2026-06-15T06:55:53+00:00 2025-06-30 350921680 CROWE LLP 4801 Olympia Park Plaza Suite 4000 Louisville KY 402412098 990 2024-07-01 020354549 Cheshire Medical Center CHES 6033545400 580 - 590 Court Street Keene NH 034315400 Todd Roberts CFO 2026-06-15 true Rachel Spurlock P00520729 5023263996 2026-06-15 2024 2025-03-06 01:10:19Z Joseph Perras 580 - 590 Court Street Keene NH 034315400 348026480 false X https://www.cheshiremed.org X 1980 NH To deliver compassionate and exceptional care to all we serve by optimizing the health and wellbeing of our communities and setting the standard for healthcare excellence. 15 7 1232 84 937684 34878 10679183 12775639 293860323 332208534 261859 87467 3105432 2954840 307906797 348026480 369917 111263 0 116771894 132588221 0 493633 195449175 207312626 312590986 340012110 -4684189 8014370 161863854 157394231 86247654 66031094 75616200 91363137 The mission of Cheshire Medical Center is to deliver compassionate and exceptional care to all we serve. false false 320681048 111263 332319008 CHESHIRE MEDICAL CENTER (CHESHIRE) IS A COMMUNITY HOSPITAL LOCATED IN KEENE, NEW HAMPSHIRE. CHESHIRE IS A NOT-FOR-PROFIT ORGANIZATION, AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS A MEMBER OF THE DARTMOUTH HEALTH SYSTEM ("DH"), A NOT-FOR-PROFIT TAX-EXEMPT CORPORATION WITH A PRINCIPAL PLACE OF BUSINESS AT ONE MEDICAL CENTER DRIVE, LEBANON, NEW HAMPSHIRE. CONSISTENT WITH THE DH VISION AND STRATEGY TO CREATE A SUSTAINABLE HEALTH SYSTEM, CHESHIRE AND DH SHARE A COMMON COMMITMENT TO IMPROVING POPULATION HEALTH, VALUE-BASED CARE, AND CREATING NEW PAYMENT MODELS FOR THE BENEFIT OF THE CITIZENS OF NEW HAMPSHIRE AND VERMONT. CHESHIRE PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A COMMUNITY HOSPITAL. THESE INCLUDE A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, AND REHABILITATION. DURING FY25, CHESHIRE PROVIDED 228,060 PROVIDER VISITS AND HAD 3,769 HOSPITAL ADMISSIONS AND DISCHARGES. THE EMERGENCY DEPARTMENT WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 21,996 ER PATIENT VISITS. THERE ARE A TOTAL OF 259 PROVIDERS CONSISTING OF 149 PHYSICIANS AND 110 ASSOCIATE PROVIDERS. EACH YEAR, CHESHIRE MEDICAL CENTER FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS CHESHIRE PROVIDES. THE MOST RECENT COMMUNITY BENEFIT REPORTS ARE AVAILABLE UPON REQUEST OR CAN BE FOUND ON CHESHIRE'S WEBSITE (https://www.cheshiremed.org/about/community-benefits-reporting). During FY2025, Cheshire's Community Benefit priorities centered around improving healthcare access in rural communities, behavioral health supports, substance use disorder prevention and supports, and aging population services. IN TOTAL, CHESHIRE PROVIDED more than $17 MILLION IN COMMUNITY BENEFITS INCLUDING UNREIMBURSED CHARITY CARE, HEALTH SERVICES, HEALTH PROFESSION EDUCATION, SUBSIDIZED HEALTH SERVICES, AND COMMUNITY-BUILDING ACTIVITIES. THESE CONTRIBUTIONS ARE IN ADDITION TO THE OVER $49 MILLION DOLLARS IN UNREIMBURSED MEDICARE COSTS ABSORBED BY CHESHIRE. 320681048 true true false true false false false false false true true true false true true false false true false false false false false false false false true true false true true true false false false false false false false false false false false false false false false true true true false false true 213 0 true 1232 true true true false false false false false false false false false false false X 15 7 false false false false true true true true true false false false true true true true true true false true false false NH X Todd Roberts 6033545400 580-590 COURT STREET KEENE NH 034315400 Daniel Smith Trustee / Vice Chair (through 11/14/24) 1.0 0 X X 0 0 0 Elizabeth Cotter Trustee/Secretary 1.0 1.0 X X 0 0 0 Joseph L Perras MD Trustee/CEO/President ex-officio 40.0 1.5 X X 0 570040 54269 Leslie Pitts MD Trustee/Ex-Officio Med. Staff Pres (through 10/31/24) 0.5 40.0 X X 0 293416 68441 Mark Bodin Trustee / Treasurer 1.0 0 X X 0 0 0 MARK GAVIN TRUSTEE / Chair 1.0 0 X X 0 0 0 Serena Shomody Trustee/Med Staff Pres. (as of 11/1/24) 40.0 0.0 X X 0 328934 54756 Alan Kintisch Trustee (as of 8/22/24) 0.5 0 X 0 0 0 Andrew G Tremblay MD TRUSTEE 1.0 40.0 X 0 307536 65144 Barbara Duckett Trustee 0.5 0 X 0 0 0 Cherie Holmes MD Trustee 0.5 40.0 X 0 387396 52481 Gina OBrien MD Trustee 0.5 40.0 X 0 443984 28237 