 0 Robert A Oden Jr PhD Trustee/Board Chair 1.5 2.5 X X 0 0 0 William W Helman IV Trustee 0.75 1.26 X 0 0 0 Peter A Delong MD Trustee/Physician 12.0 28.0 X 324332 0 33087 Richard I Rothstein MD Trustee/Dept Chair Med 12.0 28.0 X 598160 0 19452 Denis A Cortese MD Trustee 0.75 1.25 X 0 0 0 Matthew B Dunne Trustee 0.75 1.25 X 0 0 0 Senator Judd A Gregg Trustee 0.75 0.75 X 0 0 0 Laura K Landy Trustee 0.75 1.25 X 0 0 0 Steven A Paris MD Trustee/Medical Director 12.0 28.51 X 362986 0 49270 Richard J Powell MD Trustee/Physician 12.0 28.8 X 469425 0 56580 Paul P Danos Trustee/BD Treas Eff 2/5/2014 1.5 2.5 X X 0 0 0 Barbara C Jobst MD Trustee Eff 1/1/14 0.75 0.75 X 0 0 0 Wayne G Granquist Trustee End 12/31/2013 0.75 1.26 X Robin Kilfeather-Mackey CPA Chief Financial Officer 17.0 44.01 X 508546 0 22575 Linda Von Reyn Chf Nursng Officer End 3/22/14 19.0 41.0 X 0 437094 23460 Daniel Jantzen CPA Chief Operating Officer 19.0 42.0 X 0 619596 23450 Stephen LeBlanc Exec VP Strtgy & Ntwrk Rltns 6.0 54.0 X 626223 0 22575 Alan Weston Chief HR Officer End 9/2/2013 19.0 41.0 X 0 375545 42511 Gregg Meyer MD CCO/EVP Pop Hlth End 1/02/14 19.0 41.0 X 896398 0 42589 Neil Castaldo Sr Advisor to CEO End 7/06/13 19.0 41.0 X 0 1003334 37270 Jeanine Arden-Ornt General Counsel End 6/30/2014 17.0 44.0 X 0 448897 33700 Vincent Fusca III Chf Stff/Intrm CHRO 9/3-2/3/14 12.0 28.0 X 0 253782 21785 Edward Merrens MD Chief Medical Officer 12.0 28.0 X 386361 0 38160 George Blike MD Chief Quality & Value Officer 12.0 28.0 X 441603 0 23159 Darlene A Saler Actg Chf Nrsng Ofr Eff 3/23/14 19.0 41.0 X 0 0 0 John S Malanowski Chief HR Officer Eff 2/3/2014 19.0 41.0 X 0 0 0 Clifford J Belden MD Actg Chf Clcl Ofr Ef 2/18/2014 12.0 28.0 X 648751 0 38476 Terrence P Carroll PHD Chf Innovtn Officr Eff 8/19/13 12.0 28.0 X 0 185713 18644 Christine Schon V.P Comm. Grp. Pract. Ops 12.0 28.01 X 226056 0 39401 William Mroz V.P. Op/Clncl Svcs End 7/27/13 19.0 41.0 X 0 191835 22336 Gail Dahlstrom V.P. Facilities Mgmt 19.0 41.0 X 0 230444 18533 Tina Naimie CPA VP Corporate Finance 12.0 29.5 X 0 217915 20157 Wendy Fielding VP Financial Planning 12.0 28.0 X 0 217934 38511 Thomas Dodds MD Dept. Chair Anesthesiology 12.0 28.0 X 544134 0 48760 Wendy Wells MD Dept. Chair Pathology 12.0 28.0 X 434575 0 54446 Jocelyn Chertoff MD MS Dept Chair Diagnost Radiology 12.0 28.5 X 504492 0 55731 Edward Catherwood MD MS Center Direct Heart & Vascular 12.0 28.0 X 482747 0 18814 Douglas Merrill Center Director Periop Svs 12.0 28.0 X 546540 0 46451 Stephen Boyce VP Ambulatory Care 12.0 28.0 X 178649 0 29414 Jeffrey OBrien VP Oncology Services 12.0 28.0 X 0 278646 40192 David Roberts MD Physician 12.0 28.0 X 932852 0 43992 Nathan Simmons MD Physician 12.0 28.0 X 853363 0 44169 Thomas Colacchio MD Former Officer/Phys 12.0 29.0 X 1084720 0 43691 Daniel Stewart MD Physician 12.0 28.0 X 1007047 0 35733 Faramarz Samie MD Physician 12.0 28.0 X 784766 0 22779 Carl DeMatteo MD Fmr Chf Ql Compl Ofr/Physician 12.0 28.0 X 100582 0 1792 John Butterly MD Fmr Offr/Exec VP Med Affairs 4.0 38.0 X 556033 0 56784 Lawrence Dacey MD Former CMO/DH Phys 12.0 29.3 X 499139 0 15534 Mary Oseid Fmr Key Emp/VP Enterprise Svcs 12.0 28.0 X 282407 0 14338 Barbara Walters DO MBA Fmr Key Emp/Med Dir Acct Care 10.0 30.0 X 359144 0 19544 Mary Kay Boudewyns Fmr Key Emp/Adm Dir Rev Mgmt 12.0 28.0 X 0 217526 8199 16255658 4678261 1333193 1139 true true false See Schedule O 0 12 12 NET PATIENT SERVICE REVENUE 621110 306275720 306275720 306275720 16288 16288 0 0 2984348 644024 536458 173829 2447890 470195 2918085 2918085 3019551 5821 2126473 -5821 893078 887257 887257 0 0 0 CONTRACTED REVENUE 621110 90432905 90321430 111475 DHC ALLOCATED LOSS FROM AFFILIATES 