2013-05-15T14:33:10-05:00 2012-06-30 PRICEWATERHOUSECOOPERS LLP 125 HIGH STREET BOSTON MA 02110 990 2011-07-01 020222139 The Hitchcock Foundation % JENNIFER REINING HITC 6036505000 One Medical Center Drive Lebanon NH 03756 Jennifer Reining 2013-05-15 6175305000 2011 2016-02-24 21:20:13Z E Ann Gormley MD One Medical Center Drive Lebanon NH 03756 28562202 false X N/A X 1946 NH To 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 sense 20 9 0 30 0 0 798428 1168266 5825735 2996371 524322 1957819 791 0 7149276 6122456 357737 324457 0 0 0 0 0 0 0 7324169 5121640 7681906 5446097 -532630 676359 22960676 21638519 1349977 1164604 21610699 20473915 X THE 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. false false 1737715 1232323 Sponsored research Funds support discrete clinical and biomedical research projects and are funded by external sources including corporations and foundations. 3251731 1764048 Advised 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. 324457 324457 These 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. 5313903 true true false false false false false false false true true false false false true false true false false false true false false false false false false false true true false false false false false false false false false false false false false true true false false false true 108 0 true 0 false false false false false false false false false false X 20 9 false false false false true true true true true false false true true true true true true false NH X JENNIFER REINING 6036531231 ONE MEDICAL CENTER DRIVE LEBANON NH 03756 X Peter Anderson MD 0.3 X X 0 210077 19869 Suzanne Beyea RN PhD X 0 112117 27843 Jocelyn Chertoff MD MS 0.3 X X 0 473994 51532 Ethan Dmitrovsky MD X X 0 0 0 Peter Gardner Esq 0.3 X 0 0 0 E Ann Gormley MD 0.3 X X 0 439014 14995 Penny Klotz MBA X 0 0 0 Brian Lacy MD 0.3 X 0 389347 42043 Michele Lauria MD 0.3 X 0 294968 37126 Peter Martin MD X 0 0 0 Robert Maue PhD 0.3 X 0 0 0 Richard Powell MD X 0 467910 50351 Richard Reindollar MD 0.3 X 0 502011 13286 R Brooks Robey MD 0.3 X 0 0 0 Barry Smith MD 0.3 X 0 65230 0 Edward Stansfield MA 0.5 X X 0 0 0 Linda Titus - Ernstoff PhD X 0 0 0 Michael Ward MS 0.3 X 0 235898 17715 John Bryant X 0 0 0 Diane Campbell RN 0.3 X 0 0 0 Charles Mannix Esq X 0 0 0 Lawrence Dacey MD 0.3 X 0 541568 20019 Susan Pepin MD 0.3 X 0 315133 17391 William Kinlaw MD X 0 0 0 Duane Compton PhD X 0 0 0 James Gorham X 0 0 0 Jeffrey Cohen MD X 0 272654 16614 Edward Boraz PhD X 0 0 0 Aine Donovan EdD X 0 0 0 William Wickner MD X 0 0 0 Michael Shoob X 0 118188 11329 Jennifer Reining 40.0 X 0 46499 20425 0 4484608 360538 0 false true false Trustees of Dartmouth College 37 Dewey Field HANOVER NH 03755 Contracted Services 2017059 Mary Hitchcock Memorial Hospital One Medical Center Drive LEBANON NH 03756 Contracted Services 2419352 2 1168266 1168266 SPONSORED RESEARCH, PROGRAM RESEARCH, AND DUES 541700 2996371 2996371 2996371 450159 450159 0 0 23947406 22439746 1507660 1507660 1507660 0 0 0 0 6122456 2996371 1957819 0 324457 324457 0 0 0 0 0 0 0 0 0 0 0 0 0 66812 66812 3115377 3072706 42671 0 20695 13156 7539 10065 10025 40 0 0 348730 346571 2159 0 351334 351259 75 0 0 993 993 0 TESTS & EXAMINATIONS 194272 194272 RESEARCH EXP & SUBJECT FEES 183521 180805 2716 EDUCATIONAL MATERIAL 203865 200365 3500 LAB FEES, EQUIPMENT,& SUPLS 396379 395043 1336 229597 225244 4353 5446097 5313903 132194 0 87620 478589 167389 0 0 0 736318 554062 0 0 0 0 25746 25132 0 0 0 0 7306 5505 2135 1801 21941468 20578935 0 0 0 0 0 0 0 0 22960676 21638519 585308 320859 0 0 0 0 0 0 0 0 0 0 0 0 0 0 764669 843745 1349977 1164604 X 6383427 7520234 13108868 10835277 2118404 2118404 21610699 20473915 22960676 21638519 X 676359 -1813143 X X false true true X true true X 8956116 8706056 2896407 798428 1168266 22525273 8956116 8706056 2896407 798428 1168266 22525273 22525273 716824 507972 520396 551891 1957819 4254902 26780175 14265616 0.84112 0.87618 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6143370 1171 56273 182698 6018116 5256297 1041686 154613 6143370 4864103 546304 154110 5256297 6325750 -1140845 320802 4864103 0.42840 0.35200 0.21960 false false 7306 5505 1801 1801 0 AGENCY ACCOUNTS 843745 843745 6122456 5446097 676359 -1813143 -1813143 -1136784 4623382 -1813143 314069 -1499074 6122456 6122456 5760166 314069 314069 5446097 5446097 Part V, Line 4 The 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. Europe (Including Iceland and Greenland) Program