STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

CHESHIRE MEDICAL CENTER: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CHESHIRE MEDICAL CENTER (EIN 02-0354549)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-08
IRS object ID
201241299349301309
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-08T11:39:23-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM STEELE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line140 STARK STREETAddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN020354549EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE CHESHIRE MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHESNameControl

US Address USAddress

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJILL BATTYName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2012-04-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL A BARBARITA CPAName
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonARTHUR NICHOLSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode
FieldValueIRS element (for citing)
Gross Receipts153728162GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHESHIRE-MED.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTHE 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 Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees1133TotalNbrEmployees
Total Nbr Volunteers235TotalNbrVolunteers
Total Gross UBI191588TotalGrossUBI
Net Unrelated Business Txbl Income-262212NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year784279ContributionsGrantsPriorYear
Contributions Grants Current Year733247ContributionsGrantsCurrentYear
Program Service Revenue Prior Year153761651ProgramServiceRevenuePriorYear
Program Service Revenue CY148687291ProgramServiceRevenueCY
Investment Income Prior Year432176InvestmentIncomePriorYear
Investment Income Current Year1029747InvestmentIncomeCurrentYear
Other Revenue Prior Year3041232OtherRevenuePriorYear
Other Revenue Current Year3277877OtherRevenueCurrentYear
Total Revenue Prior Year158019338TotalRevenuePriorYear
Total Revenue Current Year153728162TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year58039730SalariesEtcPriorYear
Salaries Etc Current Year62719447SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year99301760OtherExpensePriorYear
Other Expenses Current Year91101239OtherExpensesCurrentYear
Total Expenses Prior Year157341490TotalExpensesPriorYear
Total Expenses Current Year153820686TotalExpensesCurrentYear
Revenues Less Expenses Prior Year677848RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-92524RevenuesLessExpensesCY
Total Assets BOY124631712TotalAssetsBOY
Total Assets EOY127769556TotalAssetsEOY
Total Liabilities BOY71976783TotalLiabilitiesBOY
Total Liabilities EOY80428389TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY52654929NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY47341167NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense138483679Expense
Revenue148959345Revenue
DescriptionTHE 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 Expense138483679TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096136NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1133NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MARY SHERWIN CONTROLLERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6033545400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1CHESHIRE MEDICAL CENTER 580 COURTAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
KATHI SNOW
TRUSTEE2.00X000
LARRY JAEGER MD
TRUSTEE2.00X000
JAMES PUTNAM
CHAIR2.00X000X
WALTER ROHR
TRUSTEE1.00X000
JAY KAHN
VICE CHAIR3.00X000X
MICHAEL NEWBOLD
TRUSTEE2.00X000
JANE BEAUCHAMP
TRUSTEE2.00X000
JOSEPH BERGMAN MD
TRUSTEE2.00X19438800
SYLVIA MCBETH
SECRETARY2.00X000X
MATTHEW GUILTINAN MD
CMC MED STAFF PRES2.00X000
JUDY KALICH
TRUSTEE2.00X000
RICK CHURCH
TRUSTEE1.00X000
ROBERT MUCHA
TREASURER2.00X000
LESLIE PITTS MD
MEDICAL DIRECTOR2.00X000X
ARTHUR NICHOLS
PRESIDENT53.00X496516052509X
ED BERGERON
TRUSTEE1.00X000
JOSEPH HALLIDAY
TRUSTEE1.00X000
STEVE HORTON
TRUSTEE2.00X000
MARY LOUISE CAFFREY
TRUSTEE2.00X000
JOHN SCHLEGELMILCH
DHK MED STAFF PRES3.00X000
KATHLEEN CRONIN
VP NURSING OPERATIONS26.00206689047798X
JILL BATTY
VP FINANCE, CFO52.00247597048609X
CINDI COUGHLIN
CNO52.00127629028794X
JULIE GREEN
VP HR51.00161980041976X
PAUL PEZONE
VP SUPPORT SERVICES51.00144991032742X
ERLI CHEN
PHYSICIST50.00210894037752X
LARRY MILLER
CHIEF CRNA50.00187678041242X
KRISTIN ROSSI