621110 -3332867 -3332867 CAFETERIA INCOME 621110 468561 468561 87568599 397665961 393264283 111475 4290191 X 1834013 1834013 484309 484309 0 0 5568476 1995116 3487821 85539 745121 745121 190327375 157474237 32853087 51 21383827 17802128 3581693 6 27217560 22658737 4558816 7 13248053 11029062 2218988 3 0 983758 42205 941553 274825 274825 16740 16740 0 0 21179125 17506797 3672328 1098674 12203 1086471 7425609 6744034 681565 10 3499480 3114537 384943 0 6204638 5499699 704939 1071311 631959 439352 0 54532 52779 1753 6758858 6015384 743474 0 17431125 15511892 1919233 1621316 1621316 MEDICAL SUPPLIES 58560594 58505860 54734 EQUIP REPAIR & MAINT 5150008 4583507 566501 ACADEMIC,GME,TEACHING & SPT 1650989 1650989 ALL OTHER EXPENSES 2682509 1761145 143379 777985 396472825 337293769 58315455 863601 15745 17320 -189306 1212852 0 0 35110240 36644169 384015 203298 0 0 6679138 5698240 330456 131794 0 0 132868928 97648236 41262295 35220692 149037 177109 0 0 1500 1067143 0 0 145206044 153480278 228949164 233852895 65608899 107044466 0 0 0 0 56747863 54850883 0 0 0 0 16748892 15310940 0 0 237395158 195604150 376500812 372810439 X -148777030 -140183441 226923 227438 998459 998459 -147551648 -138957544 228949164 233852895 X 1193136 28072 7372896 X X false true X true true true X 142981 0 0 0 12 142993 365093409 368081102 298584597 402775030 306275720 1740809858 0 0 0 365236390 368081102 298584597 402775030 306275732 1740952851 0 0 0 0 0 0 0 0 0 1740952851 3383606 3085762 -66568 86263 3644660 10133723 0 3383606 3085762 -66568 86263 3644660 10133723 905573 5244 910817 0 287656 287656 368619996 371454520 299423602 402866537 309920392 1752285047 0.99353 0.99135 0.00578 0.00559 X false true false false false false true 52080 false true 32267 84347 false Lobbying activity explanation FORM 990 SCHEDULE C, PART II B, LINES 1B & 1G Dartmouth-Hitchcock Clinic employs two full time staff whose duties include lobbying. Typical expenses associated with the lobbying activities include staff salary, travel, membership fees and dues. From time to time, Dartmouth-Hitchcock Clinic, through its employees and the use of consultants, contacts government officials and legislators. This contact is for the purpose of proposing legislation or expressing an opinion on changes in legislation that affect the Clinic and its ability to carry out its mission. Typical activities include emailing, calling, and meeting with government officials and legislators.For the fiscal year ended June 30, 2014, Dartmouth-Hitchcock Clinic incurred $52,080 in conjunction with these activities. Form 990 Schedule C, Part II B, Line 1I DHC pays dues to various organizations related to its exempt mission. The amount reported under other activities on line 1I refers to the amount of lobbying activities identified in dues payments to outside organizations. 1000483 112492 461 1113436 999533 950 1000483 998459 0 1074 0 0 0 999533 998459 0 0 0 0 0 998459 855478 142981 998459 0.89670 0.10330 false false 3051827 7215859 10267686 5489231 72493046 54610246 23372031 27569190 26863620 705570 17049775 16174370 875405 35220692 INVESTMENT IN CAPTIVE - HAMDEN 106524233 BOND ISSUANCE COSTS - NET 123026 DHC 457(B) PLAN ASSETS 43542654 DUE FROM AFFILIATE 1351674 OTHER MISC ASSETS 1938691 153480278 0 INTEREST RATE SWAP 12826322 ACCRUED POST RETIRMNT PENSION 103482645 RESERVES FOR INSUR. RLTD LOSS 79316234 DUE TO AFFILIATES AND 3RD PART -21051 195604150 INTENDED USE OF ENDOWMENT FUNDS FORM 990 SCHEDULE D PART V LINE 4 THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH-HITCHCOCK CLINIC. ASC 740 (FIN 48) Footnote Form 990 Schedule D, Part X No ASC 740 (Fin 48) footnote was included in the audited financial statements