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HITCHCOCK FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HITCHCOCK FOUNDATION (EIN 02-0222139)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201321359349307007
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-15T14:33:10-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PRICEWATERHOUSECOOPERS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1125 HIGH STREETAddressLine1
CityBOSTONCity
StateMAState
ZIP Code02110ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN020222139EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1The Hitchcock FoundationBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JENNIFER REININGInCareOfName
Name ControlHITCNameControl
Phone6036505000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1
CityLebanonCity
StateNHState
ZIP Code03756ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJennifer ReiningName
TitleExecutive DirectorTitle
Date Signed2013-05-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone6175305000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonE Ann Gormley MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1
CityLebanonCity
StateNHState
ZIP Code03756ZIPCode
FieldValueIRS element (for citing)
Gross Receipts28562202GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTo aid & advance the study & investigation of human ailments & injuries; the causes, prevention, relief, & cure thereof, hygiene, health & public welfare, & to assist in research in the broadest senseActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year798428ContributionsGrantsPriorYear
Contributions Grants Current Year1168266ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5825735ProgramServiceRevenuePriorYear
Program Service Revenue CY2996371ProgramServiceRevenueCY
Investment Income Prior Year524322InvestmentIncomePriorYear
Investment Income Current Year1957819InvestmentIncomeCurrentYear
Other Revenue Prior Year791OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year7149276TotalRevenuePriorYear
Total Revenue Current Year6122456TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year357737GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY324457GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7324169OtherExpensePriorYear
Other Expenses Current Year5121640OtherExpensesCurrentYear
Total Expenses Prior Year7681906TotalExpensesPriorYear
Total Expenses Current Year5446097TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-532630RevenuesLessExpensesPriorYear
Revenues Less Expenses CY676359RevenuesLessExpensesCY
Total Assets BOY22960676TotalAssetsBOY
Total Assets EOY21638519TotalAssetsEOY
Total Liabilities BOY1349977TotalLiabilitiesBOY
Total Liabilities EOY1164604TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY21610699NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY20473915NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE PURPOSE OF THE HITCHCOCK FOUNDATION SHALL BE TO AID AND ADVANCE THE STUDY AND INVESTIGATION OF HUMAN AILMENTS AND INJURIES, AND THE CAUSES, PREVENTION, RELIEF, AND CURE THEREOF, AND THE STUDY AND INVESTIGATION OF PROBLEMS OF HYGIENE, HEALTH AND PUBLIC WELFARE, AND THE PROMOTION OF MEDICAL, SURGICAL AND SCIENTIFIC LEARNING, SKILL, EDUCATION AND INVESTIGATION, AND TO ENGAGE IN AND CONDUCT AND TO AID AND ASSIST IN MEDICAL, SURGICAL AND SCIENTIFIC RESEARCH IN THE BROADEST SENSE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1737715Expense
Revenue1232323Revenue
DescriptionSponsored research Funds support discrete clinical and biomedical research projects and are funded by external sources including corporations and foundations.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3251731Expense
Revenue1764048Revenue
DescriptionAdvised Funds are established by the Executive Director under the authority of the Board of Trustees. They are funded with contributions intended to support activities consistent with our charitable mission - particularly clinical research and education. They are not donor advised funds; rather the advisors are scientists and clinicians with expertise in the areas of research and education supported by the fund.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense324457Expense
Grants324457Grants
DescriptionThese expenses represent funding for research grants and fellowships. Amounts awarded range from 1,000 to 125,000. All grants are awarded on a competitive basis.Description
FieldValueIRS element (for citing)
Total Program Service Expense5313903TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiestrueForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096108NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJENNIFER REININGNamePerson
Telephone Number6036531231TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1
CityLEBANONCity
StateNHState
ZIP Code03756ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Peter Anderson MD
Board Secretary/Phys0.3XX021007719869
Suzanne Beyea RN PhD
Trustee (Ended 5/1/12)/DHC DirX011211727843
Jocelyn Chertoff MD MS
Board Chair/Phy0.3XX047399451532
Ethan Dmitrovsky MD
Treasurer (Ended 5/1/12)XX000
Peter Gardner Esq
Trustee0.3X000
E Ann Gormley MD
Vice Chair/Phy0.3XX043901414995
Penny Klotz MBA
Trustee (Ended 5/1/12)X000
Brian Lacy MD
Trustee/Phy0.3X038934742043
Michele Lauria MD
Trustee/Phy0.3X029496837126