CRNA50.00160704035237X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2139066TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation366659TotalOtherCompensation
Number Individuals GT100 K28NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HUTTER CONSTRUCTION
130 SPIT BROOK ROADNASHUANH03062CONSTRUCTION MANAGERS1216760
QUEST DIAGNOSTICS
5763 COLLECTION CENTER DRIVECHICAGOIL60693LAB DIAGNOSTIC SERVICES886820
NEW ENGLAND MEDICAL TRANSCRIPTION
PO BOX 430WOOLWICHME04579TRANSCRIPTION624106
MARY HITCHCOCK MEMORIAL
ONE MEDICAL CENTER DRLEBANONNH03755LAB DIAGNOSTIC SERVICES477123
HEALTHSOUTH OF CONCORD
254 PLEASANT STNASHUANH03301REHAB PROGRAM MGT SVCS390380
FieldValueIRS element (for citing)
Number Of Contractors GT100 K23NumberOfContractorsGT100K
Government Grants268467GovernmentGrants
All Other Contributions464780AllOtherContributions
Total Contributions733247TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU621300148639799148639799
CONTRACT REVENUE6213004749247492
FieldValueIRS element (for citing)
Total Program Service Revenue148687291TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column624673TotalRevenueColumn
Exclusion$624,673ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities405074Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities405074Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column405074TotalRevenueColumn
Exclusion$405,074ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
PHARMACY & DRUGS6213001196036$1,196,036
FOOD SERVICE621300933924$933,924
CHILD CARE CENTER624410591649$400,061191588

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column556268TotalRevenueColumn
Related Or Exempt Function Income272054RelatedOrExemptFunctionIncome
Exclusion$284,214ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3277877TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column153728162TotalRevenueColumn
Related Or Exempt Function Income148959345RelatedOrExemptFunctionIncome
Unrelated Business Revenue191588UnrelatedBusinessRevenue
Exclusion$3,843,982ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1272819Total
Program Services1081896ProgramServices
Management And General190923ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total40964125Total
Program Services34737578ProgramServices
Management And General6226547ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4709335Total
Program Services3993516ProgramServices
Management And General715819ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total12505262Total
Program Services10604462ProgramServices
Management And General1900800ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3267906Total
Program Services2771184ProgramServices
Management And General496722ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total102862Total
Management And General102862ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total131460Total
Management And General131460ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total630951Total
Program Services535046ProgramServices
Management And General95905ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total322427Total
Program Services322427ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total362157Total
Program Services307109ProgramServices
Management And General55048ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6482116Total
Program Services5496834ProgramServices
Management And General985282ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total188089Total
Program Services188089ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1237450Total
Program Services1049358ProgramServices
Management And General188092ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7830568Total
Program Services6640322ProgramServices
Management And General1190246ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1203491Total
Program Services1020560ProgramServices
Management And General182931ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
DRUGS, CHEMICALS, SUPPL1493184314931843
CONTRACT LABOR1101162311011623
BAD DEBTS87571998757199
MEDICAL & SURG. SUPPLIE72390837239083
OTHER PURCHASED SERVICE688476258382781046484

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total23785158Total
Program Services21957272ProgramServices
Management And General1827886ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total153820686Total
Program Services138483679ProgramServices
Management And General15337007ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY14984165BOY