as there were no material uncertain tax positions at or since adoption. East Asia and the Pacific Program Services Educational Travel Exp 3720 Europe (Including Iceland and Greenland) Program Services Collection Services 5068 Europe (Including Iceland and Greenland) Program Services Dues 281 Europe (Including Iceland and Greenland) Program Services Honorarium Payments 194 Europe (Including Iceland and Greenland) Program Services Insurance 110799 Europe (Including Iceland and Greenland) Program Services Publications 1550 North America Program Services Honorarium Payments 1428 North America Program Services License 14005 North America Program Services Marketing Services 11904 North America Program Services Moving and Supplies 7815 North America Program Services Professional Services 1550 North America Program Services Publications 320 North America Program Services Software 8075 North America Program Services Educational Travel Exp 38959 North America Program Services Waste 80 Sub-Saharan Africa 3 Program Services Medical Svcs in Rwanda 41905 3 3 247653 247653 true false true true true false true Good Neighbor Health Clinic 70 No Main St White River Jct VT 05001 030346949 501(C)(3) 20150 FMV Program/Clinic Svcs Stagecoach 7 Bayberry Way Mont Vernon NH 03057 030276517 501(C)(3) 11625 FMV Transportn Subsidy Granite State United Way 46 South Main St Concord NH 03301 026006033 501(c)(3) 8366 FMV Program Support Grafton Country Senior Citizens Council P O Box 433 Lebanon NH 03766 237248316 501(C)(3) 6204 FMV Elder Services David's House 461 Mount Support Rd Lebanon NH 03766 222593431 501(C)(3) 10385 FMV Program Support The Trustees of Dartmouth College 1 Rope Ferry Road Lebanon NH 03755 020222111 501(C)(3) 1656956 FMV Educ and Prog Sppt Lamprey Health 22 Prospect Street Nashua NH 03060 237305106 501(C)(3) 23250 FMV Program Services Advance Transit PO Box 1027 Wilder VT 05088 222558708 501(C)(3) 31236 FMV Transportn Subsidy Upper Valley Transporation MGMT Association 195 N Main St WRJ VT 05001 030355283 501(C)(3) 9300 FMV Transportn Subsidy City Year NH Pledge 287 Cloumbus Avenue Boston MA 02116 222882549 501(C)(3) 7750 FMV Program Support Upper Valley Housing Coalition Po Box 17 Lebanon NH 03766 200363702 501(C)(3) 6200 FMV Program Support 11 The Trustees of Dartmouth College 54 265225 FMV D-H Tuition Reimbursement Program 516 206687 FMV Varnum Nursing Awards 43 12397 FMV Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants For each award established by Dartmouth-Hitchcock Clinic there are written and established guidelines and procedures. Grant award payments are processed in accordance with the specific terms of each of the grants 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. X true true X X X X true true false false false false false false false James N Weinstein DO MS Trustee Ex-Officio/CEO 945851 0 200 0 64668 0 2250 0 21324 0 1034293 0 0 0 William Abdu MD MS Trustee End 12/31/2013 529524 0 16343 0 59041 0 2250 0 21325 0 628483 0 0 0 Carl DeMatteo MD Fmr Chf Ql Compl Ofr/Physician 98296 0 0 0 2286 0 346 0 1446 0 102374 0 0 0 Robin Kilfeather-Mackey CPA Chief Financial Officer 474737 0 0 0 33809 0 2250 0 20325 0 531121 0 0 0 Linda Von Reyn Chf Nursng Officer End 3/22/14 0 325452 0 0 0 111642 0 3125 0 20335 0 460554 0 0 Daniel Jantzen CPA Chief Operating Officer 0 515734 0 200 0 103662 0 3125 0 20325 0 643046 0 0 Stephen LeBlanc Exec VP Strtgy & Ntwrk Rltns 478986 0 0 0 147237 0 2250 0 20325 0 648798 0 0 0 John Butterly MD Fmr Offr/Exec VP Med Affairs 504542 0 0 0 51491 0 35460 0 21324 0 612817 0 0 0 Lawrence Dacey MD Former CMO/DH Phys 444468 0 13622 0 41049 0 2250 0 13284 0 514673 0 0 0 Alan Weston Chief HR Officer End 