2014-05-15T11:45:56-05:00 2013-06-30 PRICEWATERHOUSECOOPERS LLP 125 HIGH STREET BOSTON MA 02110 990 2012-07-01 222519596 DARTMOUTH-HITCHCOCK CLINIC % ROBIN KILFEATHER-MACKEY DART 6036505000 ONE MEDICAL CENTER DRIVE Suite LEBANON NH 03756 Robin Kilfeather-Mackey 2014-05-09 6175305000 2012 2015-11-30 17:44:51Z James Weinstein DO MS One Medical Center Drive Lebanon NH 03756 407298233 false X www.dartmouth-hitchcock.org X 1983 NH 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. 22 15 4484 600 624628 5244 0 0 247880635 312867125 -66567 86264 53429403 93249217 301243471 406202606 173027 2646503 0 0 189868415 253764588 0 0 884514 111870818 131081080 301912260 387492171 -668789 18710435 301634312 228949164 518759859 376500812 -217125547 -147551648 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 320097884 230215 402644857 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 that operates clinics throughout New Hampshire and Vermont, provides medical services to patients and performs medical education and research. Health care services in 2013 resulted in approx. 665,693 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 is a member 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 hospital and only academic medical center in New Hampshire, and for 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 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. In 2012, Dartmouth-Hitchcock (D-H) was selected by the Centers for Medicare and Medicaid (CMS) as one of 32 organizations nationally to participate in the Pioneer Accountable Care demonstration project. At the end of one year, it was one of only 13 to meet all quality and safety metrics and show significant cost reductions, while providing coordinated, patient-centered care to the assigned Medicare population. Also in 2012, D-H joined with Fletcher Allen Health Care, Vermont's academic medical center, to form OneCare Vermont, an ACO 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). During the same period, Dartmouth-Hitchcock entered into a non-ownership affiliation with Mayo Clinic as part of the Mayo Clinic Care Network. 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 in 2012. 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. The Dartmouth-Hitchcock Center for Telehealth currently offers neurological and stroke care via telemedicine, as well as dermatology services. Additional care disciplines are being brought on line as of this writing. In late 2012, Dartmouth-Hitchcock formed the Partners in Community Wellness, a group of more than 300 volunteer members from throughout New Hampshire and Vermont. With the resources of D-H, the group is engaged in education and community health initiatives. An example is the Vial of Life campaign, through which the Partners have distributed, at no charge, more than 10,000 emergency information kits to physicians, emergency responders, fire departments and public safety organizations, and businesses and individuals. This ongoing effort will next focus on getting the kits to more than 1,000 schools in the region. 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 19 health systems and the TRICARE system of the Department of Defense. Together, they have a patient base of more than 100 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 Clinic and Hospital were 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 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, 2013 the Hospital provided financial assistance to patients in the amount of $21,329,978, as measured by gross charges. The estimated cost of providing this care for the year ended June 30, 2013 was $6,861,854. The Clinic also routinely provides services to Medicaid patients at reimbursement levels that are well below the cost of the care provided. The community health activities section of the report includes the cost or value of several different types of hospital-sponsored programs, such as 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 Partners in Community Wellness, ReThink Health, the Women's Health Resource Center, and smoking prevention and cessation programs. 