Peter Martin MD
Trustee (Ended 5/1/12)X000
Robert Maue PhD
Trustee0.3X000
Richard Powell MD
Trustee (Ended 5/1/12)/PhyX046791050351
Richard Reindollar MD
Trustee/DHC Dept Chair OBGYN0.3X050201113286
R Brooks Robey MD
Trustee0.3X000
Barry Smith MD
Trustee/Phy0.3X0652300
Edward Stansfield MA
Trustee/Treasurer Eff 5/1/120.5XX000
Linda Titus - Ernstoff PhD
Trustee (Ended 5/1/12)X000
Michael Ward MS
Trustee/DHC VP NCCC0.3X023589817715
John Bryant
Ex-Officio (Ended 4/1/12)X000
Diane Campbell RN
Ex-Officio (Ended 10/1/11)0.3X000
Charles Mannix Esq
Ex-Officio (Ended 10/1/2011)X000
Lawrence Dacey MD
Ex-Officio/CMO0.3X054156820019
Susan Pepin MD
Trustee/Phy0.3X031513317391
William Kinlaw MD
Ex-Officio (Ended 10/1/11)X000
Duane Compton PhD
Ex-Officio (Eff 10/1/2011)X000
James Gorham
Ex-Officio (Eff 3/1/12)X000
Jeffrey Cohen MD
Ex-Officio (Eff 3/2/12)X027265416614
Edward Boraz PhD
Trustee (Eff 10/1/11)/PhyX000
Aine Donovan EdD
Trustee (Eff 10/1/11)X000
William Wickner MD
Trustee (Eff 10/1/11)X000
Michael Shoob
Executive Dire End 10/17/2011X011818811329
Jennifer Reining
Executive Dir Eff 10/17/201140.0X04649920425
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4484608TotalReportableCompFrmRltdOrgs
Total Other Compensation360538TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Trustees of Dartmouth College
37 Dewey FieldHANOVERNH03755Contracted Services2017059
Mary Hitchcock Memorial Hospital
One Medical Center DriveLEBANONNH03756Contracted Services2419352
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions1168266AllOtherContributions
Total Contributions1168266TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionSPONSORED RESEARCH, PROGRAM RESEARCH, AND DUESDescription
Business Code541700BusinessCode
Total Revenue Column2996371TotalRevenueColumn
Related Or Exempt Function Income2996371RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2996371TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column450159TotalRevenueColumn
Exclusion$450,159ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities23947406Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities22439746Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1507660Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1507660TotalRevenueColumn
Exclusion$1,507,660ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6122456TotalRevenueColumn
Related Or Exempt Function Income2996371RelatedOrExemptFunctionIncome
Exclusion$1,957,819ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total324457Total
Program Services324457ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total66812Total
Management And General66812ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3115377Total
Program Services3072706ProgramServices
Management And General42671ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20695Total
Program Services13156ProgramServices
Management And General7539ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10065Total
Program Services10025ProgramServices
Management And General40ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total348730Total
Program Services346571ProgramServices
Management And General2159ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total351334Total
Program Services351259ProgramServices
Management And General75ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total993Total
Management And General993ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
TESTS & EXAMINATIONS194272194272
RESEARCH EXP & SUBJECT FEES1835211808052716
EDUCATIONAL MATERIAL2038652003653500
LAB FEES, EQUIPMENT,& SUPLS3963793950431336

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total229597Total
Program Services225244ProgramServices
Management And General4353ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5446097Total
Program Services5313903ProgramServices
Management And General132194ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY87620BOY
EOY478589EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY167389BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY736318BOY
EOY554062EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY25746BOY
EOY25132EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7306LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5505LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2135BOY
EOY1801EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY21941468BOY
EOY20578935EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY22960676BOY
EOY21638519EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY585308BOY
EOY320859EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY764669BOY
EOY843745EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1349977BOY
EOY1164604EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6383427BOY
EOY7520234EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY13108868BOY
EOY10835277EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2118404BOY
EOY2118404EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21610699BOY
EOY20473915EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22960676BOY
EOY21638519EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses676359ReconcilationRevenueExpenses
Reconcilation Other Changes-1813143ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8956116CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8706056CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2896407CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year798428CurrentTaxYearMinus1Year