9/2/2013 0 261730 0 200 0 113615 0 26790 0 15721 0 418056 0 0 David Roberts MD Physician 591354 0 267424 0 74074 0 26790 0 17202 0 976844 0 0 0 Nathan Simmons MD Physician 531422 0 267674 0 54267 0 22200 0 21969 0 897532 0 0 0 Mary Oseid Fmr Key Emp/VP Enterprise Svcs 274655 0 0 0 7752 0 2250 0 12088 0 296745 0 0 0 Christine Schon V.P Comm. Grp. Pract. Ops 220913 0 300 0 4843 0 23666 0 15735 0 265457 0 0 0 William Mroz V.P. Op/Clncl Svcs End 7/27/13 0 189736 0 0 0 2099 0 17287 0 5049 0 214171 0 0 Gail Dahlstrom V.P. Facilities Mgmt 0 221560 0 200 0 8684 0 2799 0 15734 0 248977 0 0 Gregg Meyer MD CCO/EVP Pop Hlth End 1/02/14 790556 0 502 0 105340 0 21690 0 20899 0 938987 0 0 0 Neil Castaldo Sr Advisor to CEO End 7/06/13 0 273185 0 0 0 730149 0 24915 0 12355 0 1040604 0 0 Peter A Delong MD Trustee/Physician 267828 0 51079 0 5425 0 24495 0 8592 0 357419 0 0 0 Richard I Rothstein MD Trustee/Dept Chair Med 541158 0 8155 0 48847 0 2250 0 17202 0 617612 0 0 0 Thomas Colacchio MD Former Officer/Phys 669732 0 0 0 414988 0 26790 0 16901 0 1128411 0 0 0 Tina Naimie CPA VP Corporate Finance 0 217604 0 200 0 111 0 17993 0 2164 0 238072 0 0 Wendy Fielding VP Financial Planning 0 217364 0 300 0 270 0 18332 0 20179 0 256445 0 0 Barbara Walters DO MBA Fmr Key Emp/Med Dir Acct Care 335906 0 0 0 23238 0 2250 0 17294 0 378688 0 0 0 Jeanine Arden-Ornt General Counsel End 6/30/2014 0 428678 0 200 0 20019 0 21690 0 12010 0 482597 0 0 Vincent Fusca III Chf Stff/Intrm CHRO 9/3-2/3/14 0 251743 0 0 0 2039 0 20034 0 1751 0 275567 0 0 Mary Kay Boudewyns Fmr Key Emp/Adm Dir Rev Mgmt 0 205225 0 250 0 12051 0 0 8199 0 225725 0 0 Steven A Paris MD Trustee/Medical Director 335556 0 0 0 27430 0 32400 0 16870 0 412256 0 0 0 Richard J Powell MD Trustee/Physician 365871 0 67915 0 35639 0 39030 0 17550 0 526005 0 0 0 Edward Merrens MD Chief Medical Officer 373068 0 200 0 13093 0 24240 0 13920 0 424521 0 0 0 George Blike MD Chief Quality & Value Officer 428424 0 0 0 13179 0 2250 0 20909 0 464762 0 0 0 Daniel Stewart MD Physician 862843 0 106344 0 37860 0 13764 0 21969 0 1042780 0 0 0 Clifford J Belden MD Actg Chf Clcl Ofr Ef 2/18/2014 621430 0 0 0 27321 0 21690 0 16786 0 687227 0 0 0 Terrence P Carroll PHD Chf Innovtn Officr Eff 8/19/13 0 184817 0 0 0 896 0 13353 0 5291 0 204357 0 0 Faramarz Samie MD Physician 602251 0 165547 0 16968 0 13764 0 9015 0 807545 0 0 0 Thomas Dodds MD Dept. Chair Anesthesiology 510210 0 0 33924 0 26790 0 21970 0 592894 0 0 0 Wendy Wells MD Dept. Chair Pathology 412232 0 0 22343 0 32910 0 21536 0 489021 0 0 0 Jocelyn Chertoff MD MS Dept Chair Diagnost Radiology 446679 0 30558 0 27255 0 34185 0 21546 0 560223 0 0 0 Edward Catherwood MD MS Center Direct Heart & Vascular 447164 0 200 0 35383 2250 0 16564 0 501561 0 0 0 Douglas Merrill Center Director Periop Svs 511992 0 0 0 34548 0 24915 0 21536 0 592991 0 0 0 Stephen Boyce VP Ambulatory Care 178063 0 250 0 336 0 9578 0 19836 0 208063 0 0 0 Jeffrey OBrien VP Oncology Services 0 271357 0 250 0 7039 0 19841 0 20351 0 318838 0 0 FORM 990 SCHEDULE J, PART I, LINE 1A FROM TIME TO TIME, THE ORGANIZATION PROVIDES CHARTERED TRAVEL SERVICES TO THE CEO. THE COST OF PROVIDING THE CHARTERED SERVICE HAS BEEN DEEMED A COST-EFFICIENT MANNER TO ALLOW THE OFFICER TO WORK WHILE TRAVELLING VERSUS THE TIME LOST DRIVING, ETC. THIS EXPENSE HAS BEEN DEEMEND AN ORDINARY AND NECESSARY BUSINESS EXPENSE AND NON-TAXABLE TO THE RECIPIENT. ALL REQUESTS ARE APPROVED BEFORE PAYMENT TO ENSURE COMPLIANCE WITH INTERNAL POLICIES. Severance Payments Form 990, Schedule J, Part I line 4a The following listed individuals received Severance and/or change in control payments during calendar year 2013: During 2012, Thomas Colacchio transitioned