TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) KATHI SNOW TRUSTEE	2.00	X		0	0
(2) LARRY JAEGER MD TRUSTEE	2.00	X		0	0
(3) JAMES PUTNAM CHAIR	2.00	X	X	0	0
(4) WALTER ROHR TRUSTEE	1.00	X		0	0
(5) JAY KAHN VICE CHAIR	3.00	X	X	0	0
(6) MICHAEL NEWBOLD TRUSTEE	2.00	X		0	0
(7) JANE BEAUCHAMP TRUSTEE	2.00	X		0	0
(8) JOSEPH BERGMAN MD TRUSTEE	2.00	X		194,388	0
(9) SYLVIA MCBETH SECRETARY	2.00	X	X	0	0
(10) MATTHEW GUILTINAN MD CMC MED STAFF PRES	2.00	X		0	0
(11) JUDY KALICH TRUSTEE	2.00	X		0	0
(12) RICK CHURCH TRUSTEE	1.00	X		0	0
(13) ROBERT MUCHA TREASURER	2.00	X		0	0
(14) LESLIE PITTS MD MEDICAL DIRECTOR	2.00	X	X	0	0
(15) ARTHUR NICHOLS PRESIDENT	53.00	X	X	496,516	52,509
(16) ED BERGERON TRUSTEE	1.00	X		0	0
(17) JOSEPH HALLIDAY TRUSTEE	1.00	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
HUTTER CONSTRUCTION 130 SPIT BROOK ROAD NASHUA,NH03062	CONSTRUCTION MANAGERS	1,216,760
QUEST DIAGNOSTICS 5763 COLLECTION CENTER DRIVE CHICAGO,IL60693	LAB DIAGNOSTIC SERVICES	886,820
NEW ENGLAND MEDICAL TRANSCRIPTION PO BOX 430 WOOLWICH,ME04579	TRANSCRIPTION	624,106
MARY HITCHCOCK MEMORIAL ONE MEDICAL CENTER DR LEBANON,NH03755	LAB DIAGNOSTIC SERVICES	477,123
HEALTHSOUTH OF CONCORD 254 PLEASANT ST NASHUA,NH03301	REHAB PROGRAM MGT SVCS	390,380
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 23

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,272,819	1,081,896	190,923
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	40,964,125	34,737,578	6,226,547
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	4,709,335	3,993,516	715,819
9	Other employee benefits .......	12,505,262	10,604,462	1,900,800
10	Payroll taxes ...........	3,267,906	2,771,184	496,722
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	102,862		102,862
c	Accounting ...........	131,460		131,460
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	630,951	535,046	95,905
12	Advertising and promotion ....	322,427	322,427
13	Office expenses .......	362,157	307,109	55,048
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	6,482,116	5,496,834	985,282
17	Travel ............	188,089	188,089
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	1,237,450	1,049,358	188,092
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	7,830,568	6,640,322	1,190,246
23	Insurance ..............	1,203,491	1,020,560	182,931
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	DRUGS, CHEMICALS, SUPPL	14,931,843	14,931,843
b	CONTRACT LABOR	11,011,623	11,011,623
c	BAD DEBTS	8,757,199	8,757,199
d	MEDICAL & SURG. SUPPLIE	7,239,083	7,239,083
e	OTHER PURCHASED SERVICE	6,884,762	5,838,278	1,046,484
f	All other expenses	23,785,158	21,957,272	1,827,886
25	Total functional expenses. Add lines 1 through 24f	153,820,686	138,483,679	15,337,007	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........		1
2	Savings and temporary cash investments .......	14,984,165	2	22,641,220
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	18,778,536	4	15,478,992
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	2,251,617	8	2,207,852
9	Prepaid expenses and deferred charges ............	1,603,607	9	1,916,756
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	164,200,786
b	Less: accumulated depreciation. .....	10b	95,034,275	69,036,247	10c	69,166,511
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	11,988,185	12	12,425,042
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	5,989,355	15	3,933,183
16	Total assets. Add lines 1 through 15 (must equal line 34)...	124,631,712	16	127,769,556
	17	Accounts payable and accrued expenses .	11,798,315	17	14,175,684
18	Grants payable ..........		18
19	Deferred revenue ..........	38,831	19
20	Tax-exempt bond liabilities ..........	12,291,042	20	11,884,485
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	14,959,855	23	15,497,187
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	32,888,740	25	38,871,033
26	Total liabilities. Add lines 17 through 25.....	71,976,783	26	80,428,389
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	50,209,368	27	44,706,598
28	Temporarily restricted net assets .....	2,445,561	28	2,634,569
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	52,654,929	33	47,341,167
34	Total liabilities and net assets/fund balances .....	124,631,712	34	127,769,556

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization THE CHESHIRE MEDICAL CENTER
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization THE CHESHIRE MEDICAL CENTER
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

27,458

Total. lines 1c through 1i ...................................