Maria Padin MD TRUSTEE (through 12/31/24) 1.0 41.5 X 0 599295 68542 Michael Chelstowski Trustee 0.5 0 X 0 0 0 Michael Farhm Trustee (through 3/19/25) 0.5 0 X 0 0 0 Michael Waters Trustee / DH Treasurer 0.5 40.0 X 0 374870 34419 Robert Palmer Trustee (through 1/17/25) 0.5 0 X 0 0 0 Stephen LeBlanc Trustee 0.5 42.5 X 0 1016111 69299 SUSAN ABERT TRUSTEE 1.0 0 X 0 0 0 Teresa Malcolm MD Trustee (as of 4/01/25) 0.5 40.0 X 0 353278 61286 Anne Tyrol Chief Nursing Officer 40.0 0 X 251503 0 43822 AnnMarie Coppo Interim CFO (through 4/28/25) 40.0 0.5 X 162388 0 48409 Kathryn F Willbarger COO 40.0 0.0 X 339266 0 36825 Todd Roberts CFO (as of 4/28/25) 40.0 0.5 X 0 242180 15534 Christy Lambert RN-First Assist 40.0 0 X 178785 0 25167 Erli Chen PHYSICiST 40.0 0 X 269933 0 38796 Lisa Hanamoto RN Baylor-WN-IP/PRCD 40.0 0 X 188016 0 26550 Matthew Borden Pharmacist 40.0 0 X 183369 0 11858 Sandra M Phipps VP PHILANTHROPY/COMM RELATIONS 40.0 0.5 X 184852 0 33176 Daniel Gross Former Chief Financial Officer 0.0 0.5 X 145799 0 20592 Jennifer L DiNubila DO Former Med Staff Pres. 0.0 40.0 X 0 100231 14275 1903911 5017271 871878 125 true true false CONIFER REVENUE CYCLE SOLUTIONS PO BOX 655025 DALLAS TX 752655025 Revenue Management 6679867 Prolucent Health inc 5420 LBJ Freeway Suite 550 Dallas TX 75240 Workforce Services 6631353 American Healthcare Staff Assoc 3009 Astoria Ct Edmond OK 73034 Workforce Services 5007057 MARY HITCHCOCK MEMORIAL HOSPITAL One Medical Center Dr Lebanon NH 03756 Workforce Services 3965405 Comphealth Medical Staffing PO Box 972651 Dallas TX 753972651 Workforce Services 2633271 47 8040412 4285039 450188 12775639 NET PATIENT SERVICE REVENUE 622110 306684244 306684244 PHARMACY REVENUE 446110 25477325 24628029 849296 Laboratory Services 621500 46965 46965 0 0 0 0 332208534 87467 41423 46044 9614 9614 0 9614 9614 0 0 Food Services 722514 1186243 1186243 Childcare Revenue 624410 752248 752248 Rebates and Discounts 622110 586368 586368 420367 420367 0 0 2945226 348026480 332319008 937684 1994149 X 4223 4223 107040 107040 1048690 24161 1024529 27140 25783 1357 94939916 90655428 4067871 216617 4077711 3893690 174717 9304 27375350 26139944 1172946 62460 5119414 4888383 219350 11681 13311 5197 8095 19 11475 11475 97089207 95177806 1823182 88219 130382 111829 18456 97 1648497 1344264 292368 11865 491428 464438 26990 6971347 5995662 975685 319999 262857 52177 4965 41563 39793 1503 267 1866602 1866602 9895561 6352212 3543349 3696429 3680409 16020 MEDICAL SUPPLIES 58589562 58589562 MEDICAID ENHANCEMENT & PILOT TAXES 11098083 11098083 Shared Services - Related Party 6273036 4130820 2142216 EQUIPMENT RENTAL AND MAINTENANCE 5085518 2885347 2197385 2786 4090626 2963298 1070322 57006 340012110 320681048 18837429 493633 15605587 13317225 248 16513441 19977731 0 0 0 0 4904983 5351475 1076029 192410 282952071 217567776 68069459 65384295 27699843 30731826 0 27994264 22439269 161863854 157394231 17484959 18013915 3118884 716871 20886037 21400085 0 0 44757774 25900223 86247654 66031094 X 40224026 49166790 35392174 42196347 75616200 91363137 161863854 157394231 X 8014370 3036782 4695785 X false true true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 40357 40357 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY CHESHIRE MEDICAL CENTER PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION AND A THIRD PARTY REPRESENTING THE RURAL HOSPITAL COALITION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1i REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES TO OUTSIDE ORGANIZATIONS ALONG WITH THE THIRD PARTY REPRESENTATIVE. 28610974 2768487 652595 30726866 26585077 5499 2628523 608125 28610974 25835380 10971 1320761 582035 26585077 27658744 -1666734 156630 25835380 21594703 2020506 4806606 763071 27658744 0.0 0.2634 0.7366 false true true 218161 218161 82799225 62479710 20319515 39961313 17968621 21992692 159973372 137119445 22853927 65384295 Closely-held equity interests Financial derivatives Investment in Pooled Fund 30731826 F 30731826 Due from Affiliate 19784702 Deferred 457(b) Plan Assets 378669 Other Assets 2275898 22439269 Federal Income Taxes DUE TO RELATED PARTY 19651117 RESERVES FOR ESTIMATED 3RD PARTY SETTLEMENTS 5578849 Right of Use Lease Obligations 670257 25900223 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUNDS ARE HELD