from an officer role to a staff physician role. As part of this transition, Thomas Colacchio received a $320,000 change of control payment from Dartmouth-Hitchcock in 2013. The payment is included on Schedule J, Part II, Column (B)iii. During calendar year 2013, Former Chief Human Resource Officer Alan Weston received a $104,614 severance payment from Dartmouth-Hitchcock. The payment is included on Schedule J, Part II, Column (B)iii. During calendar year 2013, Former Senior Advisor to the CEO Neil Castaldo received a $675,000 severance payment from Dartmouth-Hitchcock. The payment is included on Schedule J, Part II, Column (B)iii. Supplemental Nonqualified Retirement Plan: FORM 990 SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): James Weinstein $63,480 William Abdu $58,267 Peter Delong $5,011 Richard Rothstein $47,767 Steven Paris $18,784 Richard Powell $32,208 Robin Kilfeather-Mackey $15,194 Linda Von Reyn $94,589 Daniel Jantzen $90,628 Stephen Leblanc $109,719 John Butterly $44,117 Alan Weston $8,132 Gregg Meyer $30,800 Neil Castaldo $43,644 Jeanine Arden Ornt $18,109 Edward Merrens $12,823 George Blike $12,765 Mary Oseid $7,682 Cliff Belden $27,195 Barbara Walters $22,050 Daniel Stewart $37,680 David Roberts $69,214 Nathan Simmons $53,997 Thomas Colacchio $94,988 Lawrence Dacey $40,275 Thomas Dodds $33,150 Wendy Wells $21,857 Jocelyn Chertoff $26,481 Edward Catherwood $35,383 Douglass Merrill $31,200 Faramarz Samie $16,920 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. DHC sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen in 1998 and therefore no further costs of the individual employee insurance premiums have been funded by the organization. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization. A New Hampshire Health and Education Facilities Auth 020279866 2011-08-31 61582591 Current Refund 2001(A) false false false A 3895747 0 61582591 0 0 0 152499 0 0 0 61430092 0 2011 true false true true A 0 A false true true false true true Morgan Stanley 29.8 true false false 0 false true A true Additional Information Part I(F) Form 990 Schedule K, Tax-Exempt Bonds Current Refund 2001(A), Issued 10/17/2001, Which Advance Refunded 1997 & 1994 Michael Ward Former Key Employee Split Dollar Life X 65346 65346 false true true Stephen LeBlanc Officer Split Dollar Life X 43293 43293 false true true Mary Oseid Former Key Employee Split Dollar Life X 28791 28791 false true true Peter Johnson Former Officer Split Dollar Life X 65868 65868 false true true 203298 Janice Kilfeather-Mackey Officer Kilfeather-Mac. 82259 Family member employed by DHC false Linda Billings FMR Key Emp. Mary Oseid 100625 Family member employed by DHC false Lynn Butterly Officer John Butterly 562237 Family member employed by DHC false Description of classes of members, persons, and the nature of their rights Form 990, Part VI, Line 6 & 7a Dartmouth-Hitchcock Health (D-HH) is the sole corporate Member of Dartmouth-Hitchcock Clinic (DHC). D-HH has specific authority and reserved powers, including the power to confirm the election of members of the DHC's Board of Trustees and the power to approve significant governance, financial and operational decisions of DHC's Trustees. Description of classes of members, persons, and the nature of their rights Form 990, Part VI, Line 7b In addition to reserved powers, Dartmouth-Hitchcock Health (D-HH) shall have the authority to take actions to establish, manage, and govern the System as an integrated health care delivery system in furtherance of the mission of the Clinic and other Organizations. These powers include but are not limited to items such as the ability to approve, disapprove or modify all material