Current Tax Year1168266CurrentTaxYear
Total22525273Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8956116CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8706056CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2896407CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year798428CurrentTaxYearMinus1Year
Current Tax Year1168266CurrentTaxYear
Total22525273Total
FieldValueIRS element (for citing)
Public Support Total17022525273PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years716824CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years507972CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years520396CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year551891CurrentTaxYearMinus1Year
Current Tax Year1957819CurrentTaxYear
Total4254902Total
FieldValueIRS element (for citing)
Total Support26780175TotalSupport
Gross Receipts From Admissions Etc14265616GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.84112PublicSupportPertcentage170
Public Support Pertcent Prior Year0.87618PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6143370BeginningOfYearBalance
Contributions1171Contributions
Investment Earnings Or Losses56273InvestmentEarningsOrLosses
Other Expenditures182698OtherExpenditures
End Of Year Balance6018116EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5256297BeginningOfYearBalance
Investment Earnings Or Losses1041686InvestmentEarningsOrLosses
Other Expenditures154613OtherExpenditures
End Of Year Balance6143370EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4864103BeginningOfYearBalance
Investment Earnings Or Losses546304InvestmentEarningsOrLosses
Other Expenditures154110OtherExpenditures
End Of Year Balance5256297EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6325750BeginningOfYearBalance
Investment Earnings Or Losses-1140845InvestmentEarningsOrLosses
Other Expenditures320802OtherExpenditures
End Of Year Balance4864103EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.42840BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.35200PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.21960TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7306OtherCostOrOtherBasis
Depreciation5505Depreciation
Book Value1801BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings1801TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionAGENCY ACCOUNTSDescription
Amount$843,745Amount
FieldValueIRS element (for citing)
Total Of Amounts843745TotalOfAmounts
Total Revenue6122456TotalRevenue
Total Expenses5446097TotalExpenses
Excess Or Deficit For Year676359ExcessOrDeficitForYear
Net Unrealized GL On Investments-1813143NetUnrealizedGLOnInvestments
Total Adjustments-1813143TotalAdjustments
Excess Or Deficit Per FS-1136784ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4623382TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-1813143NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities314069DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990-1499074RevenueNotRptdF990
Revenue Subtotal6122456RevenueSubtotal
Total Revenue Per Form9906122456TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt5760166TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities314069DonatedServicesUseOfFacilities
Expenses Not Rptd F990314069ExpensesNotRptdF990
Expenses Subtotal5446097ExpensesSubtotal
Total Expenses Per Form9905446097TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart V, Line 4Identifier
ExplanationThe Hitchcock Foundation's endowment funds include resources for the following uses: Tiffany Blake Endowment Supports a research training fellowship for a young investigator at Dartmouth-Hitchcock Medical Center who is committed to clinically oriented research. Henry Heyl Endowment Supports medical research grants. Helmut Schumann Lecture Endowment Supports an annual public lecture in "Studies in Healthful Living." Helmut Schumann Fellowship Endowment Supports a fellowship for a Dartmouth-Hitchcock Medical Center faculty to develop programs in primary prevention and health promotion. Residents' Revolving Loan Fund Emergency Loan Fund for Residents and Fellows in training at Dartmouth-Hitchcock Medical Center Neurosurgical Research Fund (Barry) Supports Neurosurgical Research Harold M. Pierce Memorial Fund - Cancer Research Supports Cancer Research Schedule D Part X, Line 2 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.Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable (5 entries)

RegionRegionType Of Activities ConductedTypeOfActivitiesConductedSpecific Services ProvidedSpecificServicesProvidedTotal ExpendituresTotalExpenditures
Europe (Including Iceland and Greenland)Program ServicesConferences & Travel13684
East Asia and the PacificProgram ServicesConferences & Travel750
Europe (Including Iceland and Greenland)Program ServicesResearch & Education20984
Middle East and North AfricaProgram ServicesConferences & Travel4829
North AmericaProgram ServicesConferences & Travel15693
FieldValueIRS element (for citing)
Subtotal Amount Spent55940SubtotalAmountSpent
Total Amount Spent55940TotalAmountSpent
Transfer To Foreign CorpfalseTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorpfalseOwnForeignCorp
Passive Foreign Invest CofalsePassiveForeignInvestCo
Foreign PartnershipfalseForeignPartnership
Boycott CountriesfalseBoycottCountries

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantMedical Research GrantsTypeOfGrant
Number Of Recipients16NumberOfRecipients
Amount Of Cash Grant324457AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPart 1 Line 2Identifier
ExplanationFellowships and large Program Project Grants are made once per year. SmalleY pilot grants are made three times per year. Amounts awarded range from $1,000 to $125,000 and are awarded on a competitive basis. All grant and fellowship-related expenses are reviewed and approved by the Foundation before paid. Requests for expenditures not in pre-approved grant budgets are rejected.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Peter Anderson MD
02000060100710001986900022994600
Jocelyn Chertoff MD MS
043823905000030755031165020367052552600
E Ann Gormley MD
034796005000004105400014995045400900
Brian Lacy MD
0345901023193020253022835019208043139000
Michele Lauria MD
028811705206799025285011841033209400
Richard Powell MD
0354781090686022443030920019431051826100
Richard Reindollar MD
04648540003715700013286051529700
Michael Ward MS
0229889000600900017715025361300
Lawrence Dacey MD
04898160005175200020019056158700
Susan Pepin MD
03017280146001194500017391033252400
Jeffrey Cohen MD
02489230790401582700016614028926800

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Supplemental Retirement PlanPart 1, Line 4BThe following individuals received amounts from the Dartmouth-Hitchcock Supplemental Retirement Plan (see below for terms). Jocelyn Chertoff $29,981 E. Ann Gormley $40,640 Brian Lacy $19,133 Michele Lauria $6,488 Richard Powell $22,029 Richard Reindollar $31,720 Lawrence Dacey $51,338 Susan Pepin $11,721 Jeffrey Cohen $12,373
Defined Contribution Supplemental Retirement PlanPart 1, Line 4BDartmouth-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 (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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (20 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Part VI Governance, Management and Disclosure - Section A, Line 6:The Hitchcock Foundation has the following membership: Dartmouth-Hitchcock Clinic, the sole voting member, retains limited powers in accordance with the bylaws, elects Trustees of the Board, and approves changes in bylaws. The operational management of The Hitchcock Foundation is delegated to the Board of Trustees, in accordance with the bylaws.
Part VI Governance, Management and Disclosure - Section A, Line 7a & 7b:Dartmouth-Hitchcock Clinic (DHC) is the sole corporate member of The Hitchcock Foundation. As such, DHC retains limited powers in accordance with the bylaws including, but not limited to, electing Trustees of the Board, and approving changes within the bylaws.
Process used by management and/or Governing Body to Review 990The Form 990 is reviewed by an independent accounting firm, The Hitchcock Foundation's (THF) Executive Director, and Dartmouth-Hitchcock Clinic's Director of Corporate Finance. A copy of the return is emailed to the entire board prior to filing. In addition, the Treasurer of THF Board of Trustees will review prior to filing the return. Audited Financial Statements Form 990, Part VI, Line 12a, and Form 990 Part XII, Line 2B The organization is in the process of finalizing the audited financial statements for fiscal year June 30, 2012.Form 990, Part VI, Line 11b
Description of Process to Monitor Transactions For Conflicts of InterestThe Hitchcock Foundation has adopted and is included in the Dartmouth-Hitchcock Conflict of Interest Policy. The Dartmouth-Hitchcock 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 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 Trustees on an ongoing basis. In the event a conflict arises, the individual may be removed in participating in any decision making regarding the identified conflict and/or its corresponding transactions. All THF board members are included in the annual conflict of interest survey. 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, Question 12c
Whistleblower PolicyThe Organization has adopted and follows the policy of a related entity, Dartmouth-Hitchcock Clinic. Document Retention and Destruction Policy Form 990 Part VI, Section B, Line 14 The Organization has adopted and follows the policy of a related entity, Dartmouth-Hitchcock Clinic. Offices & Positions for Which Process was Used & Year Undertaken Form 990, Part VI, Question 15b The Director and staff of The Hitchcock Foundation are donated by Dartmouth-Hitchcock Clinc and Mary Hitchcock Memorial Hospital. Compensation for Officers are evaluated by an independent third party firm for reasonableness and national data benchmarking by the related organizations. 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 2012 for each person identified as an Officer.Part VI, Section B, Line 13
Part VI Governance, Management and Disclosure - Section B, Line 19THF's governing documents are available through the New Hampshire Department of State. Certain financial information is disclosed through the Community Benefits Annual Report. The audited financial statements and the conflict of interest policy are available upon request in either electronic or hardcopy form.