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 reported as provision for bad debts, which is not included in the amounts reported above. During the year ended June 30, 2013, the Clinic reported a bad debt expense of $17,325,863. 19572548 2416288 130172 As a component of an integrated academic medical center, the Clinic provides significant support for academic and research programs. Through its affiliation with The Geisel School of Medicine at Dartmouth, the Clinic provides support for physicians' unpaid teaching time, 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 awarded to the Hospital and Medical School, to offset costs in excess of grant awards. 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. 339670432 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 4484 true true true true BD false false false false false false false false X 22 15 false false true false true true 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 Wayne G Granquist 2.0 5.5 X X 0 0 0 Alan C Keiller 2.0 4.5 X X 0 0 0 Jennie L Norman 2.0 4.0 X X 0 0 0 Hugh C Smith MD 1.0 2.0 X 0 0 0 James Weinstein DO MS 17.0 44.5 X X 833051 0 59682 Michael J Goran MD 1.0 2.0 X 0 0 0 Vincent S Conti 1.0 2.0 X 0 0 0 Barbara Couch 1.0 2.0 X 0 0 0 Anne-Lee Verville 1.0 2.0 X 0 0 0 William Abdu MD MS 12.0 29.0 X 634897 0 60774 Wiley Souba MD ScD 1.0 2.5 X 0 0 0 Richard S Shreve 1.0 2.0 X 0 0 0 William J Conaty 1.0 2.0 X 0 0 0 Robert A Oden Jr PhD 2.0 4.0 X X 0 0 0 Stephen D Surgenor MD MS 12.0 29.0 X 406696 0 63062 Nancy Formella MSN RN 18.0 42.5 X X 0 3209060 58814 William W Helman IV 1.0 2.5 X 0 0 0 Ruth Williams Brinkley 1.0 2.0 X 0 0 0 Peter Delong MD 12.0 28.0 X 270762 0 48410 Richard I Rothstein MD 12.0 28.0 X 564259 0 51200 Denis A Cortese MD 1.0 2.0 X 0 0 0 Matthew B Dunne 1.0 2.0 X 0 0 0 Senator Judd A Gregg 1.0 2.0 X 0 0 0 Laura K Landy 1.0 2.0 X 0 0 0 Steven A Paris MD 1.0 X 351548 0 56119 Richard J Powell MD 12.0 28.3 X 520702 0 92517 Robin Kilfeather-Mackey CPA 17.0 44.0 X 451645 0 37043 Linda Von Reyn 19.0 41.0 X 0 458727 37027 Daniel Jantzen CPA 19.0 42.0 X 0 608217 59542 Stephen LeBlanc 6.0 54.0 X 535986 0 36773 John Butterly MD 8.0 52.0 X 538707 0 93348 Alan Weston 19.0 41.0 X 0 311437 65426 Gregg Meyer MD 19.0 41.0 X 531180 0 97818 Neil Castaldo 19.0 41.0 X 0 622913 70272 Jeanine Arden Ornt 17.0 39.0 X 0 415319 72262 Vincent Fusca 19.0 41.0 X 0 230806 20753 Edward Merrens MD 12.0 28.0 X 343307 0 65544 George Blike MD 19.0 41.0 X 389078 0 48677 Mary Oseid 12.0 28.0 X 258638 0 45523 Christine Schon 12.0 28.0 X 209756 0 58175 William Mroz 19.0 41.0 X 0 245900 48844 Gail Dahlstrom 19.0 41.0 X 0 225829 32934 Michael Ward 12.0 28.0 X 182530 0 29397 Tina Naimie CPA 12.0 29.5 X 0 213338 39214 Wendy Fielding 12.0 28.0 X 0 213833 70331 Barbara Walters DO MBA 12.0 28.0 X 353318 0 57527 David Roberts MD 12.0 28.0 X 856984 0 81196 Nathan Simmons MD 12.0 28.0 X 753172 0 75941 Kadir Erkmen MD 12.0 28.0 X 1123113 0 49966 Thomas Colacchio MD 12.0 29.0 X 1041556 0 66668 Daniel Stewart MD 12.0 28.0 X 824442 0 67649 Carl DeMatteo MD 12.0 28.0 X 496126 0 7530 Lawrence Dacey MD 12.0 29.0 X 507485 0 37711 Andrew Gettinger MD 12.0 28.0 X 336449 0 39315 Sandra Dickau 12.0 28.0 X 0 127765 0 Mary Kay Boudewyns 12.0 28.0 X 0 212298 48103 13315387 7095442 2051087 1095 true true false See Schedule O 0 0 NET PATIENT SERVICE REVENUE 621110 312867125 312867125 312867125 16245 16245 0 0 2961261 644024 741230 147370 2220031 496654 2716685 2716685 -19842 296888 207027 -19842 89861 70019 70019 0 0 0 CONTRACTED REVENUE 621110 83453774 82829694 624080 RISK SHARING REVENUE & INCOME FROM AFFILIATES 211110 3359593 3359593 DHC ALLOCATED REVENUE 621110 3247560 3247012 548 471605 471605 90532532 406202606 402775029 624628 2802949 2180200 2180200 466303 466303 0 0 6273875 2940966 3017365 315544 795167 795167 184443212 161133099 23310071 42 