governance, programmatic and financial decisions of DHC's Board of Trustees, to appoint or remove a member of the Clinic's Board of Trustees, assess the Clinic a monetary amount for the payment of the expenses of D-HH, approve the Clinic's budget, approve the borrowings or dispositions of assets by the Clinic, approve key strategic relationships, approve the elimination or addition of any material health care service or program, and other authority to take action on behalf of the clinic. Process used by management and/or Governing Body to Review 990 Form 990, Part VI, 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. Description of Process to Monitor Transactions For Conflicts of Interest Form 990, Part VI Section B Line 12C The Dartmouth-Hitchcock Clinic Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock, Office of Policy Support, Compliance and Audit Services conducts an annual survey of all officers and trustees and performs other procedures as considered necessary to report on compliance with the conflict of interest policy. The Compliance and Audit Services Department then reports to each board any potential conflicts for their review. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trusteees on an ongoing basis. In the event a conflict arises, the individual may be removed from participating in any decision making regarding the identified conflict and/or its corresponding transactions. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Line 15a 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 last undertaken in 2014. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Line 15b Compensation for officers and key employees are evaluated by internal HR staff using national benchmarking data, along with ongoing evaluations by an independent third party firm for reasonableness, with the last formal process in 2012. External benchmarking from an independent third party has been used for any Officer who was hired or received a compensation adjustment since the last process 2012. Compensation rates are determined by following the guidelines of the compensation committee charter and philosophy documents and/or a formal review by compensation committee members. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Line 19 DHC's governing documents are available through the New Hampshire Secretary of State. Certain financial information is disclosed through the Community Benefits Annual Report. The audited financial statements, governing documents, and conflict of interest policy are available upon request either in electronic or hardcopy form. Average Hours Per Week Form 990 Part VII Section A, Line 1A, Column B As part of DHC's and Mary Hitchcock Memorial Hospital's affiliation agreement, the two organizations share officers. As such, the average hours per week are allocated between the two organizations' 990's even though compensation reported in part VII is based on the entity issuing the W-2. In addition, certain officers spend time on Dartmouth-Hitchcock Health, the sole corporate member of both MHMH and DHC, along with two supporting organizations Dartmouth-Hitchcock Medical Center and Hamden Risk Retention Group, and a related hospital, New London Hospital. Independent Contractors Form 990 Part VII Section B Dartmouth-Hitchcock Clinic is part of the Dartmouth-Hitchcock (D-H) Healthcare System which includes DHC, Mary Hitchcock Memorial Hospital (MHMH) and subsidiaries. MHMH received authority from the Internal Revenue Service to act as DHC's Pay Agent and implemented this process at the beginning of fiscal year 2010. All expenses are paid directly by MHMH and reimbursed by DHC. MHMH manages all required IRS reporting