EOY22641220EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18778536BOY
EOY15478992EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2251617BOY
EOY2207852EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1603607BOY
EOY1916756EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis164200786LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec95034275LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY69036247BOY
EOY69166511EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY11988185BOY
EOY12425042EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5989355BOY
EOY3933183EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY124631712BOY
EOY127769556EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11798315BOY
EOY14175684EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY38831BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY12291042BOY
EOY11884485EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY14959855BOY
EOY15497187EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY32888740BOY
EOY38871033EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY71976783BOY
EOY80428389EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY50209368BOY
EOY44706598EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2445561BOY
EOY2634569EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY52654929BOY
EOY47341167EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY124631712BOY
EOY127769556EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-92524ReconcilationRevenueExpenses
Reconcilation Other Changes-5221238ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$27,458OtherActivitiesAmount
Total Lobbying Expenditures IIB27458TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF AHA & NHHA DUES ARE ALLOCATED TO LOBBYING EXPENSEExplanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2445561BeginningOfYearBalance
Contributions168756Contributions
Investment Earnings Or Losses299947InvestmentEarningsOrLosses
Other Expenditures279695OtherExpenditures
End Of Year Balance2634569EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1479480BeginningOfYearBalance
Contributions164317Contributions
Investment Earnings Or Losses1124611InvestmentEarningsOrLosses
Other Expenditures322848OtherExpenditures
End Of Year Balance2445561EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1408853BeginningOfYearBalance
Investment Earnings Or Losses88740InvestmentEarningsOrLosses
Other Expenditures18113OtherExpenditures
End Of Year Balance1479480EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4058474OtherCostOrOtherBasis
Book Value4058474BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis74593240OtherCostOrOtherBasis
Depreciation36728683Depreciation
Book Value37864557BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis85549072OtherCostOrOtherBasis
Depreciation58305592Depreciation
Book Value27243480BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings69166511TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
POOLED INVESTMENTS11480195F
FUNDED DEPR ACCOUNT944847F
FieldValueIRS element (for citing)
Total Of Book Value Securities12425042TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
PENSION LIABILITY$33,904,316
AMOUNTS PAYABLE TO THIRD PARTY$712,384
MISCELLANEOUS OTHER LIABILITIES$548,138
DUE TO AFFILIATES$3,706,195
FieldValueIRS element (for citing)
Total Of Amounts38871033TotalOfAmounts
Total Revenue153728162TotalRevenue
Total Expenses153820686TotalExpenses
Excess Or Deficit For Year-92524ExcessOrDeficitForYear
Net Unrealized GL On Investments-596500NetUnrealizedGLOnInvestments
Other-$4,624,738OtherAmount
Total Adjustments-5221238TotalAdjustments
Excess Or Deficit Per FS-5313762ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt152586689TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal152586689RevenueSubtotal
Other Revenues Not Included1141473OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1141473RevenueNotRptdOnFinStmt
Total Revenue Per Form990153728162TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt152679213TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal152679213ExpensesSubtotal
Other Expenses Not Included1141473OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1141473ExpensesNotRptdOnFinStmt
Total Expenses Per Form990153820686TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:INCOME FROM THE ENDOWMENTS ARE USED TO SUPPORT THE ORGANIZATION'S PROGRAMS.
