2014-05-15T11:45:56-05:00 2013-06-30 PRICEWATERHOUSECOOPERS LLP 125 HIGH STREET BOSTON MA 02110 990 2012-07-01 222715483 Dartmouth-Hitchcock Medical Center % TINA NAIMIE DART 6036531155 One Medical Center Drive Suite Lebanon NH 037560001 Tina E Naimie 2014-05-09 6175305000 2012 2015-11-30 17:44:51Z Tina Naimie ONE MEDICAL CENTER DRIVE Lebanon NH 03756 5084343 false X www.dhmc.org X 1983 NH Provides health care admin,planning & other services to supported orgs to promote, advance & strengthen activities such as regional programs, education & research,gov't & public relations,fundraising & other svcs 10 7 0 7 0 1749941 871037 4671034 3995121 591 400 150895 194228 6572461 5060786 1737047 862979 0 0 0 0 0 0 3643882 4858116 4135974 6595163 4998953 -22702 61833 4534519 3951669 1206301 567508 3328218 3384161 X DARTMOUTH-HITCHCOCK MEDICAL CENTER'S MISSION IS TO OFFER ADMINISTRATIVE, PLANNING, AND OTHER SERVICES DESIGNED TO PROMOTE, ADVANCE, AND STRENGTHEN THE INTERDEPENDENT AND SYNERGISTIC ACTIVITIES OF THE INDEPENDENT SUPPORTED ORGANIZATIONS IN THE AREAS OF HEALTHCARE, EDUCATION AND RESEARCH, GOVERNMENT AND PUBLIC RELATIONS, CHARITABLE FUNDRAISING AND OTHER RESOURCE DEVELOPMENT ACTIVITIES NOT INCONSISTENT WITH THE PURPOSES OF THE SUPPORTED ORGANIZATIONS. false false 1331230 862979 4106917 Promotion of multidisciplinary and regional health care programs, education and research, government and public relations, charitable fundraising and other resource development activities. 1331230 true true false false false false false false false false true false false false true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true 4 0 true 0 false false false false false false false false false false false X 10 7 false false false false true true false true true false false true true true true true true false false false NH X TINA NAIMIE 6036531155 ONE MEDICAL CENTER DRIVE LEBANON NH 037560001 X Peter M Fahey 0.5 X 0 0 0 Wayne G Granquist 1.5 6.0 X X 0 0 0 Alfred L Griggs 0.5 2.0 X X 0 0 0 Alan C Keiller 0.5 6.0 X 0 0 0 James N Weinstein DO MS 1.5 60.0 X X 0 833051 59682 William W Wyman 0.5 X 0 0 0 William W Helman IV 0.5 3.0 X 0 0 0 Wiley Souba MD ScD 0.5 43.0 X 0 828357 45120 Marc F Levenson MD 0.5 40.0 X 0 195931 0 Deborah Amdur MSW 0.5 X 0 0 0 Carol Folt PhD 0.5 40.0 X 0 633455 40945 Nancy Formella MSN RN 0.5 60.0 X X 0 3209060 58814 Tina E Naimie CPA 1.5 40.0 X 0 213338 39214 Anne Page CPA 40.0 X 0 240860 54273 0 6154052 298048 0 true true false Trustees of Dartmouth College 1 Rope Ferry Road HANOVER NH 03755 Devlpmnt and Fundrsg 3643882 1 871037 23557 871037 ASSESSMENTS TO MEMBERS FOR SERVICES 900099 3995121 3995121 3995121 587 587 0 0 0 0 0 23370 23557 -187 -187 -187 0 0 0 REIM OF PROP TAXES BY SUPPORTED ORGS 900099 111796 111796 INCOME FROM ANNUITIES 900099 82432 82432 194228 5060786 4106917 82832 X 862979 862979 0 0 0 0 0 0 0 0 0 0 0 23841 23841 0 0 0 2979107 2979107 0 118293 1402 116891 63367 63367 0 389982 389982 63494 63494 0 31041 31041 0 0 27755 27755 0 PROPERTY TAXES 439094 439094 4998953 1331230 23841 3643882 0 0 1238737 898853 0 0 272677 58333 0 0 0 0 0 0 0 0 82624 81225 3204415 508424 2723746 2695991 78859 72969 0 0 0 0 0 0 137876 144298 4534519 3951669 1120725 564370 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85576 3138 1206301 567508 X 3191977 3239863 136241 144298 0 0 3328218 3384161 4534519 3951669 61833 -5890 X false true X false false X X X false false false MARY HITCHCOCK MEMORIAL HOSPITAL 020222140 03 true 442424 DARTMOUTH-HITCHCOCK CLINIC 222519596 0 true 0 TRUSTEES OF DARTMOUTH COLLEGE 020222111 02 true 420155 VETERANS AFFAIRS MEDICAL CENTER 741612229 02 true 0 4 862579 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2675179 2675179 355231 334419 20812 174005 174005 2695991 0 ANNUITY LIABILITY 3138 3138 Schedule D, Part X, Line 2 Audited Financial Statement Footnote Regarding