CHESHIRE MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHESHIRE MEDICAL CENTER (EIN 02-0354549)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2013-11-15
- IRS object ID
- 201323199349300932
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T07:07:39-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020383073 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM STEELE & ASSOCIATES PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 STARK STREET | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020354549 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CHESHIRE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHES | NameControl |
| Phone | 6033545400 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 COURT STREET | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JILL BATTY | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 6033545400 | Phone |
| Date Signed | 2013-11-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM G STEELE JR CPA | Name |
| PTIN | P00233103 | PTIN |
| Phone | 6036228881 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ARTHUR NICHOLS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 COURT STREET | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 158992896 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHESHIRE-MED.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1980 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | THE PRIMARY PURPOSE OF THE CHESHIRE MEDICAL CENTER IS TO ENSURE ACCESS TO QUALITY HEALTH CARE SERVICES TO ALL RESIDENTS OF THE MONADNOCK REGION. THE ORGANIZATION'S CHARITABLE MISSION IS ENHANCED THROUGH THE OPERATION OF A JOINT OPERATING PARTNERSHIP AGREEMENT WITH THE HITCHCOCK CLINIC. THE PURPOSE OF THE JOINT OPERATING PARTNERSHIP AGREEMENT IS TO PROVIDE A MORE EXTENSIVE AND EFFECTIVE HEALTH CARE DELIVERY SYSTEM TO THE COMMUNITIES IN THE MONADNOCK REGION BY ESTABLISHING JOINT PLANNING AND DECISION MAKING PROCESSES, INTERGRATING HEALTH CARE SERVICES AND ESTABLISHING MECHANISMS FOR THE REINVESTMENT OF RESOURCES TO IMPROVE COMMUNITY HEALTH. THE FINANCIAL RESULTS OF THE JOINT OPERATING PARTNERSHIP ARE REPORTED ANNUALLY ON FORM 1065, US PARTNERSHIP RETURN OF INCOME. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1151 | TotalNbrEmployees |
| Total Nbr Volunteers | 202 | TotalNbrVolunteers |
| Total Gross UBI | 224907 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -109334 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 516909 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 721869 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 115775671 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 153224890 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 637151 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1408537 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3354458 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3637600 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 120284189 | TotalRevenuePriorYear |
| Total Revenue Current Year | 158992896 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 46503524 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 61842012 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 73879547 | OtherExpensePriorYear |
| Other Expenses Current Year | 94352388 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 120383071 | TotalExpensesPriorYear |
| Total Expenses Current Year | 156194400 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -98882 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2798496 | RevenuesLessExpensesCY |
| Total Assets BOY | 130251331 | TotalAssetsBOY |
| Total Assets EOY | 136587126 | TotalAssetsEOY |
| Total Liabilities BOY | 79483485 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 68373250 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 50767846 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 68213876 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE PRIMARY PURPOSE OF THE CHESHIRE MEDICAL CENTER IS TO ENSURE ACCESS TO QUALITY HEALTH CARE SERVICES TO ALL RESIDENTS OF THE MONADNOCK REGION. THE ORGANIZATION'S CHARITABLE MISSION IS ENHANCED THROUGH THE OPERATION OF A JOINT OPERATING PARTNERSHIP AGREEMENT WITH THE HITCHCOCK CLINIC. THE PURPOSE OF THE JOINT OPERATING PARTNERSHIP AGREEMENT IS TO PROVIDE A MORE EXTENSIVE AND EFFECTIVE HEALTH CARE DELIVERY SYSTEM TO THE COMMUNITIES IN THE MONADNOCK REGION BY ESTABLISHING JOINT PLANNING AND DECISION MAKING PROCESSES, INTERGRATING HEALTH CARE SERVICES AND ESTABLISHING MECHANISMS FOR THE REINVESTMENT OF RESOURCES TO IMPROVE COMMUNITY HEALTH. THE FINANCIAL RESULTS OF THE JOINT OPERATING PARTNERSHIP ARE REPORTED ANNUALLY ON FORM 1065, US PARTNERSHIP RETURN OF INCOME. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 140994452 | Expense |
| Revenue | 154533231 | Revenue |
| Description | THE CHESHIRE MEDICAL CENTER IS A COMMUNITY HEALTH CARE ORGANIZATION SERVING AS A REGIONAL REFERRAL CENTER FOR KEENE AND THE SURROUNDING SERVICE AREA. IT IS FULLY COMMITTED TO MEETING THE HEALTH CARE NEEDS OF THESE COMMUNITIES AND PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES AND PROGRAMS. AS A NON-PROFIT CORPORATION, THE CHESHIRE MEDICAL CENTER ACKNOWLEDGES ITS COMMITMENT TO PROVIDE SERVICES TO THE COMMUNITY. THESE SERVICES ARISE PRIMARILY FROM THE FOUR FOLLOWING GENERAL SERVICE CATEGORIES. 1) SUBSIDIZATION OF GOVERNMENT-SPONSORED HEALTHCARE PROGRAMS - PRINCIPALLY MEDICARE AND MEDICAID. 2) SPONSORSHIP AND/OR SUBSIDIZATION OF HEALTH-RELATED COMMUNITY SERVICES AND EDUCATIONAL PROGRAMS. 3) PROVISION OF HEALTHCARE AT NO CHARGE OR REDUCED CHARGE, ACCORDING TO FINANCIAL NEED. 4) PROVISION OF 24-HOUR EMERGENCY ROOM SERVICES, WITHOUT REGARD FOR ABILITY TO PAY. THE CHESHIRE MEDICAL CENTER, AS A MATTER OF POLICY AND PRACTICE HAS PROVIDED, AND WILL CONTINUE TO PROVIDE, A SIGNIFICANT CONTRIBUTION TO THE COMMUNITIES IT SERVES. | Description |
| Total Program Service Expense | 140994452 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 1 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 176 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1151 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY SHERWIN CONTROLLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6033545400 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CHESHIRE MEDICAL CENTER 580 COURT | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| KATHI SNOW | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| LARRY JAEGER MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GREGG TEWKSBURY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| WALTER ROHR | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JAY KAHN | ||||||||