27,458

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES:	PART II-B, LINE 1I:	A PORTION OF AHA & NHHA DUES ARE ALLOCATED TO LOBBYING EXPENSE

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	2,445,561	1,479,480	1,408,853
b	Contributions ........	168,756	164,317
c	Investment earnings or losses ...	299,947	1,124,611	88,740
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	279,695	322,848	18,113
f	Administrative expenses ....
g	End of year balance ......	2,634,569	2,445,561	1,479,480

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

100.000 %

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	4,058,474		4,058,474
b	Buildings ................	74,593,240	36,728,683	37,864,557
c	Leasehold improvements ............
d	Equipment ................	85,549,072	58,305,592	27,243,480
e	Other .................
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				69,166,511

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) POOLED INVESTMENTS	11,480,195	F
(B) FUNDED DEPR ACCOUNT	944,847	F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	12,425,042

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
PENSION LIABILITY		33,904,316
AMOUNTS PAYABLE TO THIRD PARTY		712,384
MISCELLANEOUS OTHER LIABILITIES		548,138
DUE TO AFFILIATES		3,706,195





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		38,871,033
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	153,728,162
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	153,820,686
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-92,524
4	Net unrealized gains (losses) on investments ..........................	4	-596,500
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8	-4,624,738
9	Total adjustments (net). Add lines 4 - 8 .............................	9	-5,221,238
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-5,313,762

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	152,586,689
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................			2e	0
3	Subtract line 2e from line 1.....................			3	152,586,689
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b	1,141,473
c	Add lines 4a and 4b.......................			4c	1,141,473
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	153,728,162

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	152,679,213
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................			2e	0
3	Subtract line 2e from line 1.....................			3	152,679,213
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b	1,141,473
c	Add lines 4a and 4b.......................			4c	1,141,473
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	153,820,686

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
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 D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 22500.0000000000 %

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	1,945	2,734,383		2,734,383	1.780 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .		16,343,984	7,239,010	9,104,974	5.920 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	1,945	19,078,367	7,239,010	11,839,357	7.700 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	16,272	2,466,971	75,741	2,391,230	1.550 %
f Health professions education (from Worksheet 5) ..	1,221	228,386	100	228,286	0.150 %
g Subsidized health services (from Worksheet 6) ..	335	242,529	9,915	232,614	0.150 %
h Research (from Worksheet 7)	50	153,597		153,597	0.100 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	5,254	301,141		301,141	0.200 %
jTotal Other Benefits ...	23,132	3,392,624	85,756	3,306,868	2.150 %
kTotal. Add lines 7d and 7j. ..	25,077	22,470,991	7,324,766	15,146,225	9.850 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	20,702	235,821		235,821	0.150 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	4,420	122,093	54,656	67,437	0.040 %
7	Community health improvement advocacy		94,428		94,428	0.060 %
8	Workforce development
9	Other
10	Total	25,122	452,342	54,656	397,686	0.250 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

3,896,954

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

974,238

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

44,635,486

Enter Medicare allowable costs of care relating to payments on line 5.....

47,785,907

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-3,150,421

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
11 KEENE HEALTH ALLIANCE	INTEGRATING HEALTH CARE SERVICES TO PROVIDE EFFECTIVE DELIVERY SYSTEM	50.000 %	0 %	0 %
23 NEW ENGLAND LIFE CARE INC	A NOT-FOR-PROFIT HOME INFUSION THERAPY COOPERATIVE.	2.000 %	0 %	0 %
34 NH LITHOTRIPSY	LITHOTRIPCY SERVICES	3.750 %	0 %	0 %
45 NH IMAGING	IMAGING SERVICES	8.330 %	0 %	0 %
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE,NH03431	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:NOT REQUIRED

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		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.
REPORTS FILED WITH STATES	PART VI, LINE 7	NH