FIN48 (ASC 740) The organization's audited financial statements did not include a footnote relating to FIN48 (ASC 740) since there have been no changes since inception. true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 501(c)3 442424 FMV Gen support Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 501(c)3 420155 FMV Gen support 2 Schedule I, Part I, Question 2 The majority of the DHMC board members are nominated by the board members of the supported organizations. All assistance represents fundraising proceeds raised on the behalf of DHMC's supported organizations and is given for general and unrestricted operating use. true true false false false false false false false James N Weinstein DO MS 0 777576 0 0 0 55475 0 38368 0 21314 0 892733 0 0 Wiley Souba MD ScD 0 707267 0 0 0 121090 0 22500 0 22620 0 873477 0 0 Marc F Levenson MD 0 93761 0 102170 0 0 0 0 0 0 0 195931 0 0 Tina E Naimie CPA 0 213166 0 0 0 172 0 37410 0 1804 0 252552 0 0 Anne Page CPA 0 218623 0 0 0 22237 0 46336 0 7937 0 295133 0 0 Carol Folt PhD 0 539641 0 0 0 93814 0 22500 0 18445 0 674400 0 0 Nancy Formella MSN RN 0 699182 0 0 0 2509878 0 39000 0 19814 0 3267874 0 0 Severance Payments Form 990, Schedule J, Part I line 4a 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. Part I Line 4B The following individuals received the following amounts from the Dartmouth-Hitchcock Supplemental Retirement Plan (see below for terms): James Weinstein $53,721 Nancy Formella $223,316 Terms of the Dartmouth-Hitchcock Supplemental Retirement Plan: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (which consists of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic), 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 Sections 401(a)(17) and/or IRC Section 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 contribution as a result of limitations imposed by IRC Sections 401(a)(17) and/or IRC Section 415. Form 990 Part VI Section A Line 6 & 7a DHMC has four Members, referred to as components: Dartmouth College/Geisel School of Medicine; Dartmouth-Hitchcock Clinic; Mary Hitchcock Memorial Hospital; and the Veterans Affairs Center. The components shall be represented, respectively, by the Dean of Geisel School of Medicine, President of the Clinic, President of the Hospital, and Director of the Veterans Affairs, all of whom shall be Ex-Officio. The College/Medical School, Clinic, and Hospital shall each be represented by two individuals (component trustees), nominated by their respective Boards of Trustees and elected by the DHMC Board. Such individuals should normally be trustees of the component boards, but is not a requirement. All members of the board, both elected and ex-officio, shall have voting rights. In addition, the DHMC board may elect as many as five Non-Component Trustees. Form 990 Part VI Section B Line 11b After preparation and review by internal tax staff and external consultants, the return is reviewed by the Treasurer. The final form 990 is shared electronically with the Trustees prior to filing, and the trustees are provided an opportunity to review, ask questions, and recommend changes before filing of the return. Form 990 Part VI Section B Line 12C The Dartmouth-Hitchcock Medical Center Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock Compliance and Audit Services Department conducts an annual survey of all officers and trustees and performs other procedures as considered necessary to report on compliance with the Dartmouth-Hitchcock Medical Center conflict of interest policy. 