| CHAIR | 3.00 | X | 0 | 0 | 0 | X | ||
| MICHAEL NEWBOLD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ROGER HANSEN | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| SYLVIA MCBETH | ||||||||
| VICE CHAIR | 2.00 | X | 0 | 0 | 0 | X | ||
| JUDITH BOULE | ||||||||
| MEDICAL STAFF PRESIDENT | 2.00 | X | 0 | 0 | 0 | |||
| JUDY KALICH | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ROBERT MUCHA | ||||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | X | ||
| ARTHUR NICHOLS | ||||||||
| PRESIDENT | 53.00 | X | 544276 | 0 | 52423 | X | ||
| ED BERGERON | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| STEVE HORTON | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MARY LOUISE CAFFREY | ||||||||
| SECRETARY | 2.00 | X | 0 | 0 | 0 | X | ||
| MARY ANN KRISTIANSEN | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| GEOF MOLINA | ||||||||
| TRUSTEE | 2.00 | X | 654 | 0 | 0 | |||
| JILL BATTY | ||||||||
| VP FINANCE, CFO | 52.00 | 263848 | 0 | 44944 | X | |||
| PAUL PEZONE | ||||||||
| VP SUPPORT SERVICES | 51.00 | 164287 | 0 | 23028 | X | |||
| CINDI COUGHLIN | ||||||||
| CNO | 52.00 | 180618 | 0 | 34023 | X | |||
| JULIE GREEN | ||||||||
| VP HR | 50.00 | 170114 | 0 | 41763 | X | |||
| ERLI CHEN | ||||||||
| PHYSICIST | 50.00 | 218569 | 0 | 29509 | X | |||
| LARRY MILLER | ||||||||
| CHIEF CRNA | 50.00 | 192809 | 0 | 37820 | X | |||
| KRISTIN ROSSI | ||||||||
| CRNA | 50.00 | 146163 | 0 | 26146 | X | |||
| DENIS FORTIER | ||||||||
| PHARMACY DIRECTOR | 50.00 | 148286 | 0 | 29222 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2029624 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 318878 | TotalOtherCompensation |
| Number Individuals GT100 K | 30 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| QUEST DIAGNOSTICS | |||||
| 5763 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | LAB DIAGNOSTIC SERVICES | 847430 |
| NEW ENGLAND MEDICAL TRANSCRIPTION INC | |||||
| PO BOX 430 | WOOLWICH | ME | 04579 | TRANSCRIPTION SERVICES | 559302 |
| ALLSCRIPTS LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 606731246 | TECHNOLOGY | 501498 |
| DARTMOUTH HITCHCOCK | |||||
| ONE MEDICAL CENTER DR | LEBANON | NH | 03755 | LAB DIAGNOSTIC SERVICES | 458041 |
| NEW HAMPSHIRE IMAGING | |||||
| 1 PILLSBURY STREET | CONCORD | NH | 033013570 | IMAGING SERVICES | 327940 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| Government Grants | 136375 | GovernmentGrants |
| All Other Contributions | 585494 | AllOtherContributions |
| Total Contributions | 721869 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621300 | 153164890 | 153164890 |
| CONTRACT REVENUE | 621300 | 60000 | 60000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 153224890 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 603239 | TotalRevenueColumn |
| Exclusion | $603,239 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 776058 | Securities |
| Other | 29240 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 776058 | Securities |
| Other | 29240 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 805298 | TotalRevenueColumn |
| Related Or Exempt Function Income | 29240 | RelatedOrExemptFunctionIncome |
| Exclusion | $776,058 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| PHARMACY & DRUGS | 621300 | 1201406 | $1,201,406 | ||
| FOOD SERVICE | 621300 | 932186 | $932,186 | ||
| CHILDCARE CENTER | 624410 | 737009 | 512102 | 224907 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 766999 | TotalRevenueColumn |
| Related Or Exempt Function Income | 766999 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3637600 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 158992896 | TotalRevenueColumn |
| Related Or Exempt Function Income | 154533231 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 224907 | UnrelatedBusinessRevenue |
| Exclusion | $3,512,889 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1307447 | Total |
| Program Services | 1111330 | ProgramServices |
| Management And General | 196117 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41903808 | Total |
| Program Services | 35534429 | ProgramServices |
| Management And General | 6369379 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4287040 | Total |
| Program Services | 3635410 | ProgramServices |
| Management And General | 651630 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11153864 | Total |
| Program Services | 9458477 | ProgramServices |
| Management And General | 1695387 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3189853 | Total |
| Program Services | 2704995 | ProgramServices |
| Management And General | 484858 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 300026 | Total |
| Management And General | 300026 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51070 | Total |
| Management And General | 51070 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 480841 | Total |
| Program Services | 407753 | ProgramServices |
| Management And General | 73088 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200671 | Total |
| Program Services | 200671 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 314966 | Total |
| Program Services | 267091 | ProgramServices |
| Management And General | 47875 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6672009 | Total |
| Program Services | 5657864 | ProgramServices |
| Management And General | 1014145 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 176573 | Total |
| Program Services | 176573 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1166241 | Total |
| Program Services | 988972 | ProgramServices |
| Management And General | 177269 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8457999 | Total |
| Program Services | 7172383 | ProgramServices |
| Management And General | 1285616 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1632116 | Total |
| Program Services | 1384034 | ProgramServices |