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) JOSEPH BERGMAN MD	(i) (ii)	194,388 0	0 0	0 0	0 0	0 0	194,388 0	0 0
(2) ARTHUR NICHOLS	(i) (ii)	348,825 0	103,053 0	44,638 0	31,410 0	21,099 0	549,025 0	0 0
(3) KATHLEEN CRONIN	(i) (ii)	158,487 0	0 0	48,202 0	30,350 0	17,448 0	254,487 0	0 0
(4) JILL BATTY	(i) (ii)	222,697 0	0 0	24,900 0	26,510 0	22,099 0	296,206 0	0 0
(5) CINDI COUGHLIN	(i) (ii)	115,667 0	0 0	11,962 0	14,597 0	14,197 0	156,423 0	0 0
(6) JULIE GREEN	(i) (ii)	124,589 0	0 0	37,391 0	23,476 0	18,500 0	203,956 0	0 0
(7) PAUL PEZONE	(i) (ii)	124,991 0	0 0	20,000 0	14,461 0	18,281 0	177,733 0	0 0
(8) ERLI CHEN	(i) (ii)	180,886 0	0 0	30,008 0	22,243 0	15,509 0	248,646 0	0 0
(9) LARRY MILLER	(i) (ii)	165,682 0	0 0	21,996 0	23,375 0	17,867 0	228,920 0	0 0
(10) KRISTIN ROSSI	(i) (ii)	138,704 0	0 0	22,000 0	16,435 0	18,802 0	195,941 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
	PART I, LINE 1A	CHESHIRE MEDICAL CENTER DOES NOT REIMBURSE EXPENSES FOR FIRST CLASS TRAVEL, HOUSING ALLOWANCE, HEALTH OR SOCIAL CLUB DUES, PERSONAL SERVICES, BUSINESS USE OF PERSONAL RESIDENCE, DISCRETIONARY SPENDING ACCOUNTS, OR PROVIDE TAX INDEMNIFICATION OR GROSS UP PAYMENTS. CHESIRE MEDICAL CENTER DOES REIMBURSE BOARD MEMBERS FOR COMPANION TRAVEL TO BUSINESS RELATED MEETING UNDER SPECIFIC CIRCUMSTANCES. ALL REIMBURSEMENTS ARE REPORTED ON FORM 1099 ISSUED TO THE BOARD MEMBER. ONE REIMBURSEMENT WAS MADE IN CALENDAR YEAR 2010.
	PART I, LINE 7	SENIOR MANAGEMENT IS ELIGIBLE FOR AN INCENTIVE COMP PAYMENT AT THE DISCRETION OF THE BOARD BASED ON, BUT NOT DIRECTLY RELATED TO, OVERALL ORGANIZATIONAL FINANCIAL PERFORMANCE AND OTHER DISCRETIONARY MEASURES.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
THE CHESHIRE MEDICAL CENTER

Employer identification number
02-0354549

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	NH HEALTH & EDUCATION FACILITIES AUTHORITY	02-0279866		08-27-2009	15,000,000	REFUND COMMERCIAL DEBT, AQUISITION OF EQUIPMENT, RENOVATIONS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .
2 Amount of bonds defeased . . . .
3 Total proceeds of issue . . . .	15,000,000
4 Gross proceeds in reserve funds . .	5,667,081
5 Capitalized interest from proceeds.
6 Proceeds in refunding escrow. . . . .
7 Issuance costs from proceeds . . .	244,244
8 Credit enhancement from proceeds.
9 Working capital expenditures from proceeds . .	578,012
10 Capital expenditures from proceeds . .	8,510,663
11 Other spent proceeds . .
12 Other unspent proceeds. . .
13 Year of substantial completion . . .	2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X
15 Were the bonds issued as part of an advance refunding issue?		X
16 Has the final allocation of proceeds been made? . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .	X
2 Is the bond issue a variable rate issue?	X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?	X
b Name of provider .	TD BANK NA
c Term of hedge . .	7.000000000000
d Was the hedge superintegrated? .		X
e Was a hedge terminated? .		X
4a Were gross proceeds invested in a GIC? .		X
b Name of provider .
c Term of GIC . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .
5 Were any gross proceeds invested beyond an available temporary period? .		X
6 Did the bond issue qualify for an exception to rebate? . . .		X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Identifier	Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6		THE SOLE MEMBER OF THE CHESHIRE MEDICAL CENTER IS THE CHESHIRE HEALTH FOUNDATION
FORM 990, PART VI, SECTION A, LINE 7A		THE 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 11		COPY OF 990 IS AVAILABLE FOR ANY BOARD MEMBER TO REVIEW PRIOR TO FILING. THE BOARD HAS FORMALLY DELEGATED REVIEW OF THE 990 TO THE FINANCE AND AUDIT COMMITTEE. COMMITTEE MEMBERS RECEIVE COPIES OF THE 990 AND IT IS REVIEWED IN A MEETING PRIOR TO FILING.
	FORM 990, PART VI, SECTION B, LINE 12C	OFFICER, BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST AND ARE REQUIRED TO RECUSE THEMSELVES FROM ALL BOARD ACTIVITY RELATED TO ALL CONFLICTS.
	FORM 990, PART VI, SECTION B, LINE 15	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 C, LINE 19	CMC MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST, THROUGH ITS ANNUAL REPORT, AND THROUGH STATE AND FEDERAL FILINGS.
ALL OTHER FUNCTIONAL EXPENSES	FORM 990, PART X, LINE 24F	MEDICAID 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.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -596,500. PENSION LIABILITY ADJUSTMENT -4,624,738. TOTAL TO FORM 990, PART XI, LINE 5: -5,221,238.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THE CHESHIRE MEDICAL CENTER