PART XI, LINE 8 - OTHER ADJUSTMENTS:PENSION LIABILITY ADJUSTMENT -4,624,738.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RECLASS FROM REVENUE TO EXPENSE 1,141,473.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:RECLASS FROM REVENUE TO EXPENSE 1,141,473.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage225.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served1945PersonsServed
Total Community Benefit Expense2734383TotalCommunityBenefitExpense
Net Community Benefit Expense2734383NetCommunityBenefitExpense
Percent Of Total Expense0.01780PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense16343984TotalCommunityBenefitExpense
Direct Offsetting Revenue7239010DirectOffsettingRevenue
Net Community Benefit Expense9104974NetCommunityBenefitExpense
Percent Of Total Expense0.05920PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served1945PersonsServed
Total Community Benefit Expense19078367TotalCommunityBenefitExpense
Direct Offsetting Revenue7239010DirectOffsettingRevenue
Net Community Benefit Expense11839357NetCommunityBenefitExpense
Percent Of Total Expense0.07700PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served16272PersonsServed
Total Community Benefit Expense2466971TotalCommunityBenefitExpense
Direct Offsetting Revenue75741DirectOffsettingRevenue
Net Community Benefit Expense2391230NetCommunityBenefitExpense
Percent Of Total Expense0.01550PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served1221PersonsServed
Total Community Benefit Expense228386TotalCommunityBenefitExpense
Direct Offsetting Revenue100DirectOffsettingRevenue
Net Community Benefit Expense228286NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Persons Served335PersonsServed
Total Community Benefit Expense242529TotalCommunityBenefitExpense
Direct Offsetting Revenue9915DirectOffsettingRevenue
Net Community Benefit Expense232614NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Persons Served50PersonsServed
Total Community Benefit Expense153597TotalCommunityBenefitExpense
Net Community Benefit Expense153597NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served5254PersonsServed
Total Community Benefit Expense301141TotalCommunityBenefitExpense
Net Community Benefit Expense301141NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served23132PersonsServed
Total Community Benefit Expense3392624TotalCommunityBenefitExpense
Direct Offsetting Revenue85756DirectOffsettingRevenue
Net Community Benefit Expense3306868NetCommunityBenefitExpense
Percent Of Total Expense0.02150PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served25077PersonsServed
Total Community Benefit Expense22470991TotalCommunityBenefitExpense
Direct Offsetting Revenue7324766DirectOffsettingRevenue
Net Community Benefit Expense15146225NetCommunityBenefitExpense
Percent Of Total Expense0.09850PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs20702NumberOfActivitiesOrPrograms
Total Community Building Expense235821TotalCommunityBuildingExpense
Net Community Building Expense235821NetCommunityBuildingExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs4420NumberOfActivitiesOrPrograms
Total Community Building Expense122093TotalCommunityBuildingExpense
Direct Offsetting Revenue54656DirectOffsettingRevenue
Net Community Building Expense67437NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense94428TotalCommunityBuildingExpense
Net Community Building Expense94428NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs25122NumberOfActivitiesOrPrograms
Total Community Building Expense452342TotalCommunityBuildingExpense
Direct Offsetting Revenue54656DirectOffsettingRevenue
Net Community Building Expense397686NetCommunityBuildingExpense
Percent Of Total Expense0.00250PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,896,954BadDebtExpenseAmount
Amount Attributable To974238AmountAttributableTo
Amount Reimbursed By Medicare44635486AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare47785907CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-3150421MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (4 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 KEENE HEALTH ALLIANCE
INTEGRATING HEALTH CARE SERVICES TO PROVIDE EFFECTIVE DELIVERY SYSTEM0.500000.000000.00000
3 NEW ENGLAND LIFE CARE INC
A NOT-FOR-PROFIT HOME INFUSION THERAPY COOPERATIVE.0.020000.000000.00000
4 NH LITHOTRIPSY
LITHOTRIPCY SERVICES0.037500.000000.00000
5 NH IMAGING
IMAGING SERVICES0.083300.000000.00000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHESHIRE MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART II: THE MEDICAL CENTER HAS BEEN ACTIVELY ENGAGED SINCE THE SPRING OF 2006 IN VISION 2020: TO MAKE KEENE AND THE SURROUNDING REGION THE HEALTHIEST IN THE NATION BY THE YEAR 2020. OVER THE PAST THREE YEARS THE ORGANIZATION HAS FOCUSED ON STREAMLINING AND IMPROVING INTERNAL OPERATIONS TO CREATE THE STRENGTH NECESSARY TO LEAD AND FACILITATE THIS INITIATIVE WITHIN THE BROADER COMMUNITY. MANAGEMENT HAS CREATED COMMUNITY-BASED WORKGROUPS TO DEFINE THE OBJECTIVES, TASKS, AND CHANGES NECESSARY TO ACHIEVE VISION 2020. THE CAMPUS HAS BUILT ON ITS EXISTING STRONG RELATIONSHIPS WITH OTHER REGIONAL PROVIDERS, AGENCIES, AND BUSINESSES TO SUPPORT THE PLAN AND HAS STARTED IMPLEMENTING A VARIETY OF PILOT PROGRAMS RELATED TO POPULATION HEALTH MANAGEMENT AND EMPLOYEE WELLNESS. THE ORGANIZATION IS A FOUNDING MEMBER OF THE COUNCIL FOR HEALTH COMMUNITIES WHICH HAS BEEN IN EXISTENCE FOR MORE THAN 10 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 5 TIMES THE REGION'S POVERTY RATE) IS AN APPROPRIATE ESIMATION 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 2011, THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE IS $974,238.