Part VII Compensation, Section A, Line 1The compensation paid by related organizations was for services provided to the related organizations and not the filing organization, with exception of the Executive Director, of which 100% of their time is spent with the Foundation. Although the individuals spent 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.
Reconciliation of Net AssetsUnrealized loss on investments ($1,813,143) Financial Statements and Reporting Part XII, Question 3a DURING FISCAL YEAR 2012, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FEDERAL FUNDING WHICH MET THE MINIMUM THRESHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. DUE TO THE NATURE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE AUDIT WAS PERFORMED ON THE FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING THE FOUNDATION.Part XI, Line 5
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Peter Anderson, M.D. TITLE:Board Secretary/Phys HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Suzanne Beyea, R.N., PhD. TITLE:Trustee (Ended 5/1/12)/DHC Dir HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Jocelyn Chertoff, M.D., M.S. TITLE:Board Chair/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:E. Ann Gormley, M.D. TITLE:Vice Chair/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Brian Lacy, M.D. TITLE:Trustee/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Michele Lauria, M.D. TITLE:Trustee/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Richard Powell, M.D. TITLE:Trustee (Ended 5/1/12)/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Richard Reindollar, M.D. TITLE:Trustee/DHC Dept Chair OBGYN HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Barry Smith, M.D. TITLE:Trustee/Phy HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Michael Ward, M.S. TITLE:Trustee/DHC VP NCCC HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Lawrence Dacey, M.D. TITLE:Ex-Officio/CMO HOURS:60FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Susan Pepin, M.D. TITLE:Trustee/Phy HOURS:40FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Dartmouth-Hitchcock Health
One Medical Center DriveLebanonNH03756264812335Parent OrgNH501(C)(3)7NAfalse
Dartmouth-Hitchcock Clinic
One Medical Center DriveLebanonNH03756222519596Phys SvcNH501(C)(3)9D-HHtrue
Hamden Assurance Risk Retention Group
30 Main Street Suite 330BurlingtonVT05401208530788Slf InsuranceVT501(C)(3)11 Type 1DHCtrue
Mary Hitchcock Memorial Hospital
One Medical Center DriveLebanonNH03756020222140HospitalNH501(C)(3)3D-HHtrue
Dartmouth Hitchcock Medical Ctr
One Medical Center DriveLebanonNH03756222715483Supportng OrGNH501(C)(3)11 Type 1NAtrue

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
OBNet Services LLP
1 Med Ctr DrLebanonNH03756043746287Database ServNHNA
Keene Hlth Alliance
580 Crt StKeeneNH03431300179297HealthcareNHNA
New Eng Phmcy Coll
1 Med Ctr DrLebanonNH03756263819035Group PurchasNHNA
DH Master Invst Prg
1 Med Ctr DrLebanonNH03756020505863InvestmentsNHNA
The Hitchcock Ptshp
1 Med Ctr DrLebanonNH03756020514823Pooled InvstNHNA

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
Pompanoosuc Investment Corp
One Medical Center DriveLebanonNH03756020352330Real Est HldgNHNAC Corp
Hamden Assurance Co LTD
980121409Liab InsNAC Corp44 Church StreetHamiltonHM EXBDBD
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Mary Hitchcock Memorial Hospital
O2486136FMV
Mary Hitchcock Memorial Hospital
P1740144FMV