2013-11-15T07:07:39-06:00 2013-06-30 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2012-07-01 020354549 THE CHESHIRE MEDICAL CENTER CHES 6033545400 580 COURT STREET KEENE NH 03431 JILL BATTY 6033545400 2013-11-07 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2012 2015-11-30 17:44:51Z ARTHUR NICHOLS 580 COURT STREET KEENE NH 03431 158992896 0 X WWW.CHESHIRE-MED.COM X 1980 NH 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. 17 16 1151 202 224907 -109334 516909 721869 115775671 153224890 637151 1408537 3354458 3637600 120284189 158992896 0 0 0 0 46503524 61842012 0 0 0 73879547 94352388 120383071 156194400 -98882 2798496 130251331 136587126 79483485 68373250 50767846 68213876 X 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. 0 0 140994452 154533231 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. 140994452 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 176 0 1 1151 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NH X MARY SHERWIN CONTROLLER 6033545400 CHESHIRE MEDICAL CENTER 580 COURT KEENE NH 03431 KATHI SNOW 2.00 X 0 0 0 LARRY JAEGER MD 2.00 X 0 0 0 GREGG TEWKSBURY 2.00 X 0 0 0 WALTER ROHR 1.00 X 0 0 0 JAY KAHN 3.00 X X 0 0 0 MICHAEL NEWBOLD 2.00 X 0 0 0 ROGER HANSEN 2.00 X 0 0 0 SYLVIA MCBETH 2.00 X X 0 0 0 JUDITH BOULE 2.00 X 0 0 0 JUDY KALICH 2.00 X 0 0 0 ROBERT MUCHA 2.00 X X 0 0 0 ARTHUR NICHOLS 53.00 X X 544276 0 52423 ED BERGERON 2.00 X 0 0 0 STEVE HORTON 2.00 X 0 0 0 MARY LOUISE CAFFREY 2.00 X X 0 0 0 MARY ANN KRISTIANSEN 1.00 X 0 0 0 GEOF MOLINA 2.00 X 654 0 0 JILL BATTY 52.00 X 263848 0 44944 PAUL PEZONE 51.00 X 164287 0 23028 CINDI COUGHLIN 52.00 X 180618 0 34023 JULIE GREEN 50.00 X 170114 0 41763 ERLI CHEN 50.00 X 218569 0 29509 LARRY MILLER 50.00 X 192809 0 37820 KRISTIN ROSSI 50.00 X 146163 0 26146 DENIS FORTIER 50.00 X 148286 0 29222 2029624 0 318878 30 0 1 0 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 21 136375 585494 721869 PATIENT SERVICE REVENU 621300 153164890 153164890 CONTRACT REVENUE 621300 60000 60000 153224890 603239 603239 776058 29240 0 0 776058 29240 805298 29240 776058 PHARMACY & DRUGS 621300 1201406 1201406 FOOD SERVICE 621300 932186 932186 CHILDCARE CENTER 624410 737009 512102 224907 766999 766999 3637600 158992896 154533231 224907 3512889 X 1307447 1111330 196117 41903808 35534429 6369379 4287040 3635410 651630 11153864 9458477 1695387 3189853 2704995 484858 300026 300026 51070 51070 480841 407753 73088 200671 200671 314966 267091 47875 6672009 5657864 1014145 176573 176573 1166241 988972 177269 8457999 7172383 1285616 1632116 1384034 248082 DRUGS, CHEMICALS, SUPPL 15133684 15133684 BAD DEBTS 13059228 13059228 CONTRACT LABOR 10864376 10864376 MEDICAL & SURG. SUPPLIE 7282539 7282539 28560049 25954643 2605406 156194400 140994452 15199948 0 26195809 26344653 12458722 12586580 2169915 2273489 2237514 2418354 177681498 109033844 67550825 68647654 13832078 16743372 5806468 7573024 130251331 136587126 13737267 9996974 24699 9825 26207556 30888852 801064 617362 38712899 26860237 79483485 68373250 X 47712572 64611817 3055274 3602059 50767846 68213876 130251331 136587126 X 2798496 424544 14222990 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21382 21382 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF AHA & NHHA DUES ARE ALLOCATED TO LOBBYING EXPENSE. 