23797653 20790083 3007565 5 25435333 22220791 3214536 6 13019348 11373950 1645395 3 0 978313 5941 972372 178938 178938 30167 30167 0 0 22365473 18084362 4281111 743367 9369 733998 6792446 6327115 465321 10 2413185 2413185 0 6174205 5155472 1018733 987590 563704 423886 0 41573 41225 348 6807571 5718360 1089211 0 16983654 14264214 2719440 1501356 1088301 413055 MEDICAL SUPPLIES 54368048 54368048 EQUIP REPAIR & MAINT 4667337 3920563 746774 ACADEMIC,GME,TEACHING & SPT 1038771 1038771 BOND RELATED EXPENSES 1106068 929097 176971 3903018 3811979 -477865 568904 387492171 339670432 46937225 884514 24313 15745 149198 -189306 0 0 36877683 35110240 354641 384015 0 0 6476070 6679138 339320 330456 0 0 140069768 98807473 46183158 41262295 93523 149037 0 0 1500 1500 0 0 211134906 145206044 301634312 228949164 56965205 65608899 0 0 0 0 58555011 56747863 0 0 0 0 18108655 16748892 0 0 385130988 237395158 518759859 376500812 X -218350102 -148777030 226096 226923 998459 998459 -217125547 -147551648 301634312 228949164 X 18710435 55513 50807951 X X false true X true true true X 4383 142981 0 0 0 147364 434650631 365093409 368081102 298584597 402775030 1869184769 0 0 0 434655014 365236390 368081102 298584597 402775030 1869332133 0 0 0 0 0 0 0 0 0 0 0 1869332133 4052931 3383606 3085762 -66568 86263 10541994 0 4052931 3383606 3085762 -66568 86263 10541994 905573 5244 910817 4574675 0 287656 4862331 443282620 368619996 371454520 299423602 402866537 1885647275 0.99135 0.98834 0.00559 0.00773 X false true false false false false true 58687 false true 28670 87357 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, 2013, Dartmouth-Hitchcock Clinic incurred $58,687 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. 999533 950 1000483 998459 0 1074 0 0 0 999533 998459 0 0 0 0 0 998459 855478 142981 998459 137536 717942 855478 0.99910 0.00090 false false 3816840 7215859 11032699 11337976 72493046 55849675 27981347 27569189 26672990 896199 17636858 16284808 1352050 41262295 INVESTMENT IN CAPTIVE - HAMDEN 109432393 BOND ISSUANCE COSTS - NET 130231 DHC 457(B) PLAN ASSETS 34264377 DUE FROM AFFILIATE 1029043 NOTES RECEIVABLE 350000 145206044 0 INTEREST RATE SWAP 13544983 ACCRUED POST RETIRMNT PENSION 122106863 RESERVES FOR INSUR. RLTD LOSS 89334998 DUE TO AFFILIATES AND 3RD PARTY ESTIMATES 12408314 237395158 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. Central America and the Caribbean Program Services Educational Travel Exp 4159 East Asia and the Pacific Program Services Educational Travel Exp 1877 Europe (Including Iceland and Greenland) Program Services Educational Travel Exp 16375 Middle East and North Africa Program Services Educational Travel Exp 1325 North America Program Services Educational Travel Exp 14313 South America Program Services Educational Travel Exp 1151 Sub-Saharan Africa Program Services Educational Travel Exp 319 North America Program Services Medical Labs & Suppls 488140 Europe (Including Iceland and Greenland) Program Services Medical Labs & Suppls 184646 Europe (Including Iceland and Greenland) Program Services Insurance Services 108190 Middle East and North Africa Program Services Collection Services 9724 North America Program Services Dues, Lic, & Publicatn 3809 North America Program Services Marketing Services 7141 North America Program Services IT Services & Misc 13541 Sub-Saharan Africa 1 Program Services Medical Svcs in Rwanda 34664 Sub-Saharan Africa Fundraising Fundraising Event 1362 1 1 890736 890736 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) 9920 FMV Program Support Grafton Country Senior Citizens Council P O Box 433 Lebanon NH 03766 237248316 501(C)(3) 11160 FMV Elder Services Indian Stream Health Center 141 Corliss Ln Colebrook NH 03756 200999212 501(C)(3) 15500 FMV Program/Clinic Svcs 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) 1949985 FMV Educ and Prog Svcs Lamprey Health 22 Prospect Street Nashua NH 03060 237305106 501(C)(3) 23029 FMV Program Services Albert Schweitzer Fellowship