| Management And General | 248082 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| DRUGS, CHEMICALS, SUPPL | 15133684 | 15133684 |
| BAD DEBTS | 13059228 | 13059228 |
| CONTRACT LABOR | 10864376 | 10864376 |
| MEDICAL & SURG. SUPPLIE | 7282539 | 7282539 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28560049 | Total |
| Program Services | 25954643 | ProgramServices |
| Management And General | 2605406 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156194400 | Total |
| Program Services | 140994452 | ProgramServices |
| Management And General | 15199948 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26195809 | BOY |
| EOY | 26344653 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12458722 | BOY |
| EOY | 12586580 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2169915 | BOY |
| EOY | 2273489 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2237514 | BOY |
| EOY | 2418354 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 177681498 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 109033844 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67550825 | BOY |
| EOY | 68647654 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13832078 | BOY |
| EOY | 16743372 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5806468 | BOY |
| EOY | 7573024 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130251331 | BOY |
| EOY | 136587126 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13737267 | BOY |
| EOY | 9996974 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24699 | BOY |
| EOY | 9825 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26207556 | BOY |
| EOY | 30888852 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 801064 | BOY |
| EOY | 617362 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38712899 | BOY |
| EOY | 26860237 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79483485 | BOY |
| EOY | 68373250 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47712572 | BOY |
| EOY | 64611817 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3055274 | BOY |
| EOY | 3602059 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50767846 | BOY |
| EOY | 68213876 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130251331 | BOY |
| EOY | 136587126 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2798496 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 424544 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 14222990 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $21,382 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 21382 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | A PORTION OF AHA & NHHA DUES ARE ALLOCATED TO LOBBYING EXPENSE. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3055274 | BeginningOfYearBalance |
| Contributions | 234785 | Contributions |
| Investment Earnings Or Losses | 688499 | InvestmentEarningsOrLosses |
| Other Expenditures | 376499 | OtherExpenditures |
| End Of Year Balance | 3602059 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2634569 | BeginningOfYearBalance |
| Contributions | 154965 | Contributions |
| Investment Earnings Or Losses | 484487 | InvestmentEarningsOrLosses |
| Other Expenditures | 218747 | OtherExpenditures |
| End Of Year Balance | 3055274 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2445561 | BeginningOfYearBalance |
| Contributions | 168756 | Contributions |
| Investment Earnings Or Losses | 299947 | InvestmentEarningsOrLosses |
| Other Expenditures | 279695 | OtherExpenditures |
| End Of Year Balance | 2634569 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1479480 | BeginningOfYearBalance |
| Contributions | 164317 | Contributions |
| Investment Earnings Or Losses | 1124611 | InvestmentEarningsOrLosses |
| Other Expenditures | 322848 | OtherExpenditures |
| End Of Year Balance | 2445561 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1408853 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 88740 | InvestmentEarningsOrLosses |
| Other Expenditures | 18113 | OtherExpenditures |
| End Of Year Balance | 1479480 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4196423 | OtherCostOrOtherBasis |
| Book Value | 4196423 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 76123525 | OtherCostOrOtherBasis |
| Depreciation | 43150960 | Depreciation |
| Book Value | 32972565 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 97361550 | OtherCostOrOtherBasis |
| Depreciation | 65882884 | Depreciation |
| Book Value | 31478666 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 68647654 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| POOLED INVESTMENTS | 15798525 | F |
| FUNDED DEPR ACCOUNT | 944847 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 16743372 | TotalOfBookValueSecurities |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| UNAMORTIZED BOND COSTS | 370819 |
| FUNDS HELD BY TRUSTEE - CURRENT | 2535521 |
| NE LIFE CARE EQUITY | 110452 |
| DUE FROM STATE OF NH | 1774408 |
| DUE FROM CHESHIRE HEALTH FOUNDATION | 2781824 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 7573024 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PENSION LIABILITY | $18,208,985 |
| AMOUNTS PAYABLE TO THIRD PARTY | $1,255,584 |
| DUE TO DARTMOUTH HITCHCOCK | $7,395,668 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 26860237 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 158113538 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 158113538 | RevenueSubtotal |
| Other Revenues Not Included | 879358 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 879358 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 158992896 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 155315042 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 155315042 | ExpensesSubtotal |
| Other Expenses Not Included | 879358 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 879358 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 156194400 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | INCOME FROM THE ENDOWMENTS ARE USED TO SUPPORT THE ORGANIZATION'S PROGRAMS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | INCLUDED IN THE CHESHIRE MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING "MANAGEMENT EVALUATED THE MEDICAL CENTER'S TAX POSITIONS AND CONCLUDED THE MEDICAL CENTER HAS MAINTAINED ITS TAX-EXEMPT STATUS, DOES NOT HAVE SIGNIFICANT UNRELATED BUSINESS INCOME AND HAD NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS." |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES INCLUDED IN AFS REVENUE 879,358. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES INCLUDED IN AFS REVENUE 879,358. |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | CENTRAL AMERICA AND THE CARIBBEAN | Region |