3055274 234785 688499 376499 3602059 2634569 154965 484487 218747 3055274 2445561 168756 299947 279695 2634569 1479480 164317 1124611 322848 2445561 1408853 88740 18113 1479480 0.00000 0.00000 1.00000 0 0 4196423 4196423 76123525 43150960 32972565 97361550 65882884 31478666 68647654 POOLED INVESTMENTS 15798525 F FUNDED DEPR ACCOUNT 944847 F 16743372 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 7573024 PENSION LIABILITY 18208985 AMOUNTS PAYABLE TO THIRD PARTY 1255584 DUE TO DARTMOUTH HITCHCOCK 7395668 26860237 X 158113538 0 158113538 879358 879358 158992896 155315042 0 155315042 879358 879358 156194400 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. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS IN INVESTMENT ENTITIES DOMICILED IN FOREIGN JURISDICTIONS 2134018 0 0 0 0 0 0 2134018 0 2134018 0 0 0 0 0 0 1 1 1 X 225.000000000000 1 X 1 1 0 1 1 1836 2570680 2570680 0.01650 14055932 2394185 11661747 0.07470 1836 16626612 2394185 14232427 0.09120 30 17071 1195009 65069 1129940 0.00720 9 524 265589 265589 0.00170 2 191 66414 66414 0.00040 1 204 157900 157900 0.00100 6 234 113083 200 112883 0.00070 48 18224 1797995 65269 1732726 0.01100 48 20060 18424607 2459454 15965153 0.10220 1 19424 204469 204469 0.00130 3 2614 83336 47491 35845 0.00020 1 27794 27794 0.00020 4 311473 311473 0.00200 9 22038 627072 47491 579581 0.00370 1 12588614 3147154 46956447 50102529 -3146082 X 1 1 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 1 1 CHESHIRE MEDICAL CENTER

580 COURT STREET KEENE NH 03431

X X X CHESHIRE MEDICAL CENTER 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 225.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X 1 X X 1 X X X X X 1 X 0 0 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 CHESHIRE MEDICAL CENTER 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 NH X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 ARTHUR NICHOLS 451776 0 45500 0 47000 0 29692 0 22731 0 596699 0 0 0 JILL BATTY 217448 0 0 0 46400 0 19495 0 25449 0 308792 0 0 0 PAUL PEZONE 127667 0 0 0 36620 0 11410 0 11618 0 187315 0 0 0 CINDI COUGHLIN 148338 0 0 0 32280 0 16868 0 17155 0 214641 0 0 0 JULIE GREEN 123724 0 0 0 46390 0 19498 0 22265 0 211877 0 0 0 ERLI CHEN 189127 0 0 0 29442 0 16509 0 13000 0 248078 0 0 0 LARRY MILLER 170319 0 0 0 22490 0 22105 0 15715 0 230629 0 0 0 KRISTIN ROSSI 124063 0 0 0 22100 0 12823 0 13323 0 172309 0 0 0 DENIS FORTIER 114831 0 0 0 33455 0 12904 0 16318 0 177508 0 0 0 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. A NH HEALTH & EDUCATION FACILITIES AUTHORITY 020279866 2012-11-15 29650000 REFUND EXISTING DEBT, ACQUISITION OF EQUIPMENT 0 0 0 A 29650000 4777102 379754 554125 4777102 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 A 1 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION 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. 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. ALL OTHER FUNCTIONAL EXPENSES 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT 14,222,990. CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE NH 03431 020202220 MNGT OF BOARD DESIGNATED, SPF, BUILDING AND ENDOWMENT FUNDS NH 501(C)(3) LINE 11B, II 0 KEENE HEALTH ALLIANCE 580 COURT STREET KEENE NH 03431 300179297 HEALTHCARE NH MEDICAL CARE 0 1 0.50000 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 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 CHESHIRE HEALTH FOUNDATION C 340508 CASH CHESHIRE HEALTH FOUNDATION D 2781824 CASH CHESHIRE HEALTH FOUNDATION J 72000 CASH CHESHIRE HEALTH FOUNDATION N 1075985 CASH