Employer identification number

02-0354549

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE,NH03431 02-0202220	MANAGEMENT OF ENDOWMENT FUNDS	NH	501(C)(3)	LINE 11B, II			No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) KEENE HEALTH ALLIANCE 580 COURT STREET KEENE,NH03431 30-0179297	HEALTHCARE	NH		MEDICAL CARE	1,341,000			No		Yes		50.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) KEENE HEALTH SERVICES 580 COURT STREET KEENE,NH03431 02-0374997	INVESTMENTS REAL ESTATE	NH	CHESHIRE HEALTH FOUNDATION	C	-18,278	-4,199,176	100.000 %
(2) KEENE HEALTH REALTY 580 COURT STREET KEENE,NH03431 02-0374998	INVESTMENTS REAL ESTATE	NH	KEENE HEALTH SERVICES	C	-58,029	-762,261	100.000 %
(3) KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE,NH03431 02-0374999	INVESTMENTS REAL ESTATE	NH	KEENE HEALTH SERVICES	C			100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) CHESHIRE HEALTH FOUNDATION	C	235,647	CASH
(2) CHESHIRE HEALTH FOUNDATION	D	538,134	CASH
(3) CHESHIRE HEALTH FOUNDATION	J	72,000	CASH
(4) CHESHIRE HEALTH FOUNDATION	M	1,082,126	CASH
(5) CHESHIRE HEALTH FOUNDATION	R	5,000,000	CASH
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE PRIMARY PURPOSE OF THE CHESHIRE MEDICAL CENTER IS TO ENSURE ACCESS TO QUALITY HEALTH CARE SERVICES TO ALL RESIDENTS OF THE MONADNOCK REGION. THE ORGANIZATION'S CHARITABLE MISSION IS ENHANCED THROUGH THE OPERATION OF A JOINT OPERATING PARTNERSHIP AGREEMENT WITH THE HITCHCOCK CLINIC. THE PURPOSE OF THE JOINT OPERATING PARTNERSHIP AGREEMENT IS TO PROVIDE A MORE EXTENSIVE AND EFFECTIVE HEALTH CARE DELIVERY SYSTEM TO THE COMMUNITIES IN THE MONADNOCK REGION BY ESTABLISHING JOINT PLANNING AND DECISION MAKING PROCESSES, INTERGRATING HEALTH CARE SERVICES AND ESTABLISHING MECHANISMS FOR THE REINVESTMENT OF RESOURCES TO IMPROVE COMMUNITY HEALTH. THE FINANCIAL RESULTS OF THE JOINT OPERATING PARTNERSHIP ARE REPORTED ANNUALLY ON FORM 1065, US PARTNERSHIP RETURN OF INCOME.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	1,133
6	Total number of volunteers (estimate if necessary) ....	6	235
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	191,588
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-262,212

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	784,279	733,247
9	Program service revenue (Part VIII, line 2g) .........	153,761,651	148,687,291
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	432,176	1,029,747
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,041,232	3,277,877
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	158,019,338	153,728,162
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	58,039,730	62,719,447
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	99,301,760	91,101,239
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	157,341,490	153,820,686
19	Revenue less expenses. Subtract line 18 from line 12......	677,848	-92,524
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	124,631,712	127,769,556
21	Total liabilities (Part X, line 26)............	71,976,783	80,428,389
22	Net assets or fund balances. Subtract line 21 from line 20 .....	52,654,929	47,341,167