Services Conferences & Travel 13684 East Asia and the Pacific Program Services Conferences & Travel 750 Europe (Including Iceland and Greenland) Program Services Research & Education 20984 Middle East and North Africa Program Services Conferences & Travel 4829 North America Program Services Conferences & Travel 15693 55940 55940 false false false false false false true Medical Research Grants 16 324457 FMV Part 1 Line 2 Fellowships 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. false true false false false false false false false Peter Anderson MD 0 200006 0 10071 0 0 0 19869 0 0 0 229946 0 0 Jocelyn Chertoff MD MS 0 438239 0 5000 0 30755 0 31165 0 20367 0 525526 0 0 E Ann Gormley MD 0 347960 0 50000 0 41054 0 0 0 14995 0 454009 0 0 Brian Lacy MD 0 345901 0 23193 0 20253 0 22835 0 19208 0 431390 0 0 Michele Lauria MD 0 288117 0 52 0 6799 0 25285 0 11841 0 332094 0 0 Richard Powell MD 0 354781 0 90686 0 22443 0 30920 0 19431 0 518261 0 0 Richard Reindollar MD 0 464854 0 0 0 37157 0 0 0 13286 0 515297 0 0 Michael Ward MS 0 229889 0 0 0 6009 0 0 0 17715 0 253613 0 0 Lawrence Dacey MD 0 489816 0 0 0 51752 0 0 0 20019 0 561587 0 0 Susan Pepin MD 0 301728 0 1460 0 11945 0 0 0 17391 0 332524 0 0 Jeffrey Cohen MD 0 248923 0 7904 0 15827 0 0 0 16614 0 289268 0 0 Supplemental Retirement Plan Part 1, Line 4B The 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 Plan Part 1, Line 4B 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 (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. 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 990 Form 990, Part VI, Line 11b The 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. Description of Process to Monitor Transactions For Conflicts of Interest Form 990, Part VI, Question 12c The 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. Whistleblower Policy Part VI, Section B, Line 13 The 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 Governance, Management and Disclosure - Section B, Line 19 THF'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 1 The 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 Assets Part XI, Line 5 Unrealized 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. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Peter Anderson, M.D. TITLE:Board Secretary/Phys HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Suzanne Beyea, R.N., PhD. TITLE:Trustee (Ended 5/1/12)/DHC Dir HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jocelyn Chertoff, M.D., M.S. TITLE:Board Chair/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:E. Ann Gormley, M.D. TITLE:Vice Chair/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Brian Lacy, M.D. TITLE:Trustee/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michele Lauria, M.D. TITLE:Trustee/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Richard Powell, M.D. TITLE:Trustee (Ended 5/1/12)/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Richard Reindollar, M.D. TITLE:Trustee/DHC Dept Chair OBGYN HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Barry Smith, M.D. TITLE:Trustee/Phy HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Ward, M.S. TITLE:Trustee/DHC VP NCCC HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lawrence Dacey, M.D. TITLE:Ex-Officio/CMO HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Susan Pepin, M.D. TITLE:Trustee/Phy HOURS:40 Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Org NH 501(C)(3) 7 NA false Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Svc NH 501(C)(3) 9 D-HH true Hamden Assurance Risk Retention Group 30 Main Street Suite 330 Burlington VT 05401 208530788 Slf Insurance VT 501(C)(3) 11 Type 1 DHC true Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(C)(3) 3 D-HH true Dartmouth Hitchcock Medical Ctr One Medical Center Drive Lebanon NH 03756 222715483 Supportng OrG NH 501(C)(3) 11 Type 1 NA true OBNet Services LLP 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 New Eng Phmcy Coll 1 Med Ctr Dr Lebanon NH 03756 263819035 Group Purchas 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 Pompanoosuc Investment Corp One Medical Center Drive Lebanon NH 03756 020352330 Real Est Hldg NH NA C Corp Hamden Assurance Co LTD 44 Church Street Hamilton HM EX BD 980121409 Liab Ins BD NA C Corp false false false false false false false false false false false false false false true true false false Mary Hitchcock Memorial Hospital O 2486136 FMV Mary Hitchcock Memorial Hospital P 1740144 FMV