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 shall 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. Form 990 Part VI Section B Line 15a The organization's treasurer is compensated by Mary Hitchcock Memorial Hospital (MHMH), a related and supported organization of DHMC. As part of their role at MHMH, their compensation is reviewed by external parties and MHMH's compensation committee. Form 990 Part VI Section C Line 19 The Organization makes its audited financial statements, governing documents, and conflict of interest policy available upon request in hardcopy form. Form 990 Part VII Section A, Line 1 The compensation paid by related organizations was for services provided to those related organizations and not the filing organization. Although the individuals worked the time listed as part of their board of trustee duties, they were not compensated with respect to those hours. The time/hours at the related organization varies by individual and organization, and would be the hours necessary to total to their respective full hours per week. Form 990 Part IX, Statement of Functional Expenses Line 11G, Purchased Services The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as Purchased services represent reimbursement for services provided by the College to DHMC. Line 25, Fundraising Expenses The Organization uses the resources of a member organization, The Trustees of Dartmouth College, to provide its Fundraising and Development Function. The amounts reported as fundraising expenses represent costs incurred raising funds for the Organization as well as fundraising on the behalf of its supported members including Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. During fiscal year 2013, the total costs paid to Dartmouth College for these services were $3,643,882. Total fundraising revenue recognized by DHMC was $871,037. All additional fundraising revenue generated by DHMC on behalf of its supported organizations was recognized directly by the Supported Organizations in the amount of $26,513,643. Statement Regarding Form 5471 Filing Requirements The Organizations's Form 5471 filing requirements have been or will be satisfied by Dartmouth-Hitchcock Clinic, One Medical Center Drive, Lebanon, New Hampshire, 03756, EIN: 22-2519596, the majority shareholder of Hamden Insurance Company Limited. Dartmouth-Hitchcock Clinic has filed the form 5471 and the applicable schedules with the IRS Service Center, Philadelphia, PA. Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Org NH 501(C)(3) 11 Type II NA false Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Group NH 501(C)(3) 9 D-H Health true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(C)(3) 3 D-H Health true Trustees of Dartmouth College 1 Rope Ferry Road Hanover NH 03755 020222111 Med. School NH 501(C)(3) 2 NA false Veterans Affairs Med & Regnl Office Cntr 215 North Main Street White River Junction VT 05001 741612229 Hospital VT N/A false Hamden Risk Retention Group 30 Main Street Suite 330 Burlington VT 05401 208530788 Slf Insurance VT 501(C)(3) 11 Type 1 DHC true The Hitchcock Foundation One Medical Center Dr Lebanon NH 03756 020222139 Research Aid NH 501(C)(3) 7 DHC true OBNET Services LLC 1 Med Ctr Dr Lebanon NH 03756 043746287 Database Serv NH NA Keene Hlth Alliance 580 Crt St Keene NH 03431 300179297 Healthcare NH NA DH Master Invst Prg 1 Med Ctr Dr Lebanon NH 03756 020505863 Investments NH NA The Hitchcock Ptshp 1 Med Ctr Dr Lebanon NH 03756 020514823 Pooled Invst NH NA OneCare VT ACOLLC 111 COLCHESTER AVE Burlington VT 05401 455399218 Shared Saving VT NA Pompanoosuc Investment Corp One Medical Center Drive Lebanon NH 03756 020352330 Real Est Hldg NH NA C Corp false Hamden Assurance Co LTD 44 Church Street Hamilton HM EX BD 980121409 Liab Ins BD NA C Corp false Hitchcock Health Connect One Medical Center Drive Lebanon NH 03756 800908979 Telehealth DE NA C Corp false false false false false false false false false true false true true false true true true false false Mary Hitchcock Memorial Hospital M 347380 FMV Mary Hitchcock Memorial Hospital L 1538619 FMV Dartmouth Hitchcock Clinic L 691264 FMV Dartmouth Hitchcock Clinic M 156069 FMV