in regards to 1099's for independent contractors. Statement of Functional Expenses Form 990 Part IX Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic operate under an affiliation agreement as directed by Dartmouth-Hitchcock Health, the sole Corporate Member of both entities. Due to the integrated operating structure, related mission, and close relationship of the two tax-exempt organizations, expenses are shared between the two entities. All expenses reported within this 990 are the organization's share of expenses as designated by the affiliation agreement. FINANCIAL STATEMENTS AND REPORTING Form 990 Part XI, Line 9 Other Changes in Net Assets Include: Pension-related charges and other $7,372,896 Audited Financial Statements Form 990 Part XII, Line 2d The organization's financial information is included in the audited financial statements of Dartmouth-Hitchcock and Subsidiaries, which consists of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and subsidiaries. A-133 Audit Form 990 Part XII, Line 3a DURING FISCAL YEAR 2014, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE MINIMUM THRESHHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133, THEREFORE REQUIRING AN AUDIT. DUE TO THE ISSUANCE OF THE COMBINED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING DARTMOUTH-HITCHCOCK CLINIC. Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) 3 D-HH true Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon NH 03756 222715483 SUPPORTNG ORG NH 501(c)(3) 11 TYPE I NA true The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 HLTHCRE RSRCH NH 501(c)(3) 7 DHC true Hamden Risk Retention Group Inc 30 Main Street Suite 330 Burlington VT 05401 208530788 SELF INS. VT 501(c)(3) 11 TYPE I DHC true Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 SUPPORTNG ORG NH 501(c)(3) 11 Type II NA false The New London Hospital Association Inc 273 County Rd New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH true EverWell Inc One Medical Center Drive Lebanon NH 03756 352506275 Supportng Org NH 501(c)(3) 11 Type I D-HH true OBNET Services LLC 1 Med Ctr Dr Lebanon NH 03756 043746287 Database Serv NH DHC Related 22928 419810 false 0 true 0.50000 D-H Mster Invst Prg 1 Med Ctr Dr Lebanon NH 03756 020505863 Pooled Invest NH NA Investment Keene Hlth Alliance 580 Court St Keene NH 03431 300179297 Healthcare NH DHC Related 846000 0 false 0 true 0.50000 One Care VT ACO LLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Related The Hitchcock Ptshp 1 Med Ctr Dr Lebanon NH 03756 020514823 Invst in Ptr NH MHMH Investment 3061 0 false false 0.38580 Pompanoosuc Investment Corporation One Medical Center Drive Lebanon NH 03756 020352330 Rl Estate Hld NH DHC C CORP 123 75632 1.00000 true Hamden Assurance Company Limited Canons Court 22 Victoria St Hamilton BD HM EX 980121409 Liab Insur. BD DHC Foreign Corp 0.70200 true Hitchcock Health Connect 1 Medical Ctr Dr Lebanon NH 03756 800908979 Telehealth DE NA C Corp true Kearsarge Community Services 273 County Road New London NH 03257 020460136 Real Est Hldg NH N/A C Corp true New London Physician Group 273 County Road New London NH 03257 020494420 Physician Group NH N/A C Corp true New London Medical Center East 273 County Road New London NH 03257 020480857 Real Est Hldg NH N/A C Corp true false false false false false false false false false false true true true true true true true true true Mary Hitchcock Memorial Hospital MNOPQ 14110218 FMV Dartmouth-Hitchcock Medical Center M 874630 FMV Dartmouth-Hitchcock Medical Center L 156757 FMV The Hitchcock Foundation Q 30950 FMV The Hitchcock Foundation P 30950 FMV Hamden Risk Retention Group M 2818385 FMV The New London Hospital Association Q 425172 FMV