| Number Of Offices | 0 | NumberOfOffices |
| Number Of Employees | 0 | NumberOfEmployees |
| Type Of Activities Conducted | INVESTMENTS IN INVESTMENT ENTITIES DOMICILED IN FOREIGN JURISDICTIONS | TypeOfActivitiesConducted |
| Total Expenditures | 2134018 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 0 | SubtotalNumberOfEmployees |
| Cont Number Of Offices | 0 | ContNumberOfOffices |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 0 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 2134018 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 2134018 | TotalAmountSpent |
| Transfer To Foreign Corp | 0 | TransferToForeignCorp |
| Interest In Foreign Trust | 0 | InterestInForeignTrust |
| Own Foreign Corp | 0 | OwnForeignCorp |
| Passive Foreign Invest Co | 0 | PassiveForeignInvestCo |
| Foreign Partnership | 0 | ForeignPartnership |
| Boycott Countries | 0 | BoycottCountries |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 225.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1836 | PersonsServed |
| Total Community Benefit Expense | 2570680 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2570680 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01650 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14055932 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2394185 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11661747 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07470 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1836 | PersonsServed |
| Total Community Benefit Expense | 16626612 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2394185 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14232427 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09120 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 30 | NumberOfActivitiesOrPrograms |
| Persons Served | 17071 | PersonsServed |
| Total Community Benefit Expense | 1195009 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 65069 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1129940 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00720 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 524 | PersonsServed |
| Total Community Benefit Expense | 265589 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 265589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 191 | PersonsServed |
| Total Community Benefit Expense | 66414 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 66414 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 204 | PersonsServed |
| Total Community Benefit Expense | 157900 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 157900 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 234 | PersonsServed |
| Total Community Benefit Expense | 113083 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 112883 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 48 | NumberOfActivitiesOrPrograms |
| Persons Served | 18224 | PersonsServed |
| Total Community Benefit Expense | 1797995 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 65269 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1732726 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 48 | NumberOfActivitiesOrPrograms |
| Persons Served | 20060 | PersonsServed |
| Total Community Benefit Expense | 18424607 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2459454 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15965153 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10220 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 19424 | PersonsServed |
| Total Community Building Expense | 204469 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 204469 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 2614 | PersonsServed |
| Total Community Building Expense | 83336 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 47491 | DirectOffsettingRevenue |
| Net Community Building Expense | 35845 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 27794 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 27794 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 311473 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 311473 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 22038 | PersonsServed |
| Total Community Building Expense | 627072 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 47491 | DirectOffsettingRevenue |
| Net Community Building Expense | 579581 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $12,588,614 | BadDebtExpenseAmount |
| Amount Attributable To | 3147154 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 46956447 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 50102529 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3146082 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (4 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| 1 KEENE HEALTH ALLIANCE | |||
| INTEGRATING HEALTH CARE SERVICES TO PROVIDE EFFECTIVE DELIVERY SYSTEM | 0.50000 | 0.00000 | 0.00000 |
| 2 NEW ENGLAND LIFE CARE INC | |||
| A NOT-FOR-PROFIT HOME INFUSION THERAPY COOPERATIVE. | 0.02000 | 0.00000 | 0.00000 |
| 3 NH LITHOTRIPSY | |||
| LITHOTRIPSY SERVICES | 0.03570 | 0.00000 | 0.00000 |
| 4 NH IMAGING | |||
| IMAGING SERVICES | 0.08330 | 0.00000 | 0.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHESHIRE MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 COURT STREET | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHESHIRE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 225.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART II: THE MEDICAL CENTER HAS BEEN ACTIVELY ENGAGED SINCE THE SPRING OF 2006 IN HEALTHY MONADNOCK (HM) 2020: TO MAKE KEENE AND THE SURROUNDING REGION THE HEALTHIEST IN THE NATION BY THE YEAR 2020. HM2020 PROMOTES BROAD-BASED COMMUNITY HEALTH MESSAGING AND OTHER ENVIRONMENTAL STRATEGIES FOR PREVENTION AND WELLNESS. THE "CHAMPIONS PROGRAM" ENGAGES INDIVIDUALS AND ORGANIZATIONS TO TAKE STEPS TO IMPROVE HEALTH AT A PERSONAL AND INSTITUTIONAL LEVEL. THE MEDICAL CENTER PROVIDES STAFFING, OFFICE SPACE AND OVERALL LEADERSHIP FOR THIS INITIATIVE. AS OF JUNE 30, 2013 THERE ARE 1,985 COMMUNITY RESIDENTS, 83 LOCAL BUSINESSES, AND 11 SCHOOLS JOINED THE ASSOCIATED CHAMPIONS PROGRAM. THE ORGANIZATION IS A FOUNDING MEMBER OF THE COUNCIL FOR HEALTH COMMUNITIES WHICH HAS BEEN IN EXISTENCE FOR OVER 15 YEARS AND HAS DEVELOPED A VARIETY OF PREVENTION, TRANSPORTATION, REFERRAL, AND HEALTH PROMOTION PROGRAMS. | ||