BY CHESHIRE HEALTH FOUNDATION, A RELATED TAX-EXEMPT ORGANIZATION. THE INTENDED USE OF ENDOWMENT FUNDS IS TO SUPPORT AND ADVANCE THE HEALTH AND WELLNESS MISSION-RELATED PROGRAMS OF CHESHIRE MEDICAL CENTER. true true X true X 225 true X true true false true true 2923672 0 2923672 0.00860 34436474 26719411 7717063 0.02270 0 0 0 0.0 0 0 37360146 26719411 10640735 0.03130 454630 0 454630 0.00134 3461919 66311 3395608 0.00999 4162667 1542570 2620097 0.00771 0 0 0 0.0 327228 50000 277228 0.00082 0 0 8406444 1658881 6747563 0.01985 0 0 45766590 28378292 17388298 0.05114 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 802190 129193 672997 0.00198 0 0.0 0 0.0 537941 537941 0.00158 0 0 1340131 129193 1210938 0.00356 true 0 0 103096686 152782094 -49685408 X true true 1 1 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 https://www.cheshiremed.org 00014 X X X IN-PATIENT REHAB CHESHIRE MEDICAL CENTER 1 false false false true true 50000 true X 225.0 300.0 X X X X X X X true true X X X true X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Cheshire Medical Center. PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF CMC. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Cheshire Medical Center. CMC HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - Cheshire Medical Center. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON CMC'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. CMC PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. CMC CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, CMC POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. CMC SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, CMC CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME. 1 CHESHIRE MEDICAL CENTER COLLECTING STATION 580-590 COURT STREET KEENE NH 03431 COLLECTING STATION Schedule H, Part V, Section B Line 3 Schedule H, Part VI - Supplemental information regarding Part V, Section B, line 3 Part V, Section B, line 3 asks whether the hospital facility conducted a community health needs assessment (CHNA) during the tax year or either of the two immediately preceding tax years. Under Treas. Reg. Section 1.501(r)-3, a CHNA is considered conducted only when all required steps have been completed, including adoption of the CHNA report by an authorized body of the hospital facility and making the CHNA report widely available to the public. Cheshire Medical Center answered line 3 "No" because its CHNA was not adopted by an authorized body of the hospital facility and made widely available to the public until after June 30, 2025. Accordingly, the facility is reporting and paying the section 4959 excise tax on Form 4720 for the failure to meet section 501(r)(3) for the tax year ended June 30, 2025. Before June 30, 2025, however, the facility had made substantial progress toward completion of the CHNA process. Prior to that date, the facility had defined the community it serves, assessed the health needs of that community, solicited and considered input from persons representing the broad interests of the community, and undertaken analysis and drafting of the CHNA report. The final CHNA report and related implementation strategy were completed and are now publicly available on the hospital facility's website at: https://www.cheshiremed.org/about/community-benefits-reporting Schedule H, Part V, Section B, Line 12 Section 501(r)(3) failure Description of Failure For the taxable year ending June 30, 2025, Cheshire Medical Center did not complete the required CHNA approval and implementation strategy approval process within the timeframes required by section 501(r)(3). The CHNA for the current cycle was not adopted by an authorized body of the hospital facility within the required three-year period ending June 30, 2025. In addition, the related implementation strategy was not adopted by the governing body by November 15, 2025, the required deadline following the end of the taxable year. Description of Correction In accordance with Rev. Proc. 2015-21, Cheshire Medical Center obtained formal governing body approval of both the CHNA and the implementation strategy on January 29, 2026. Following approval, the CHNA and implementation strategy were finalized and made widely available to the public. Description of Practices or Procedures