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 138,483,679 including grants of $ ) (Revenue $ 148,959,345 )
	THE CHESHIRE MEDICAL CENTER IS A COMMUNITY HEALTH CARE ORGANIZATION SERVING AS A REGIONAL REFERRAL CENTER FOR KEENE AND THE SURROUNDING SERVICE AREA. IT IS FULLY COMMITTED TO MEETING THE HEALTH CARE NEEDS OF THESE COMMUNITIES AND PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES AND PROGRAMS. AS A NON-PROFIT CORPORATION, THE CHESHIRE MEDICAL CENTER ACKNOWLEDGES ITS COMMITMENT TO PROVIDE SERVICES TO THE COMMUNITY. THESE SERVICES ARISE PRIMARILY FROM THE FOUR FOLLOWING GENERAL SERVICE CATEGORIES. 1) SUBSIDIZATION OF GOVERNMENT-SPONSORED HEALTHCARE PROGRAMS - PRINCIPALLY MEDICARE AND MEDICAID. 2) SPONSORSHIP AND/OR SUBSIDIZATION OF HEALTH-RELATED COMMUNITY SERVICES AND EDUCATIONAL PROGRAMS. 3) PROVISION OF HEALTHCARE AT NO CHARGE OR REDUCED CHARGE, ACCORDING TO FINANCIAL NEED. 4) PROVISION OF 24-HOUR EMERGENCY ROOM SERVICES, WITHOUT REGARD FOR ABILITY TO PAY. THE CHESHIRE MEDICAL CENTER, AS A MATTER OF POLICY AND PRACTICE HAS PROVIDED, AND WILL CONTINUE TO PROVIDE, A SIGNIFICANT CONTRIBUTION TO THE COMMUNITIES IT SERVES.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 138,483,679

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) STEVE HORTON TRUSTEE	2.00	X			0	0	0
(19) MARY LOUISE CAFFREY TRUSTEE	2.00	X			0	0	0
(20) JOHN SCHLEGELMILCH DHK MED STAFF PRES	3.00	X			0	0	0
(21) KATHLEEN CRONIN VP NURSING OPERATIONS	26.00		X		206,689	0	47,798
(22) JILL BATTY VP FINANCE, CFO	52.00		X		247,597	0	48,609
(23) CINDI COUGHLIN CNO	52.00		X		127,629	0	28,794
(24) JULIE GREEN VP HR	51.00			X	161,980	0	41,976
(25) PAUL PEZONE VP SUPPORT SERVICES	51.00			X	144,991	0	32,742
(26) ERLI CHEN PHYSICIST	50.00			X	210,894	0	37,752
(27) LARRY MILLER CHIEF CRNA	50.00			X	187,678	0	41,242
(28) KRISTIN ROSSI CRNA	50.00			X	160,704	0	35,237

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,139,066	0	366,659

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		268,467

f	All other contributions, gifts, grants, and similar amounts not included above1f		464,780
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			733,247
			Business Code
2a	PATIENT SERVICE REVENU		621,300	148,639,799	148,639,799
b	CONTRACT REVENUE		621,300	47,492	47,492
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			148,687,291
3	Investment income (including dividends, interest
	and other similar amounts).....			624,673			624,673
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	405,074
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	405,074
d	Net gain or (loss)..........			405,074			405,074
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	PHARMACY & DRUGS		621,300	1,196,036			1,196,036
b	FOOD SERVICE		621,300	933,924			933,924
c	CHILD CARE CENTER		624,410	591,649		191,588	400,061
d	All other revenue ....			556,268	272,054		284,214
e	Total. Add lines 11a–11d ......			3,277,877
12	Total revenue. See Instructions....			153,728,162	148,959,345	191,588	3,843,982


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........				1
2	Savings and temporary cash investments .......			14,984,165	2	22,641,220
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			18,778,536	4	15,478,992
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			2,251,617	8	2,207,852
9	Prepaid expenses and deferred charges ............			1,603,607	9	1,916,756
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	164,200,786
b	Less: accumulated depreciation. .....	10b	95,034,275	69,036,247	10c	69,166,511
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			11,988,185	12	12,425,042
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			5,989,355	15	3,933,183
16	Total assets. Add lines 1 through 15 (must equal line 34)...			124,631,712	16	127,769,556
17	Accounts payable and accrued expenses .			11,798,315	17	14,175,684
18	Grants payable ..........				18
19	Deferred revenue ..........			38,831	19
20	Tax-exempt bond liabilities ..........			12,291,042	20	11,884,485
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			14,959,855	23	15,497,187
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			32,888,740	25	38,871,033
26	Total liabilities. Add lines 17 through 25.....			71,976,783	26	80,428,389
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			50,209,368	27	44,706,598
28	Temporarily restricted net assets .....			2,445,561	28	2,634,569
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			52,654,929	33	47,341,167
34	Total liabilities and net assets/fund balances .....			124,631,712	34	127,769,556