| PART III, LINE 4: CHESHIRE MEDICAL CENTER MANAGEMENT ESTIMATES THAT APPROXIMATELY 25% OF BAD DEBT EXPENSE (APPROXIMATELY 2.5 TIMES THE REGION'S POVERTY RATE) IS AN APPROPRIATE ESTIMATION OF PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM BUT DID NOT APPLY. THIS ESTIMATION IS BASED ON THE RECOGNITION THAT THE FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO RESIDENTS WITH INCOMES OF UP TO THREE TIMES THE FEDERALLY DEFINED POVERTY INCOME LEVELS AND THE ASSUMPTION THAT PATIENTS WHO CHOOSE NOT TO PAY THEIR BILLS ARE MORE LIKELY TO FALL WITHIN THE LOWER INCOME LEVELS. FOR 2013, THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE IS $3,147,154.CHESHIRE MEDICAL CENTER ESTIMATES THAT ACCOUNT BALANCES AFTER INSURANCE CONTRACTUAL ALLOWANCES AND PAYMENTS (AMOUNTS REPRESENTING PATIENT COINSURANCE AND COPAYMENT) HAVE BEEN INCLUDED AT 100%. ACCOUNT BALANCES FOR PATIENTS WITHOUT INSURANCE HAVE BEEN REDUCED TO THE ESTIMATED COST OF THE SERVICES PROVIDED.FOR A DESCRIPTION OF BAD DEBT EXPENSE, SEE PAGE 9, ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE, OF THE ATTACHED AUDITED FINANCIAL STATEMENT. | ||
| PART III, LINE 8: THE MEDICARE COST REPORT FOR THE PERIOD ENDED JUNE 30, 2013 HAS NOT BEEN COMPLETED AS OF THE DUE DATE OF THIS FORM 990. THE MEDICARE REVENUE AND ALLOWABLE COST AMOUNTS REPORTED AT PART III, SECTION B ARE ESTIMATES BASED ON ALL AVAILABLE INFORMATION. THESE AMOUNTS WILL BE REVISED AFTER THE COST REPORTS ARE FILED. THIS SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE WE ARE THE ONLY HOSPITAL/MEDICAL CENTER IN CHESHIRE COUNTY, NEW HAMPSHIRE AND WE ARE DESIGNATED BY CMS AS A MEDICARE DEPENDENT HOSPITAL (MDH) DUE TO GREATER THAN 60% OF OUR AVERAGE DAILY CENSUS BEING COMPRISED OF MEDICARE PATIENTS. OUR PRESENCE IN THE COMMUNITY ALLOWS THE RESIDENTS OF CHESHIRE COUNTY, ESPECIALLY THE ELDERLY POPULATION, TO RECEIVE COMPREHENSIVE HOSPITAL AND MEDICAL SERVICES CLOSE TO HOME. | ||
| PART III, LINE 9B: SYSTEMS ARE IN PLACE TO CAPTURE FINANCIAL ASSISTANCE ACCOUNTS PRIOR TO A BILL GOING TO THE PATIENT | ||
| PART V, SECTION B, LINE 3: NEEDS WERE PRIORITIZED BASED ON DATA COLLECTED FROM SEVERAL CURRENT ASSESSMENT PROCESSES. PRIORITIZATION WAS COMPLETED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT LEADERSHIP TEAM. SEVERAL HUNDRED PEOPLE PARTICIPATED IN FORUMS AND SURVEYS TO IDENTIFY COMMUNITY NEEDS. | CHESHIRE MEDICAL CENTER | |
| PART V, SECTION B, LINE 6I: A VARIETY OF COMMUNITY HEALTH IMPROVEMENT INITIATIVES ARE UNDERWAY. | CHESHIRE MEDICAL CENTER | |
| PART VI, LINE 2: IN 2008, THE COMMUNITY NEEDS ASSESSMENT WAS COORDINATED WITH THE ASSISTANCE OF THE BROAD-BASED COMMUNITY HEALTH COALITION, THE COUNCIL FOR A HEALTHIER COMMUNITY. IN PROMOTING THE HEALTHIEST COMMUNITY INITIATIVE, KNOWN LOCALLY AS HEALTHY MONADNOCK 2020 (HM2020), THE COUNCIL IDENTIFIED COMMUNITY NEEDS TOWARD A GOAL OF BECOMING THE HEALTHIEST COMMUNITY IN THE NATION BY THE YEAR 2020. HM2020 HAD THREE COMMUNITY SUMMITS BRING TOGETHER OVER 150 PEOPLE EACH TIME. THE FIRST SUMMIT GATHERED COMMUNITY INPUT ABOUT THE HEALTHY MONADNOCK COMMUNITY INDICATORS BY IDENTIFYING CONTRIBUTING FACTORS AND POSSIBLE STRATEGIES FOR EACH INDICATOR. THE SECOND SUMMIT FOCUSED ON HEALTHY EATING AND ACTIVE LIVING INDICATORS, IDENTIFIED COMMUNITY-LEVEL STRATEGIES FOR EACH INDICATOR, AND RECRUITED PARTNERS FOR IMPLEMENTATION EFFORTS. THE THIRD SUMMIT FOCUSED ON SOCIAL DETERMINANTS OF HEALTH AND AGAIN IDENTIFIED STRATEGIES AND RECRUITED PARTNERS FOR IMPLEMENTATION. HM2020 ALSO CONDUCTS A COMMUNITY SURVEY EVERY TWO YEARS. THE SURVEY IS A STATISTICALLY SIGNIFICANT RANDOMIZED TELEPHONE SURVEY OF CHESHIRE COUNTY RESIDENTS THAT ASSESSES HEALTH BEHAVIORS, HEALTH ACCESS, HEALTH LITERACY, AND SOCIAL CAPITAL.CHESHIRE MEDICAL CENTER PROVIDES STAFF FOR THE HEALTHY MONADNOCK (HM) 2020 INITIATIVE AND FUNDS THE COMMUNITY ASSESSMENT PROCESS THROUGH AN EVALUATION PARTNERSHIP CONTRACT WITH ANTIOCH NEW ENGLAND UNIVERSITY. ON NOVEMBER 10, 2011 COMMUNITY MEMBERS ATTENDED SUMMIT II AND REVIEWED 31 CORE IMPLEMENTATION STRATEGIES. THE (HM 2020) HEALTHIEST COMMUNITY ADVISORY BOARD, COMPRISED OF 30 COMMUNITY REPRESENTATIVES, PROVIDES ONGOING OVERSIGHT OF THE IMPLEMENTATION OF THE STRATEGIES AND COMMUNITY PLANNING PROCESS. IN 2013, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS COMPLETED WITH AN IMPLEMENTATION STRATEGY IDENTIFIED FOR COMMUNITY BENEFIT ACTIVITIES FOR THE NEXT THREE YEARS. THE 2013 CHNA REPORT SUMMARIZES THE WORK OF THE CHNA LEADERSHIP TEAM AND THE EFFORTS OF OTHER LOCAL COLLABORATIVE GROUPS TO ASSESS THE NEEDS OF OUR REGION. SEVERAL COMMUNITY PARTNERS RECENTLY COMPLETED COMMUNITY NEEDS ASSESSMENTS, INCLUDING HEALTHY MONADNOCK 2020. THE RESULTS WERE USED TO STRENGTHEN AND SUPPORT THE NEEDS ASSESSMENT PROCESS. FOUR COMMUNITY NEEDS WERE PRIORITIZED ABOVE THE OTHER IDENTIFIED NEEDS: -BEHAVIORAL HEALTH SERVICES INCREASING THE EFFECTIVENESS OF LOCAL SERVICES-URGENT CARE TIMELY AND ECONOMICAL ACCESS TO SERVICES INSTEAD OF EMERGENCY ROOM CARE -TRANSPORTATION INCREASE ACCESS TO PUBLIC/PRIVATE TRANSPORTATION PARTICULARLY IN RURAL TOWNS-IMPROVED COORDINATION AND COMMUNICATION BETWEEN SERVICES IMPROVING LINKAGES BETWEEN CLINICAL SERVICES, FAITH-BASED ORGANIZATIONS, AND INFORMAL SUPPORT NETWORKIN ADDITION TO THESE PRIORITIES, THE IMPLEMENTATION STRATEGY ALSO PROVIDES AN OVERVIEW OF OTHER CMC/DHK COMMUNITY BENEFIT ACTIVITIES THAT ARE ALIGNED WITH OUR MISSION OR CONSIDERED NECESSARY TO SUPPORT ONGOING EFFORTS FROM PREVIOUSLY IDENTIFIED COMMUNITY NEEDS. THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA PROVIDE THE BASIS FOR THE DEVELOPMENT OF THE IMPLEMENTATION STRATEGY. THE CHESHIRE MEDICAL CENTER/DARTMOUTH HITCHCOCK KEENE COMMUNITY ADVISORY COMMITTEE REVIEWED AND COMMENTED ON THE COMMUNITY BENEFIT REPORT. THE 2013 CHNA, IMPLEMENTATION STRATEGY AND COMMUNITY BENEFIT REPORT IS AVAILABLE TO THE PUBLIC ON THE CHESHIRE MEDICAL CENTER WEBSITE: WWW.CHESHIRE-MED.ORG. | ||