PART III, LINE 8: 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 VI, LINE 2: 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 VISION 2020, THE COUNCIL IDENTIFIED COMMUNITY NEEDS TOWARD A GOAL OF BECOMING THE HEALTHIEST COMMUNITY IN THE NATION BY THE YEAR 2020. THE COUNCIL FORMED FIVE WORKGROUPS AROUND STRATEGIC THEMES INCLUDING: HEALTH STATUS, HEALTHCARE ACCESS; HEALTH LITERACY, WELLNESS, AND SOCIAL CAPITAL. THE WORKGROUPS MET FROM JANUARY 2008 - OCTOBER 2009 TO IDENTIFY KEY GOALS, KEY MEASURES, AND LOCAL COMMUNITY ASSETS. THIS WORK IS SUMMARIZED IN THE COMMUNITY NEEDS ASSESSMENT FOUND AT THE WEB SITE HEALTHIESTCOMMUNITY.ORG. WE HOSTED A PLANNING SUMMIT IN MAY OF 2010 TO IDENTIFY CONTRIBUTING FACTORS FOR EACH INDICATOR IN THE COMMUNITY ASSESSMENT. THE 215 ATTENDEES ALSO IDENTIFIED POSSIBLE PROGRAMS AND POLICIES TO ADDRESS EACH NEED. SUMMIT INFORMATION WILL BE USED TO DEVELOP ACTION PLANS DURING THE FALL AND WINTER OF 2010. CHESHIRE MEDICAL CENTER PROVIDES STAFF FOR THE VISION 2020 INITIATIVE AND FUNDED THE COMMUNITY ASSESSMENT PROCESS THROUGH AN EVALUATION PARTNERSHIP CONTRACT WITH ANTIOCH NEW ENGLAND UNIVERSITY. THE COMMUNITY ADVISORY COMMITTEE, SERVING IN AN ADVISORY CAPACITY FOR BOTH HOME HEALTHCARE, HOSPICE AND COMMUNITY SERVICES, AND CHESHIRE MEDICAL CENTER/DARTMOUTH HITCHCOCK KEENE, REVIEWED AND COMMENTED ON THE COMMUNITY BENEFIT PLAN. THE REPORT IS AVAILABLE TO THE PUBLIC ON THE CHESHIRE MEDICAL CENTER WEBSITE: CHESHIREMED.ORG
PART VI, LINE 3: CMC IS COMMITTED TO PROVIDING MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. NON-EMERGENCY 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. 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 PATIENTS 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 2010 CENSUS, THE MEDICAL CENTER'S PSA REPRESENTED APPROXIMATELY 5.01% OF NEW HAMPSHIRES POPULATION. THE PSA'S TOTAL POPULATION WAS 66,017 WITH 23,409 RESIDING IN KEENE, THE LARGEST COMMUNITY IN THE SERVICE AREA. AS OF 2010, 8,350 OR 12.65% OF THE MEDICAL CENTER'S PSA RESIDENTS WERE 65 YEARS OF AGE OR OLDER. APPROXIMATELY 2,744 RESIDENTS, OR 4.1% OF THE TOTAL PSA POPULATION, WERE 80 YEARS OF AGE OR OLDER. AS OF 2010, APPROXIMATELY 42% OF THE POPULATION OF THE MEDICAL CENTERS PSA WAS 45 YEARS OF AGE OR OLDER. APPROXIMATELY 40% OF THE POPULATION OF THE MEDICAL CENTERS PSA WAS BETWEEN 15 AND 44, THE AS OF FEBRUARY 2010, THE STATE UNEMPLOYMENT RATE WAS 5.2% AND THE UNEMPLOYMENT RATE FOR CHESHIRE COUNTY WAS 5.5%. ACCORDING TO THE 2010 CENSUS, THE POVERTY RATE FOR CHESHIRE COUNTY WAS 10% AS COMPARED TO 7.8% FOR THE STATE OF NEW HAMPSHIRE.