Going Forward This situation was inadvertent and administrative in nature and did not reflect a failure to identify or address community health needs. The underlying CHNA activities and related planning were performed, and the delay was limited to the timing of formal governing body approval. Cheshire Medical Center has updated its internal compliance calendar and governance procedures to ensure that future CHNAs are completed within the required three-year cycle and that implementation strategies are adopted within the required timeframe. Cheshire Medical Center remains committed to full compliance with Section 501(r)(3). Schedule H, Part I, Line 7g Subsidized Health Services The amount on line 7g, column c, does not include any costs attributable to a physician clinic. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, ratio of patient care to cost-to-charges for lines 7a and 7b. Lines 7e, 7f, 7g, and 7i are based on actual costs. Schedule H, Part II Community Building Activities The Center for Population Health at Cheshire Medical Center is the state-designated coalition building entity for the Monadnock Regional Public Health Network, which brings together organizations and individuals from around the region to promote and provide for the public health in lieu of a local governmental public health department model. Cheshire Medical Center receives some grant dollars through the New Hampshire Department of Health and Human Services to provide local public health service organization and oversight. However, Cheshire is committed to the health and wellbeing of its region and commits additional community benefit support beyond what the grant is able to financially reimburse, providing additional funding for expert staff support, direct public health programming, and community organizing around public health initiatives. The Regional Public Health Network coalition, known as the Healthy Monadnock Alliance, is driven by a shared set of priority areas identified through community health needs assessment. Currently the priority areas around which coalition members unite concern improving access to healthcare, food access, active living, substance use prevention and supports for youth, emergency preparedness, and behavioral health for community members. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AS A RESULT OF ACCOUNTING GUIDANCE (STATEMENT 15 AND ASC 606), BAD DEBT IS NO LONGER AN EXPENSE BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Bad Debt is no longer treated as an expense due to accounting guidance (Statement 15 and ASC 606). As a result, an amount attributable to patients eligible under the organization's financial assistance policy is unable to be reasonably estimated. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE CHESHIRE MEDICAL CENTER IS INCLUDED IN THE DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. AS A RESULT OF ACCOUNTING CHANGES (ASC 606), BAD DEBT IS NO LONGER AN EXPENSE BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. THEREFORE, THERE IS NO SEPARATE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY WAS COMPLETED ACCORDING TO GUIDANCE PROVIDED BY THE INTERNAL REVENUE SERVICE. THE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THE CHESHIRE MEDICAL CENTER IS THE ONLY HOSPITAL/MEDICAL CENTER IN CHESHIRE COUNTY, NEW HAMPSHIRE AND IS DESIGNATED BY CMS AS A MEDICARE DEPENDENT HOSPITAL (MDH) DUE TO GREATER THAN HALF 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance CHESHIRE MEDICAL CENTER HAS A CREDIT AND COLLECTION POLICY THAT ADDRESSES THE PROCEDURES FOR PATIENTS WHO QUALIFY FOR REDUCED-COST CARE. THE POLICY PROHIBITS USING EXTRAORDINARY COLLECTION PRACTICES OR PLACING AMOUNTS WITH COLLECTION AGENCIES. IF A FINANCIAL-ASSISTANCE-POLICY-ELIGIBLE PATIENT HAS A BALANCE FOR WHICH THEY ARE RESPONSIBLE AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE STANDARD PRACTICES ARE FOLLOWED AS OUTLINED IN THE CREDIT AND COLLECTIONS POLICY. Schedule H, Part V, Section B, Line 16a FAP website - CHESHIRE MEDICAL CENTER: Line 16a URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - CHESHIRE MEDICAL CENTER: Line 16b URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CHESHIRE MEDICAL CENTER: Line 16c URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment IN ADDITON TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL USES REGULAR FEEDBACK FROM THE COMMUNITY, PROVIDED THROUGHOUT THE YEAR, TO ASSESS ITS HEALTH NEEDS. Center for Population Health department staff participate in or lead multiple community coalitions and projects collaborating and connecting with a wide array of stakeholders. We regularly review emerging public health data and statistics at the state level and gather local statistics through a variety of methods including a social drivers of health screener administered to primary care patients at our facilities, a community health and wellbeing survey conducted every 2-3 years with support from the University of New Hampshire survey center, and other locally available data. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Cheshire Medical Center is committed to providing medically necessary care to all patients regardless of ability to pay for services. As part of the Dartmouth Health System, Cheshire Medical participates in several shared policies for patient payment supports including financial assistance support programs and family resource counseling to connect patients with needed services. Patients are screened for assistance qualification through a number of departments and can access information on assistance policies by viewing them online, being connected to a community health worker embedded within the hospital, or reading printed educational information available across hospital service sites. More information on policies and available services for patients can be found here: (https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance). Schedule H, Part VI, Line 4 Community information Cheshire Medical Center is the only hospital in its primary service area which is described below. Geography: Cheshire Medical Center serves Cheshire County in the southwestern corner of New Hampshire. The county is comprised of 22 towns and 1 city, ranging in population from a few hundred to several thousand, and the county seat is the city of Keene where Cheshire Medical Center's main campus is located. Cheshire County is designated as a rural county with a low-density population, as more than two thirds of people (69%) reside in a rural area. General Population: The latest population estimates put a total county population of 77,703 residents. The county is an aging one, with more than 1 in 5 residents (23%) age 65 or older. There are around 14,000 children under the age of 18 residing in the county, or 18% of the overall population. Most community members identify as non-Hispanic white (93%), with English being the predominantly spoken language (95%). Socioeconomic Factors: The median household income is around $69,000 annually. Most adult residents over the age of 25 have completed high school (94%), and two thirds of residents have completed some college education (68%). 70% of households own their home. 1 in 4 residents age 16-64 are unemployed (26%). 1 out of 10 residents lives in poverty (10%), and the same proportion of residents are experiencing food insecurity (11%), with 1 in 10 children living in poverty and 15% living in single parent homes. 7% of the adult population is not covered by any type of health insurance, while only 4% of children are uninsured. Population Health Epidemiology: The average life expectancy of Cheshire County residents is 78 years, on par with the state average. 15% of the adult population report being in poor or fair health overall, experiencing on average 4 days a month of poor physical health and 5 days a month of poor mental health. 1 in 3 adults are obese (31%), and 1 in 5 residents report having little to no regular physical activity (20%). Schedule H, Part VI, Line 5 Promotion of community health Cheshire Medical Center's Center for Population Health promotes the health and wellbeing of the Greater Monadnock Community through a variety of programs and services geared toward different communities of interest. The Center for Population Health is the principal supporter of The Healthy Monadnock Alliance, which serves as the Greater Monadnock Regional Public Health Network. Working in collaboration with other respected agencies and non-profits, the department supports population health initiatives like assessments and planning as well as