| PART VI, LINE 3: CMC IS COMMITTED TO PROVIDING MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. NON-EMERGENT PATIENTS SIGN A FINANCIAL RESPONSIBILITY STATEMENT UPON ADMISSION TO CERTIFY RECOGNITION OF THEIR RESPONSIBILITY FOR PAYMENT OF THEIR BILLS. HOWEVER, THERE WILL BE INSTANCES WHERE THE PATIENT, DUE TO THE LACK OF FUNDS OR THIRD PARTY COVERAGE, WILL NOT BE ABLE TO MEET THIS OBLIGATION. CMC NOTIFIES PATIENTS OF THEIR POTENTIAL TO OBTAIN ASSISTANCE THROUGH THE REGISTRATION AND BILLING PROCESSES. UPON REGISTRATION, PATIENTS WITHOUT INSURANCE ARE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IN ADDITION, RECEPTIONISTS AND CLINICIANS IN ALL AREAS ARE EDUCATED TO REFER PATIENTS TO THE FINANCIAL ASSISTANCE PROCESS IN THE EVENT PATIENTS EXPRESS CONCERNS WITH THEIR ABILITY TO PAY FOR SERVICES. THE APPLICATION INFORMATION IS POSTED ON THE INTRANET AND BROCHURES DESCRIBING THE PROGRAM ARE READILY AVAILABLE TO PATIENTS. THERE ARE SIGNS POSTED IN REGISTRATION AND THROUGHOUT THE FACILITY INFORMING PATIENTS ABOUT FINANCIAL ASSISTANCE. PATIENTS ARE INFORMED OF THE PROGRAM AVAILABILITY ON ANY INVOICES THEY RECEIVE AND INDIVIDUALS WHO ATTEMPT TO COLLECT PATIENT BALANCES ARE ALSO TRAINED TO REFER PATIENTS TO THE FINANCIAL ASSISTANCE PROCESS. THE FINANCIAL ASSISTANCE APPLICATION PROCESS IS COMPREHENSIVE AND EVALUATES A PATIENT'S ELIGIBILITY FOR A VARIETY OF FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS IN ADDITION TO CMC'S INTERNALLY FUNDED FINANCIAL ASSISTANCE PROGRAM. | ||
| PART VI, LINE 4: THE MEDICAL CENTER IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA ("PSA"). MANAGEMENT DEFINES ITS PSA AS THE CITY OF KEENE AND 19 GEOGRAPHICALLY PROXIMATE COMMUNITIES. TOWNS AND CITIES INCLUDED IN THE PSA INCLUDE ALSTEAD, CHESTERFIELD, FITZWILLIAM, GILSUM, HARRISVILLE/CHESHAM, KEENE, MARLBOROUGH, MARLOW, NELSON/MUNSONVILLE, RICHMOND, ROXBURY, STODDARD, SULLIVAN, SURRY, SWANZEY, TROY, WALPOLE, WESTMORELAND AND WINCHESTER, ALL LOCATED IN CHESHIRE COUNTY. ACCORDING TO THE US CENSUS BUREAU, 2007-2011 FIVE YEAR ESTIMATES, THE MEDICAL CENTER'S PSA REPRESENTED APPROXIMATELY 5.09% OF NEW HAMPSHIRE'S POPULATION. THE PSA'S TOTAL POPULATION WAS 77,301 WITH 22,563 RESIDING IN KEENE, THE LARGEST COMMUNITY IN THE SERVICE AREA. ACCORDING TO THE US CENSUS BUREAU, 2007-2011 FIVE YEAR ESTIMATES, 11,265 OR 14.57% OF THE MEDICAL CENTER'S PSA RESIDENTS WERE 65 YEARS OF AGE OR OLDER. APPROXIMATELY 44% OF THE POPULATION OF THE MEDICAL CENTER'S PSA WAS 45 YEARS OF AGE OR OLDER. APPROXIMATELY 36% OF THE POPULATION OF THE MEDICAL CENTER'S PSA WAS BETWEEN 18 AND 44, THE ACCORDING TO THE US BUREAU OF LABOR STATISTICS, APRIL 2013, THE STATE UNEMPLOYMENT RATE WAS 5.10% AND THE UNEMPLOYMENT RATE FOR CHESHIRE COUNTY WAS 5.00%. ACCORDING TO THE US CENSUS BUREAU, 2007-2011 FIVE YEAR ESTIMATES, THE POVERTY RATE FOR CHESHIRE COUNTY WAS 9.87% AS COMPARED TO 7.97% FOR THE STATE OF NEW HAMPSHIRE. | ||
| PART VI, LINE 5: A COMPLETE COPY OF THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND AT:HTTP://WWW.CHESHIRE-MED.COM/IMAGES/STORIES/COMMHEALTH/COMMUNITY_BENEFITS_2013.PDFPART VI, LINE 6: THE MEDICAL CENTER PLAYS AN ACTIVE ROLE IN PROMOTING COMMUNITY HEALTH AND OFFERS EDUCATIONAL PROGRAMS INCLUDING CLASSES AND WORKSHOPS. THE 2013 YEAR PROGRAMS OFFERED A VARIETY OF CHRONIC DISEASE AND WELLNESS TOPICS SUCH AS NUTRITION, DIABETES, END OF LIFE ISSUES, ALTERNATIVE MEDICINE OPTIONS, AIR POLLUTION, MOBILITY ISSUES, AND GARDENING. IN ADDITION, THE MEDICAL CENTER OFFERS SEVERAL COMMUNITY PROGRAMS INCLUDING: CHESHIRE SMILES, A SCHOOL-BASED DENTAL HEALTH PROGRAM FOR CHILDREN IN GRADES K-3, PROVIDES SCREENING, PREVENTION AND RESTORATIVE DENTAL CARE FOR CHILDREN IN CHESHIRE COUNTY SCHOOLS. CHESHIRE MEDICAL CENTER /DARTMOUTH-HITCHCOCK KEENE ALSO WORKS IN PARTNERSHIP WITH OTHER COMMUNITY HEALTH AND HUMAN SERVICE ORGANIZATIONS TO MEET THE DENTAL HEALTH NEEDS OF UNDERSERVED POPULATIONS SUCH AS THE CHRONICALLY MENTALLY ILL, PREGNANT WOMEN WHO CANNOT AFFORD DENTAL CARE, CHILDREN IDENTIFIED THROUGH THE SCHOOL BASED CHESHIRE SMILES PROGRAM, AND OTHERS. THE MEDICAL CENTER SPONSORS PATIENT VISITS AT DENTAL HEALTH WORKS, A PUBLIC/PRIVATE PROGRAM SERVING UNDERSERVED RESIDENTS OF CHESHIRE COUNTY. THE MEDICAL CENTER ALSO PROVIDES LEADERSHIP AND SUPPORT TO THE DENTAL PUBLIC HEALTH TASK FORCE, A COALITION OF DENTAL STAFF, HOSPITAL STAFF AND CONCERNED CITIZENS ADDRESSING THE ORAL HEALTH NEEDS OF ADULTS. CHESHIRE COALITION FOR TOBACCO-FREE YOUTH IS COMMITTED TO REDUCING THE NUMBER OF YOUNG PEOPLE IN THE COMMUNITY WHO USE TOBACCO PRODUCTS. WORKING WITH LOCAL SCHOOLS, POLICE AND HEALTH PROVIDERS, THE COALITION HAS IMPLEMENTED VENDOR COMPLIANCE PROGRAMS, HAS PROVIDED A TOBACCO AVOIDANCE CURRICULUM FOR USE IN AREA SCHOOLS AND HAS PRODUCED ITS OWN TELEVISION AND RADIO PUBLIC SERVICE ANNOUNCEMENTS ADDRESSING TOBACCO USE. MEDICATION ASSISTANCE PROGRAM ADDRESSES THE CRITICAL NEED FOR PROGRAMS TO HELP LOW INCOME PEOPLE AFFORD MEDICATIONS. THE MEDICATION ASSISTANCE PROGRAM AT THE MEDICAL CENTER WAS INITIATED IN MARCH, 1999. IT WAS THE FIRST HOSPITAL-BASED PROGRAM OF ITS KIND IN THE STATE OF NEW HAMPSHIRE AND WAS THE FIRST RECIPIENT OF THE NEW HAMPSHIRE MEDICATION BRIDGE AWARD. ADVOCATES FOR HEALTHY YOUTH ("AFHY") IS A COMMUNITY COALITION SUPPORTED BY THE MEDICAL CENTER WHICH HAS BEEN WORKING CLOSELY WITH COMMUNITY HEALTH PROVIDERS, KEENE STATE COLLEGE, ANTIOCH UNIVERSITY NEW ENGLAND, KEENE PARKS AND RECREATION CENTER, AND AREA SCHOOLS TO ADDRESS THE EPIDEMIC OF CHILDHOOD OBESITY. IN 2007, AFHY BEGAN TAKING STEPS TO IMPLEMENT THE 5-2-1-0 COMMUNITY PUBLIC MESSAGING CAMPAIGN TO EDUCATE FAMILIES ABOUT CHILDHOOLD OBESITY AND TO ADVOCATE HEALTH PROMOTION OPTIONS TO PREVENT OR REDUCE OBESITY. THE PROGRAM IS NOW WORKING WITH LOCAL SCHOOLS AND AFTERSCHOOL PROGRAMS TO IMPLEMENT THE COORDINATED APPROACH TO CHILD HEALTH (CATCH) PROGRAM. A STRONG PARTNERSHIP BETWEEN THE MEDICAL CENTER, KEENE STATE COLLEGE AND THE KEENE FAMILY YMCA ALLOWED FOR THE DEVELOPMENT OF THE FAMILY BEFIT PROGRAM TO SUPPORT FAMILIES TO LEARN SKILLS AND CHANGE BEHAVIOR RELATED TO HEALTH EATING AND ACTIVE LIVING SKILLS. THE CHESHIRE COUNTY HEAL (CC HEAL) ENGAGES ORGANIZATION CHAMPIONS TO ADOPT HEALTHY EATING, ACTIVE LIVING INITIATIVES THAT PROMOTE AND SUPPORT WORKSITE WELLNESS. USING THE CDC