Inc 10 Sausville Road Etna NH 03750 131982786 501(C)(3) 6200 FMV Program Support Advance Transit PO Box 1027 Wilder VT 05088 222558708 501(C)(3) 29748 FMV Transportn Subsidy Connecticut River Transit 706 Rockingham Road Rockingham VT 05101 861069523 501(C)(3) 9300 FMV Transportn Subsidy City of Manchester NH 1 City Hall Plaza Manchester NH 03101 7750 FMV Child Hlth Svcs Child Health Services 1245 Elm St Manchester NH 03105 020348711 501(C)(3) 18427 FMV Program Support 13 0 The Dartmouth Institute Scholarships 45 264171 FMV D-H Tuition Reimbursement Program 294 189731 FMV Varnum Nursing Awards 34 12400 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 Weinstein DO MS 777576 0 0 0 55475 0 38368 0 21314 0 892733 0 0 0 William Abdu MD MS 541170 0 39445 0 54282 0 39460 0 21314 0 695671 0 0 0 Stephen D Surgenor MD MS 330926 0 59000 0 16770 0 41323 0 21739 0 469758 0 0 0 Carl DeMatteo MD 56240 0 0 0 439886 0 6733 0 797 0 503656 0 0 0 Robin Kilfeather-Mackey CPA 420635 0 0 0 31010 0 17000 0 20043 0 488688 0 0 0 Linda Von Reyn 0 310148 0 0 0 148579 0 17000 0 20027 0 495754 0 0 Daniel Jantzen CPA 0 477890 0 0 0 130327 0 39500 0 20042 0 667759 0 0 Stephen LeBlanc 451778 0 0 0 84208 0 17000 0 19773 0 572759 0 0 0 John Butterly MD 491826 0 0 0 46881 0 72035 0 21313 0 632055 0 0 0 Lawrence Dacey MD 464816 0 0 0 42669 0 24265 0 13446 0 545196 0 0 0 Alan Weston 0 307083 0 0 0 4354 0 45316 0 20110 0 376863 0 0 David Roberts MD 597676 0 192665 0 66643 0 63995 0 17201 0 938180 0 0 0 Nathan Simmons MD 513705 0 192665 0 46802 0 53995 0 21946 0 829113 0 0 0 Kadir Erkmen MD 597982 0 495107 0 30024 0 28697 0 21269 0 1173079 0 0 0 Mary Oseid 251102 0 0 0 7536 0 34000 0 11523 0 304161 0 0 0 Christine Schon 206145 0 0 0 3611 0 42749 0 15426 0 267931 0 0 0 William Mroz 0 242039 0 0 0 3861 0 40833 0 8011 0 294744 0 0 Sandra Dickau 0 0 0 0 0 127765 0 0 0 0 0 127765 0 0 Gail Dahlstrom 0 219112 0 0 0 6717 0 17000 0 15934 0 258763 0 0 Michael Ward 177843 0 0 0 4687 0 20568 0 8829 0 211927 0 0 0 Nancy Formella MSN RN 0 699182 0 0 0 2509878 0 39000 0 19814 0 3267874 0 0 Gregg Meyer MD 530732 0 0 0 448 0 83828 0 13990 0 628998 0 0 0 Andrew Gettinger MD 190974 0 0 0 145475 0 31490 0 7825 0 375764 0 0 0 Neil Castaldo 0 490202 0 70000 0 62711 0 48907 0 21365 0 693185 0 0 Peter Delong MD 245333 0 25159 0 270 0 39245 0 9165 0 319172 0 0 0 Richard I Rothstein MD 499410 0 24162 0 40687 0 34000 0 17200 0 615459 0 0 0 Thomas Colacchio MD 987376 0 0 0 54180 0 46995 0 19673 0 1108224 0 0 0 Tina Naimie CPA 0 213166 0 0 0 172 0 37410 0 1804 0 252552 0 0 Wendy Fielding 0 213563 0 0 0 270 0 50447 0 19884 0 284164 0 0 Barbara Walters DO MBA 330728 0 0 0 22590 0 39421 0 18106 0 410845 0 0 0 Jeanine Arden Ornt 0 413330 0 0 0 1989 0 58995 0 13267 0 487581 0 0 Vincent Fusca 0 228833 0 0 0 1973 0 19471 0 1282 0 251559 0 0 Mary Kay Boudewyns 0 203146 0 0 0 9152 0 39000 0 9103 0 260401 0 0 Steven A Paris MD 329228 0 0 0 22320 0 40093 0 16026 0 407667 0 0 0 Richard J Powell MD 353783 0 144900 0 22019 0 70995 0 21522 0 613219 0 0 0 Edward Merrens MD 331888 0 0 0 11419 0 51519 0 14025 0 408851 0 0 0 George Blike MD 376104 0 0 0 12974 0 27682 0 20995 0 437755 0 0 0 Daniel Stewart MD 739910 0 60000 0 24532 0 45697 0 21952 0 892091 0 0 0 CHARTERED TRAVEL SERVICES 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. 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 2012: During 2012 Nancy Formella received a $2,281,750 separation package which included severance pay, medical and dental benefits, life and disability benefits (including tax gross-up, and a SERP make-up benefit). The separation payment is in lieu of a multi-year contractual obligation.The payment is included on Schedule J, Line B, Part iii. 