offers direct community programs through the hospital like worksite wellness, school-based supports, nutrition and active lifestyle classes, mental health and substance abuse recovery classes and support groups, etc. The Center for Population Health also collects and reports information about other Community Benefit programs conducted by other hospital departments and staff. Our annual Community Benefits Highlights Report highlights just a few of the other programs and initiatives Cheshire Medical Center employs to address the needs identified in the community each year. In the previous year, Cheshire Medical Center has offered support to a regional mobile dental clinic, conducted a "Teddy Bear Clinic" for parents and families in the community to empower children's health, provided emergency medical services training such as CPR and Naloxone administration, entered the second year of support for a Family Medicine Residency program to train physicians to care for rural populations, and more. Information about additional activities and programs to address the health of the community can be found here: (https://www.cheshiremed.org/about/community-benefits-reporting). Cheshire Medical Center's volunteer Board of Trustees represents a broad range of interests which exist in the communities it serves. In particular the trustees who are neither employees nor independent contractors (nor family members thereof) of the Cheshire Medical Center, are representative of the consumer interests of the various neighborhoods and localities which are serviced by the hospital. CMC EXTENDS PROFESSIONAL STAFF PRIVILEGES TO QUALIFIED AND APPROPRIATE PHYSICIANS WHO ARE EMPLOYEES OF DARTMOUTH HITCHCOCK CLINIC, MARY HITCHCOCK MEMORIAL HOSPITAL, AND DARTMOUTH COLLEGE, WHO ALSO HOLD A FACULTY APPOINTMENT AT GEISEL SCHOOL OF MEDICINE. Schedule H, Part VI, Line 6 Affiliated health care system As part of the Dartmouth Health System, Cheshire Medical Center and its affiliate clinic sites promote the health and wellbeing of our communities through the Dartmouth Health 2030 Strategic Plan: One Team One Vision (https://www.dartmouth-health.org/2030). The plan outlines 3 strategic goals to provide the highest value and safest care for patients, create an environment of excellence that attracts and inspires innovation, and build partnerships to improve the health of populations we collectively serve. In particular, the system is focused on growing sites of care and services in rural southern New Hampshire areas, design innovative care models that address an aging population, and measurably improve health equity in our region. Cheshire Medical Center also serves as the principal supporter of The Healthy Monadnock Alliance, which is the regional public health network of the Monadnock Region. Cheshire Medical Center staff play a critical role in helping identify, design, and evaluate different initiatives and programs that support the region's public health through this strong community system. Schedule H, Part VI, Line 7 State filing of community benefit report NH true Patient and family support/assistance 44 4868 Book Nursing and healthcare scholarships 22 102172 Book Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE COORDINATORS OF THE PROGRAM ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS. false true false false false false false false false Jennifer L DiNubila DO Former Med Staff Pres. 0 79345 0 0 0 20886 0 4802 0 9473 0 114506 0 0 Leslie Pitts MD Trustee/Ex-Officio Med. Staff Pres (through 10/31/24) 0 292642 0 0 0 774 0 28170 0 40271 0 361857 0 0 Joseph L Perras MD Trustee/CEO/President ex-officio 0 504078 0 42400 0 23562 0 20700 0 33569 0 624309 0 0 Serena Shomody Trustee/Med Staff Pres. (as of 11/1/24) 0 305664 0 0 0 23270 0 25705 0 29051 0 383690 0 0 Cherie Holmes MD Trustee 0 356978 0 0 0 30418 0 32970 0 19511 0 439877 0 0 Stephen LeBlanc Trustee 0 733963 0 155000 0 127148 0 32970 0 36329 0 1085410 0 0 Maria Padin MD TRUSTEE (through 12/31/24) 0 505838 0 62420 0 31037 0 32970 0 35572 0 667837 0 0 Andrew G Tremblay MD TRUSTEE 0 307122 0 0 0 414 0 29284 0 35860 0 372680 0 0 Michael Waters Trustee / DH Treasurer 0 328262 0 39600 0 7008 0 32970 0 1449 0 409289 0 0 Gina OBrien MD Trustee 0 420681 0 17700 0 5603 0 20700 0 7537 0 472221 0 0 Teresa Malcolm MD