PART VI, LINE 6: A COMPLETE COPY OF THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND AT:HTTP://WWW.CHESHIRE-MED.COM/IMAGES/STORIES/COMMHEALTH/COMMUNITY_BENEFITS_2011.PDFTHE MEDICAL CENTER PLAYS AN ACTIVE ROLE IN PROMOTING COMMUNITY HEALTH AND OFFERS EDUCATIONAL PROGRAMS INCLUDING CLASSES AND WORKSHOPS IN DIABETES AND ASTHMA, STRESS MANAGEMENT, NUTRITIONAL COUNSELING, SMOKING CESSATION, HEALTHY BACK, WEIGHT CONTROL, TIME MANAGEMENT AND BREAST SELF-EXAMINATION. IN ADDITION, THE MEDICAL CENTER WORKS WITH THE COUNCIL FOR A HEALTHIER COMMUNITY, COMPRISED OF COMMUNITY LEADERS, TO OFFER 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. A PUBLIC HEALTH HYGIENIST HIRED BY THE MEDICAL CENTER IS ASSISTED BY AREA DENTISTS. 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. 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 2005, AFHY COMPLETED IMPLEMENTATION OF A PILOT PROGRAM IN TWO AREA SCHOOLS. IN 2006 THE PROGRAM EXPANDED EFFORTS BY OFFERING SMALL GRANTS TO SCHOOLS AND AFTER SCHOOL PROGRAMS TO SUPPORT COSTS OF PHYSICAL ACTIVITY AND NUTRITION PROGRAMS. GRANT PROJECTS INCORPORATED THE KEY LESSONS LEARNED DURING THE PILOT PROJECT. IN 2007, AFHY BEGAN TAKING STEPS TO IMPLEMENT THE 5-2-1-0 COMMUNITY PUBLIC MESSAGING CAMPAIGN TO EDUCATE FAMILIES ABOUT CHILDHOOD 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. THE CHESHIRE HEALTHY EATING ACTIVE LIVING (HEAL) INITIATIVE CREATED THE TURN A NEW LEAF MENU LABELING PROGRAM IN LOCAL RESTAURANTS. THIS INITIATIVE IS ALSO AVAILABLE IN THE LOCAL COMMUNITY KITCHEN TO BRING HEALTHY EATING OPTIONS TO OUR MOST VULNERABLE POPULATION. 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, AND ATTEND WORKSHOPS AND HEALTH LECTURES WITH A SENIOR FOCUS. A NEWSLETTER IS SENT QUARTERLY TO PASSPORT HOLDERS. AS A PROGRAM OF THE VISION 2020 INITIATIVE, THE HEALTHY COMMUNITY CHAMPIONS PROGRAM HAS ENROLLED 1000 MEMBERS THAT HAVE MADE A COMMITMENT TO ACTIVELY ENGAGE IN IMPROVING THEIR HEALTH AND THE HEALTH OF OTHERS WHERE THEY LIVE, LEARN, WORK AND PLAY. THE TOTAL EXPENDITURES ASSOCIATED WITH THESE AND OTHER PROGRAMS FOR PERIOD ENDING 9/30/11 IS $6,438,937.
NHREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOSEPH BERGMAN MD
194388000000000194388000
ARTHUR NICHOLS
34882501030530446380314100210990549025000
KATHLEEN CRONIN
158487000482020303500174480254487000
JILL BATTY
222697000249000265100220990296206000
CINDI COUGHLIN
115667000119620145970141970156423000
JULIE GREEN
124589000373910234760185000203956000
PAUL PEZONE
124991000200000144610182810177733000
ERLI CHEN
180886000300080222430155090248646000
LARRY MILLER
165682000219960233750178670228920000
KRISTIN ROSSI
138704000220000164350188020195941000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ACHESHIRE 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 YEAR 2010.
PART I, LINE 7SENIOR 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

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1NH HEALTH & EDUCATION FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN020279866IssuerEIN
Date Issued2009-08-27DateIssued
Issue Price15000000IssuePrice
Description Of PurposeREFUND COMMERCIAL DEBT, AQUISITION OF EQUIPMENT, RENOVATIONSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds15000000TotalProceeds
Amount In Reserve Fund5667081AmountInReserveFund
Issuance Costs From Proceeds244244IssuanceCostsFromProceeds
Working Capital Expenditures578012WorkingCapitalExpenditures
Capital Expenditures8510663CapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1TD BANK NABusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge7.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CHESHIRE MEDICAL CENTER IS THE CHESHIRE HEALTH FOUNDATION
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF TRUSTEES CONSISTS OF NO FEWER THAN 15 VOTING MEMBERS WHICH INCLUDES THE PRESIDENT/CEO AND PRESIDENT OF THE MEDICAL STAFF. OTHER MEMBERS ARE NOMINATED BY THE CHESHIRE HEALTH FOUNDATION GOVERNANCE COMMITTEE AND ELECTED BY THE FOUNDATION BOARD
FORM 990, PART VI, SECTION B, LINE 11COPY 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.
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 12C
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."FORM 990, PART VI, SECTION B, LINE 15
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 VI, SECTION C, LINE 19
ALL OTHER FUNCTIONAL EXPENSESMEDICAID ENHANCEMENT TAX : PROGRAM SERVICE EXPENSES 5,312,400. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,312,400. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 4,012,512. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,012,512. JOA GAINSHARE : PROGRAM SERVICE EXPENSES 2,907,792. MANAGEMENT AND GENERAL EXPENSES 521,208. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,429,000. MAINTENANCE CONTRACTS : PROGRAM SERVICE EXPENSES 2,025,397. MANAGEMENT AND GENERAL EXPENSES 363,043. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,388,440. DATA PROCESSING FEES : PROGRAM SERVICE EXPENSES 1,847,976. MANAGEMENT AND GENERAL EXPENSES 331,241. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,179,217. FOOD & FOOD SUPPLIES : PROGRAM SERVICE EXPENSES 978,418. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 978,418. CHILDCARE CENTER EXPENSE : PROGRAM SERVICE EXPENSES 962,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 962,163. MAINTENANCE & REPAIR : PROGRAM SERVICE EXPENSES 678,063. MANAGEMENT AND GENERAL EXPENSES 121,540. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 799,603. RENTAL AND LEASE EXPENSE : PROGRAM SERVICE EXPENSES 672,853. MANAGEMENT AND GENERAL EXPENSES 120,606. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 793,459. DUES & SUBSCRIPTIONS : PROGRAM SERVICE EXPENSES 435,163. MANAGEMENT AND GENERAL EXPENSES 78,001. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 513,164. MISCELLANEOUS EXPENSE : PROGRAM SERVICE EXPENSES 393,010. MANAGEMENT AND GENERAL EXPENSES 70,445. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 463,455. INSTRUMENTS & MINOR EQUIPMENT : PROGRAM SERVICE EXPENSES 349,162. MANAGEMENT AND GENERAL EXPENSES 62,586. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 411,748. POSTAGE : PROGRAM SERVICE EXPENSES 326,739. MANAGEMENT AND GENERAL EXPENSES 58,567. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 385,306. COLLECTION EXPENSE : PROGRAM SERVICE EXPENSES 362,161. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 362,161. LICENSES & TAXES : PROGRAM SERVICE EXPENSES 202,183. MANAGEMENT AND GENERAL EXPENSES 36,240. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,423. AFFILIATION EXPENSES : PROGRAM SERVICE EXPENSES 134,854. MANAGEMENT AND GENERAL EXPENSES 24,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 159,026. LINENS & APPAREL : PROGRAM SERVICE EXPENSES 130,177. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,177. BANK FEES : PROGRAM SERVICE EXPENSES 61,431. MANAGEMENT AND GENERAL EXPENSES 11,011. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,442. QUALITY CONTROL : PROGRAM SERVICE EXPENSES 59,355. MANAGEMENT AND GENERAL EXPENSES 10,639. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,994. RECRUITMENT : PROGRAM SERVICE EXPENSES 42,096. MANAGEMENT AND GENERAL EXPENSES 7,546. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,642. COURIER FEES : PROGRAM SERVICE EXPENSES 37,657. MANAGEMENT AND GENERAL EXPENSES 6,750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,407. MANGEMENT SERVICES : PROGRAM SERVICE EXPENSES 14,303. MANAGEMENT AND GENERAL EXPENSES 2,564. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,867. BOND FEES : PROGRAM SERVICE EXPENSES 7,352. MANAGEMENT AND GENERAL EXPENSES 1,318. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,670. TRUSTEE DEVELOPMENT : PROGRAM SERVICE EXPENSES 2,282. MANAGEMENT AND GENERAL EXPENSES 409. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,691. PATIENT VALUABLES : PROGRAM SERVICE EXPENSES 1,773. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,773.FORM 990, PART X, LINE 24F
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -596,500. PENSION LIABILITY ADJUSTMENT -4,624,738. TOTAL TO FORM 990, PART XI, LINE 5: -5,221,238.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CHESHIRE HEALTH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode
FieldValueIRS element (for citing)
EIN020202220EIN
Primary ActivitiesMANAGEMENT OF ENDOWMENT FUNDSPrimaryActivities
Legal Domicile StateNHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 11B, IIPublicCharityStatus
Controlled Org0ControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1KEENE HEALTH ALLIANCEBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1580 COURT STREETAddressLine1
CityKEENECity
StateNHState
ZIP Code03431ZIPCode
FieldValueIRS element (for citing)
EIN300179297EIN
Primary ActivityHEALTHCAREPrimaryActivity
Legal Domicile StateNHLegalDomicileState
Predominant Income TypeMEDICAL CAREPredominantIncomeType
Share Of Total Income1341000ShareOfTotalIncome
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner1GeneralOrManagingPartner
Percentage Ownership0.50000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
KEENE HEALTH SERVICES
580 COURT STREETKEENENH03431020374997INVESTMENTS REAL ESTATENHCHESHIRE HEALTH FOUNDATIONC-18278-41991761.00000
KEENE HEALTH REALTY
580 COURT STREETKEENENH03431020374998INVESTMENTS REAL ESTATENHKEENE HEALTH SERVICESC-58029-7622611.00000
KEENE HEALTH ENTERPRISES
580 COURT STREETKEENENH03431020374999INVESTMENTS REAL ESTATENHKEENE HEALTH SERVICESC1.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHESHIRE HEALTH FOUNDATION
C235647CASH
CHESHIRE HEALTH FOUNDATION
D538134CASH
CHESHIRE HEALTH FOUNDATION
J72000CASH
CHESHIRE HEALTH FOUNDATION
M1082126CASH
CHESHIRE HEALTH FOUNDATION
R5000000CASH