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. The payment is included on Schedule J, Line B, Part i. During 2012 Carl Dematteo received a $436,667 separation payment in lieu of a multi-year contracutal obligation.The payment is included on Schedule J, Line B, Part 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)): William Mroz $2,955 Nancy Formella $223,316 Andrew Gettinger $145,475 Neil Castaldo $40,949 Richard Rothstein $40,121 Thomas Colacchio $54,180 Barbara Walters $21,402 James Weinstein $53,721 William Abdu $53,677 Stephen Surgenor $16,546 Carl DeMatteo $2,020 Robin Kilfeather-Mackey $13,832 Linda Von Reyn $117,277 Daniel Jantzen $98,663 Stephen LeBlanc $61,531 John Butterly $43,380 Lawrence Dacey $41,895 Alan Weston $3,580 David Roberts $61,449 Nathan Simmons $46,532 Kadir Erkman $29,969 Mary Oseid $7,536 Richard Powell $21,555 Edward Merrens $11,149 George Blike $12,560 Daniel Stewart $24,376 Thomas Dodds $32,130 Wendy Wells $2,823 Cliff Belden $21,264 Douglass Merrill $25,500 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. 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 0 0 61582591 0 0 0 152499 0 0 0 61430092 0 2011 true false 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) 0 Form 990 Schedule K, Tax-Exempt Bonds Current Refund 2001(A), Issued 10/17/2001, Which Advance Refunds 1997 & 1994 Thomas Colacchio Former Officer Split Dollar Life X 52828 52828 false true true Stephen LeBlanc Officer Split Dollar Life X 40776 40776 false true true Mary Oseid Key Employee Split Dollar Life X 27130 27130 false true true David Roberts Highly-Compensated Split Dollar Life X 72474 72474 false true true Michael Ward Key Employee Split Dollar Life X 61612 61612 false true true Andrew Gettinger Former Officer Split Dollar Life X 56363 56363 false true true Richard Rothstein Trustee Split Dollar Life X 72832 72832 false true true 384015 Janice Kilfeather-Mackey Officer Kilfeather-Mac. 76465 Family member employed by DHC false Linda Billings Key Emp. Mary Oseid 79057 Family member employed by DHC false Lynn Butterly Officer John Butterly 432342 Family member employed by DHC false Changes to Organizational Documents Since Last 990 Filing FORM 990 Part VI Section A Line 4 Effective January 1, 2013, the Dartmouth-Hitchcock Clinic (DHC) Board of Trustees amended and restated the DHC Bylaws. The primary purpose of the amendments was to simplify the corporation's governance structure, which had become unwieldy. The amendments did not alter the mission of DHC, the role of its Board of Trustees, the Trustees' oversight of the chief executive officer selection, performance and compensation, the disposition of assets upon dissolution, or any other fundamental component of the DHC governance documents. The following is a brief statement of the significant changes to the DHC Bylaws: 1. The number of Trustees was reduced from 28 to a range from 17 to 24. Two new categories of Trustees also were established: a physician Trustee who is a Clinical Chair or Center Director, and a physician who practices in one of the Community Group Practices. 2. The Assembly of Overseers, primarily responsible for nominating Trustees and serving in an advisory role to the Board, was eliminated. The Bylaws now provide for different nominations by category of Trustee. For example, the Board of Governors will nominate physician positions, and the DHC Board will nominate candidates for the Public Trustee positions. Others serve ex officio. 3. The Board of Governors was reduced in size from 31 to 18 and will be chaired by the DHC President/CEO. Three new categories of Governors were established: a provider from a Community Group Practice, a nurse, and an associate provider. The Board of Governors' role was consolidated to the following three functions: -Serve as the executive committee of the professional staff in satisfaction of Joint Commission requirements; -Provide input and make recommendations to the CEO as to management issues and matters of concern to the professional staff; and -Provide input and make recommendations to the DHC Board of Trustees. 4. The selection process for a new President/CEO must be reviewed by the Board of Governors and include two criteria: (1) the candidate must be a licensed physician; and (2) a preference for an internal candidate. 