Trustee (as of 4/01/25) 0 318408 0 33960 0 910 0 20700 0 40586 0 414564 0 0 Daniel Gross Former Chief Financial Officer 116300 0 27140 0 2359 0 8755 0 11837 0 166391 0 0 0 Kathryn F Willbarger COO 307502 0 30900 0 864 0 32331 0 4494 0 376091 0 0 0 Anne Tyrol Chief Nursing Officer 227233 0 24000 0 270 0 15818 0 28004 0 295325 0 0 0 AnnMarie Coppo Interim CFO (through 4/28/25) 161887 0 0 0 501 0 11929 0 36480 0 210797 0 0 0 Todd Roberts CFO (as of 4/28/25) 0 208902 0 25200 0 8078 0 14531 0 1003 0 257714 0 0 Erli Chen PHYSICiST 249027 0 0 0 20906 0 24211 0 14585 0 308729 0 0 0 Sandra M Phipps VP PHILANTHROPY/COMM RELATIONS 183726 0 0 0 1126 0 14556 0 18620 0 218028 0 0 0 Matthew Borden Pharmacist 183226 0 0 0 143 0 10972 0 886 0 195227 0 0 0 Lisa Hanamoto RN Baylor-WN-IP/PRCD 182678 0 0 0 5338 0 14167 0 12383 0 214566 0 0 0 Christy Lambert RN-First Assist 173559 0 5000 0 226 0 11801 0 13366 0 203952 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE CEO IS PAID BY DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Dartmouth Hitchcock Clinic (DHC) sponsors a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen to new participants in 1998. THE FOLLOWING INDIVIDUAL HAS A SPLIT DOLLAR LIFE PLAN ARRANGEMENT AND RESPECTIVE EMPLOYER PREMIUM: STEPHEN LEBLANC $70,131. Separate from the Split Dollar Life plan, the following individuals received payments from a nonqualified retirement plan (which are reflected in schedule J, Part II, Column B (III)): Stephen LeBlanc $65,562 Maria Padin $25,884 Cherie Holmes $12,932 Gina O'Brien $3,377 Theresa Malcolm $496 Jennifer DiNubila $6,552 A NH HEALTH AND ED FACILITIES AUTHORITY 020279866 64461XMG7 2025-05-28 20340118 Refund the 2012 Cheshire Medical Center Issue Dated 11/28/2012. false false false A 20340118 145308 20194810 true false false true A false true true true false false 0.0 0.0 0.0 false false 0 false true A false true false false true false 0 false false false 0 false false true A true Schedule K, Part I Bond A The proceeds of this bond issue benefited the following subsidiaries of Dartmouth-Hitchcock Obligated group - Dartmouth-Hitchcock Health (EIN: 26-4812335), Alice Peck Day Memorial Hospital (EIN: 02-0222791), Mary Hitchcock Memorial Hospital (EIN: 02-0222140), Cheshire Medical Center (EIN: 02-0354549), Valley Regional Hospital, Inc. (EIN: 02-0222118), and Dartmouth-Hitchcock Clinic (EIN: 22-2519596). The portion of the issue that has been loaned to each subsidiary is being reported on that subsidiary member's schedule K. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH CEO COMPENSATION THE CEO IS PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS EVALUATED BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSIDERATION WITH THE INDEPENDENT THIRD-PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2025. Form 990, Part VI, Line 1a Delegate broad authority to a committee As described in the organization's bylaws, the Executive Committee shall consist of the officers of the Board of Trustees of the Corporation and an additional trustee recommended by the Chairperson of the Board and approved by the Board. The Chairperson of the Board of Trustees shall be the Chairperson of the Executive Committee, which shall work at the direction of (and report to) the Board of Trustees, undertaking specific activities assigned to it by the full Board. The Executive Committee shall serve as a resource in the following areas: policy formulation, preparation of background material and analysis for Board deliberations, evaluation of the CEO's performance and recommendations on compensation, and other areas in which the Board requires the deliberation of the officers. The Executive Committee shall have the power to transact all regular business of the Corporation between meetings of the Board. The Executive Committee shall also perform functions of the "Executive Compensation Committee." Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE CHESHIRE MEDICAL CENTER. D-HH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF THE CHESHIRE MEDICAL CENTER'S BOARD OF TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE SOLE MEMBER HAS THE RIGHT TO RATIFY THE CHESHIRE MEDICAL CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD, APPROVE THE DISSOLUTION OR LIQUIDATION OF THE CHESHIRE MEDICAL CENTER; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS REVIEWED BY EXTERNAL TAX ADVISORS AND THE CFO BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO THE OFFICIAL FILING OF THE FORMS. Form 990, Part VI, Line 12c Conflict of interest policy CHESHIRE MEDICAL CENTER'S BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS AND TRUSTEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CURCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 15b Process to establish compensation of other employees THE EXECUTIVE COMMITTEE HAS A COMPENSATION REVIEW PROCESS TO PROVIDE AN ORDERLY STRUCTURE FOR EXECUTIVE COMPENSATION DECISIONS. ANNUALLY, THE COMMITTEE USES A MULTI-TIERED APPROACH THAT INCLUDES INDEPENDENT COMPARABILITY DATA TO GAUGE APPROPRIATE COMPARATIVE MARKET LEVELS OF COMPENSATION AND BENEFITS. AN ANNUAL PERFORMANCE EVALUATION IS BASED ON SUBJECTIVE AND OBJECTIVE CRITERIA WHICH FLOWS FROM THE ORGANIZATION'S 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, WHICH PROVIDE ALIGNMENT BETWEEN EXECUTIVE COMPENSATION AND ACHIEVEMENT OF THE HOSPITAL'S STRATEGIC INITIATIVES. DURING FY25, COMPENSATION FOR THE FOLLOWING POSITIONS WERE REVIEWED: CHIEF NURSING OFFICER, CHIEF OPERATING OFFICER, AND THE CHIEF FINANCIAL OFFICER. THE PRESIDENT OF THE MEDICAL STAFF IS PAID BY A RELATED PARTY WHO CONDUCTED A SIMILAR REVIEW. Form 990, Part VI, Line 19 Required documents available to the public THE CHESHIRE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other - Total Revenue: 420367, Related or Exempt Function Revenue: 420367, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Contracted Healthcare Services - Total Expense: 69795565, Program Service Expense: 69795565, Management and General Expenses: , Fundraising Expenses: ; Lab and Radiology Services - Total Expense: 1880028, Program Service Expense: 1880028, Management and General Expenses: , Fundraising Expenses: ; Consulting and Other Services - Total Expense: 25413614, Program Service Expense: 23502213, Management and General Expenses: 1823182, Fundraising Expenses: 88219; Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSET TRANSFERS - 4695785; Total - 4695785; Form 990, Part XII, Line 3a FINANCIAL STATEMENTS AND REPORTING THE MEDICAL CENTER WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM. DURING FISCAL YEAR 2025, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FEDERAL FUNDING WHICH MET THE MINIMUM THRESHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 . DUE TO THE NATURE OF THE CONSOLIDATED FINANCIAL STATEMENTS, THE AUDIT WAS PERFORMED ON THE FINANCIAL INFORMATION OF ALL ORGANIZATIONS, INCLUDING CHESHIRE MEDICAL CENTER. CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE NH 03431 020202220 SUPPORTING ORGANIZATION NH 501(c)(3) Type I CMC true CHESHIRE HEALTH SERVICES 580-590 COURT STREET KEENE NH 03431 473379283 HEALTHCARE NH 501(c)(3) 3 CMC true DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYSICIAN SERVICES NH 501(c)(3) 10 D-HH false DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORGANIZATION NH 501(c)(3) 7 NA false MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(c)(3) 3 D-HH false THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(c)(3) 3 D-HH false WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(c)(3) 3 D-HH false ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(c)(3) 3 D-HH false DARTMOUTH HEALTH HOME CARE INC 88 Prospect Street White River Junction VT 05001 036006494 HOSPICE VT 501(c)(3) 10 D-HH false SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 HOSPITAL VT 501(c)(3) 3 D-HH false Valley Regional Healthcare Inc 243 Elm Street Claremont NH 03743 020397338 Supporting Organization NH 501(c)(3) Type II D-HH false KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE NH 03431 020374999 REAL ESTATE HOLDING NH CMC C Corporation 0 0 1 true KEENE HEALTH REALTY 580 COURT STREET KEENE NH 03431 020374998 REAL ESTATE HOLDING NH CMC C Corporation -63827 416423 1 true KEENE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 020374997 REAL ESTATE HOLDING NH CMC C Corporation 882 1428780 1 true false false true true true false false false false true true true true true true true true true true Cheshire Health Foundation K 72000 Book Cheshire Health Foundation C 8031532 Book Cheshire Health Foundation Q 75551 Book