WORKSITE HEALTH SCORECARD ASSESSMENT TOOL, CC HEAL ASSISTS BUSINESSES AND ORGANIZATIONS TO IMPLEMENT PROGRAMS, PROJECTS AND POLICIES THAT ARE RELEVANT AND FEASIBLE FOR THEIR WORKSITE. IN ADDITION TO WORKSITE WELLNESS, CC HEAL IS COORDINATING EFFORTS FOR HEALTHIER MENU OPTIONS IN LOCAL FOOD VENUES. TURN A NEW LEAF; (TANL) IS A HEALTHY EATING PROGRAM THAT HAS BEEN LAUNCHED LOCALLY IN RESTAURANTS, CAFETERIAS AND OTHER FOOD VENUES TO MAKE IT EASIER FOR CHESHIRE COUNTY RESIDENTS TO CHOOSE HEALTHIER OPTIONS WHEN DINING OUT. MENU ITEMS ARE LABELED WITH A LEAF AND A HEART TO ASSIST PATRONS IN IDENTIFYING THE HEALTHY OPTIONS. SENIOR PASSPORT PROGRAM IS DESIGNED TO SERVE THE MEDICAL CENTER'S COMMUNITIES' ELDERS. PASSPORT MEMBERSHIP, WHICH IS OFFERED AT NO COST TO THOSE SIXTY YEARS AND OLDER, ENTITLES HOLDERS TO ENJOY LOW COST, HEART HEALTHY MEALS IN THE MEDICAL CENTER CAFETERIA, ATTEND WORKSHOPS AND HEALTH LECTURES WITH A SENIOR FOCUS, AND PARTICIPATE IN THE CHESHIRE WALKERS PROGRAM WHICH IS A WALKING GROUP THAT TAKES ORGANIZED NATURE AND HISTORIC WALKS IN THE SPRING AND FALL. THE TOTAL EXPENDITURES ASSOCIATED WITH THESE AND OTHER PROGRAMS FOR THE FISCAL YEAR ENDING 6/30/13 IS $5,124,151. | ||
| NH | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ARTHUR NICHOLS | ||||||||||||||
| PRESIDENT | 451776 | 0 | 45500 | 0 | 47000 | 0 | 29692 | 0 | 22731 | 0 | 596699 | 0 | 0 | 0 |
| JILL BATTY | ||||||||||||||
| VP FINANCE, CFO | 217448 | 0 | 0 | 0 | 46400 | 0 | 19495 | 0 | 25449 | 0 | 308792 | 0 | 0 | 0 |
| PAUL PEZONE | ||||||||||||||
| VP SUPPORT SERVICES | 127667 | 0 | 0 | 0 | 36620 | 0 | 11410 | 0 | 11618 | 0 | 187315 | 0 | 0 | 0 |
| CINDI COUGHLIN | ||||||||||||||
| CNO | 148338 | 0 | 0 | 0 | 32280 | 0 | 16868 | 0 | 17155 | 0 | 214641 | 0 | 0 | 0 |
| JULIE GREEN | ||||||||||||||
| VP HR | 123724 | 0 | 0 | 0 | 46390 | 0 | 19498 | 0 | 22265 | 0 | 211877 | 0 | 0 | 0 |
| ERLI CHEN | ||||||||||||||
| PHYSICIST | 189127 | 0 | 0 | 0 | 29442 | 0 | 16509 | 0 | 13000 | 0 | 248078 | 0 | 0 | 0 |
| LARRY MILLER | ||||||||||||||
| CHIEF CRNA | 170319 | 0 | 0 | 0 | 22490 | 0 | 22105 | 0 | 15715 | 0 | 230629 | 0 | 0 | 0 |
| KRISTIN ROSSI | ||||||||||||||
| CRNA | 124063 | 0 | 0 | 0 | 22100 | 0 | 12823 | 0 | 13323 | 0 | 172309 | 0 | 0 | 0 |
| DENIS FORTIER | ||||||||||||||
| PHARMACY DIRECTOR | 114831 | 0 | 0 | 0 | 33455 | 0 | 12904 | 0 | 16318 | 0 | 177508 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | CHESHIRE MEDICAL CENTER DOES NOT REIMBURSE EXPENSES FOR FIRST CLASS TRAVEL, HOUSING ALLOWANCE, HEALTH OR SOCIAL CLUB DUES, PERSONAL SERVICES, BUSINESS USE OF PERSONAL RESIDENCE, DISCRETIONARY SPENDING ACCOUNTS, OR PROVIDE TAX INDEMNIFICATION OR GROSS UP PAYMENTS. CHESIRE MEDICAL CENTER DOES REIMBURSE BOARD MEMBERS FOR COMPANION TRAVEL TO BUSINESS RELATED MEETING UNDER SPECIFIC CIRCUMSTANCES. ALL REIMBURSEMENTS ARE REPORTED ON FORM 1099 ISSUED TO THE BOARD MEMBER. ONE REIMBURSEMENT WAS MADE IN CALENDAR 2012. |
| PART I, LINE 7 | SENIOR MANAGEMENT IS ELIGIBLE FOR AN INCENTIVE COMP PAYMENT AT THE DISCRETION OF THE BOARD BASED ON, BUT NOT DIRECTLY RELATED TO, OVERALL ORGANIZATIONAL FINANCIAL PERFORMANCE AND OTHER DISCRETIONARY MEASURES. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NH HEALTH & EDUCATION FACILITIES AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 020279866 | IssuerEIN |
| Date Issued | 2012-11-15 | DateIssued |
| Issue Price | 29650000 | IssuePrice |
| Description Of Purpose | REFUND EXISTING DEBT, ACQUISITION OF EQUIPMENT | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 29650000 | TotalProceeds |
| Amount In Reserve Fund | 4777102 | AmountInReserveFund |
| Issuance Costs From Proceeds | 379754 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 554125 | WorkingCapitalExpenditures |
| Capital Expenditures | 4777102 | CapitalExpenditures |
| Year Of Subst Completion | 2013 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 1 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 1 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K SUPPLENTAL INFORMATION | Identifier |
| Explanation | SCHEDULE K PART V: THE MEDICAL CENTER IS IN THE PROCESS OF ESTABLISHING WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED AND ARE EXPECTED TO BE COMPLETED BY NOVEMBER 2013. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CHESHIRE MEDICAL CENTER IS THE CHESHIRE HEALTH FOUNDATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BY-LAWS OF THE MEDICAL CENTER STIPULATE THAT THE BOARDS OF TRUSTEES SHALL CONSIST OF NOT LESS THAN FIFTEEN MEMBERS. THE CURRENT BOARD CONSISTS OF 17 TRUSTEES, INCLUDING THE PRESIDENT/CEO OF THE MEDICAL CENTER AND THE PRESIDENT OF THE MEDICAL STAFF, WHO SERVE AS EX-OFFICIO, VOTING MEMBERS. EACH TRUSTEE SERVES FOR THREE YEARS AND MAY SERVE THREE CONSECUTIVE TERMS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | COPY OF 990 IS AVAILABLE FOR ANY BOARD MEMBER TO REVIEW PRIOR TO FILING. THE BOARD HAS FORMALLY DELEGATED REVIEW OF THE 990 TO THE FINANCE AND AUDIT COMMITTEE. COMMITTEE MEMBERS RECEIVE COPIES OF THE 990 AND IT IS REVIEWED IN A MEETING PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICER, BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST AND ARE REQUIRED TO RECUSE THEMSELVES FROM ALL BOARD ACTIVITY RELATED TO ALL CONFLICTS. | |
| FORM 990, PART VI, SECTION B, LINE 15A | CHESHIRE MEDICAL CENTER/DARTMOUTH HITCHCOCK KEENE HAS RETAINED YAFFE & COMPANY, INC. TO PROVIDE CONSULTATION TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REGARDING EXECUTIVE COMPENSATION, BENEFITS, AND PERQUISITES. YAFFE & COMPANY, INC. IS A INDEPENDENT CONSULTING FIRM WITH 35 YEARS OF SERVICE AND PROVIDES SERVICES TO NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS. FURTHER YAFFE & COMPANY, INC. HAS BEEN ENGAGED DIRECTLY BY THE BOARD OF TRUSTEES OF CHESHIRE MEDICAL CENTER THROUGH ITS EXECUTIVE COMMITTEE TO ONLY PROVIDE SERVICES TO THE BOARD. AN EXECUTIVE COMMITTEE D/B/A COMPENSATION COMMITTEE CHARTER AND COMPENSATION PHILOSOPHY (APPROVED BY THE BOARD) DOCUMENTS THE COMPENSATION REVIEW PROCESS AND GUIDELINES SO AS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE TOTAL COMPENSATION DECISIONS. ANNUALLY, A MULTI-TIERED APPROACH USING INDEPENDENT COMPARABILITY DATA IS UTILIZED TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOW FROM THE STRATEGIC PLAN. BY WAY OF QUESTIONNAIRE, BOARD MEMBERS PARTICIPATE IN THE PERFORMANCE REVIEW PROCESS AND A SUMMARY REPORT IS SHARED WITH THE CEO. VARIABLE PAY IS AWARDED BASED ON ACHIEVEMENT OF SPECIFIC QUALITATIVE AND QUANTITATIVE GOALS. IN CONJUNCTION WITH THE EXECUTIVE COMMITTEE, CHALLENGING AND MEASURABLE GOALS ARE ESTABLISHED FOR THE OFFICE OF THE PRESIDENT WHICH PROVIDES AN ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC GOALS." KEY EMPLOYEE COMPENSATION IS SET AT THE DISCRETION OF THE CEO BASED ON PERFORMANCE & MARKET DATA. | |