5. The Committees of the DHC Board were reorganized into six standing committees: Governance, Value, Finance, Compensation, Research and Education, and Audit and Compliance. 6. The process for amending or repealing the DHC Bylaws, which maintain the requirements of a 2/3 majority vote of all Trustees, was modified to require the following in lieu of the requirements contained in the previous DHC Bylaws regarding the change in control process and involvement of the Divisional Boards of Governors of the Community Practices: - The proposed amendment(s) and the reason for it must be published and available to all Dartmouth-Hitchcock employees. - All Dartmouth-Hitchcock employees will be given the opportunity to provide input to the Trustees about the amendment. - All physicians credentialed at any Dartmouth-Hitchcock facility will have the opportunity to vote on an advisory recommendation regarding the amendment. - All associate providers credentialed at any Dartmouth-Hitchcock facility will have the opportunity to vote on an advisory recommendation regarding the amendment. - The Board of Trustees must request the written advice and recommendation of the Board of Governors on each proposed amendment. Description of classes of Members, Persons, and their rights Form 990, Part VI, Question 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. In addition, The Dartmouth-Hitchcock Assembly of Overseers (Overseers) acts in an advisory capacity to the DHC Board of Trustees. It elects the Public Trustee members of the DHC Board, subject to the subsequent confirmation of such members by the D-HH Board of Trustees. The Overseers have no other voting rights with respect to the Board of Trustees. Form 990, Part VI, Question 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 Audit Committee of the DHC Board of Trustees is presented with a substantially complete Form 990. 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. The Committee members are expected to review these forms before the meeting. AT THE MEETING A PRESENTATION IS MADE BY THE VICE PRESIDENT OF CORPORATE FINANCE, WITH TIME ALLOTTED FOR QUESTIONS FROM THE COMMITTEE. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL 990 AND 990-T COMPLETE ELECTRONIC VERSION IS SENT OUT TO EACH BOARD MEMBER PRIOR TO THE OFFICIAL FILING. Description of Process to Monitor Transactions For Conflicts of Interest Form 990, Part VI, Question 12c The Dartmouth-Hitchcock Clinic Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Compliance and Audit Services Department conducts an annual survey 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 the 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 Trustees on an ongoing basis. If a conflict arises, the individual is asked to recuse themselves from voting on any related items. The policy applies to all trustees, employees, and their immediate family members. All DHC board members are included in the annual conflict of interest survey. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Question 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 2013. Form 990, Part VI, Question 15b Compensation for Officers and Key Employees are 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 2013 for each person identified as an Officer or Key Employee. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 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 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. 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, Question 5 Other Changes in Net Assets Include: Pension-related charges and other ($50,807,951) Audited Financial Statements Form 990 Part XII, Question 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, Question 3a DURING FISCAL YEAR 2013, 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 Healthcare 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. 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