| FORM 990, PART VI, SECTION C, LINE 19 | CMC MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST, THROUGH ITS ANNUAL REPORT, AND THROUGH STATE AND FEDERAL FILINGS. | |
| FORM 990, PART IX, LINE 24E | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,849,816. MANAGEMENT AND GENERAL EXPENSES 869,307. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,719,123. MEDICAID ENHANCEMENT TAX: PROGRAM SERVICE EXPENSES 4,657,932. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,657,932. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,464,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,464,205. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 2,367,206. MANAGEMENT AND GENERAL EXPENSES 424,310. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,791,516. DATA PROCESSING FEES: PROGRAM SERVICE EXPENSES 1,872,770. MANAGEMENT AND GENERAL EXPENSES 335,685. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,208,455. JOA GAINSHARE: PROGRAM SERVICE EXPENSES 1,484,848. MANAGEMENT AND GENERAL EXPENSES 266,152. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,751,000. FOOD & FOOD SUPPLIES: PROGRAM SERVICE EXPENSES 951,267. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 951,267. RENTAL AND LEASE EXPENSE: PROGRAM SERVICE EXPENSES 779,226. MANAGEMENT AND GENERAL EXPENSES 139,673. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 918,899. CHILDCARE CENTER EXPENSE: PROGRAM SERVICE EXPENSES 896,724. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 896,724. MAINTENANCE & REPAIR: PROGRAM SERVICE EXPENSES 643,959. MANAGEMENT AND GENERAL EXPENSES 115,427. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 759,386. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 489,833. MANAGEMENT AND GENERAL EXPENSES 87,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 577,633. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 404,810. MANAGEMENT AND GENERAL EXPENSES 72,560. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 477,370. INSTRUMENTS & MINOR EQUIPMENT: PROGRAM SERVICE EXPENSES 374,265. MANAGEMENT AND GENERAL EXPENSES 67,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,350. LOSS ON EXTINGUISHMENT OF DEBT: PROGRAM SERVICE EXPENSES 360,734. MANAGEMENT AND GENERAL EXPENSES 64,660. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 425,394. POSTAGE: PROGRAM SERVICE EXPENSES 314,565. MANAGEMENT AND GENERAL EXPENSES 56,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 370,949. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 353,928. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 353,928. LICENSES & TAXES: PROGRAM SERVICE EXPENSES 202,099. MANAGEMENT AND GENERAL EXPENSES 36,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,324. AFFILIATION EXPENSES: PROGRAM SERVICE EXPENSES 96,924. MANAGEMENT AND GENERAL EXPENSES 17,373. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,297. COMPUTERS: PROGRAM SERVICE EXPENSES 87,053. MANAGEMENT AND GENERAL EXPENSES 15,604. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,657. LINENS & APPAREL: PROGRAM SERVICE EXPENSES 94,232. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,232. QUALITY CONTROL: PROGRAM SERVICE EXPENSES 68,927. MANAGEMENT AND GENERAL EXPENSES 12,355. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,282. BANK FEES: PROGRAM SERVICE EXPENSES 64,237. MANAGEMENT AND GENERAL EXPENSES 11,514. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,751. COURIER FEES: PROGRAM SERVICE EXPENSES 37,473. MANAGEMENT AND GENERAL EXPENSES 6,717. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,190. RECRUITMENT: PROGRAM SERVICE EXPENSES 23,734. MANAGEMENT AND GENERAL EXPENSES 4,254. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,988. TRUSTEE DEVELOPMENT: PROGRAM SERVICE EXPENSES 8,298. MANAGEMENT AND GENERAL EXPENSES 1,487. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,785. BOND FEES: PROGRAM SERVICE EXPENSES 4,656. MANAGEMENT AND GENERAL EXPENSES 834. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,490. PATIENT VALUABLES: PROGRAM SERVICE EXPENSES 922. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 922. | ALL OTHER FUNCTIONAL EXPENSES |
| FORM 990, PART XI, LINE 9: | PENSION LIABILITY ADJUSTMENT 14,222,990. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHESHIRE HEALTH FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 COURT STREET | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020202220 | EIN |
| Primary Activities | MNGT OF BOARD DESIGNATED, SPF, BUILDING AND ENDOWMENT FUNDS | PrimaryActivities |
| Legal Domicile State | NH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11B, II | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEENE HEALTH ALLIANCE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 580 COURT STREET | AddressLine1 |
| City | KEENE | City |
| State | NH | State |
| ZIP Code | 03431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300179297 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
| Predominant Income Type | MEDICAL CARE | PredominantIncomeType |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| KEENE HEALTH SERVICES | ||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374997 | INVESTMENTS REAL ESTATE | NH | CHESHIRE HEALTH FOUNDATION | C | 1.00000 | 0 |
| KEENE HEALTH REALTY | ||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374998 | INVESTMENTS REAL ESTATE | NH | KEENE HEALTH SERVICES | C | 1.00000 | 0 |
| KEENE HEALTH ENTERPRISES | ||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374999 | INVESTMENTS REAL ESTATE | NH | KEENE HEALTH SERVICES | C | 1.00000 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CHESHIRE HEALTH FOUNDATION | ||
| C | 340508 | CASH |
| CHESHIRE HEALTH FOUNDATION | ||
| D | 2781824 | CASH |
| CHESHIRE HEALTH FOUNDATION | ||
| J | 72000 | CASH |
| CHESHIRE HEALTH FOUNDATION | ||
| N | 1075985 | CASH |