Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
A For the 2020 calendar year, or tax year beginning 07-01-2020 , and ending 06-30-2021
BCheck if applicable:
CName of organization
Dartmouth-Hitchcock Clinic
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
One Medical Center Drive
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Lebanon, NH03756
D Employer identification number

22-2519596
E Telephone number

G Gross receipts $ 623,398,483
F Name and address of principal officer:
Joanne M Conroy MD
One Medical Center Drive
Lebanon,NH03756
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.dartmouth-hitchcock.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1983
M State of legal domicile: NH
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Advancing health through research, education, clinical practice, and community partnerships; providing each person the best care in the right place, at the right time, every time.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 16
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ...... 5 5,599
6 Total number of volunteers (estimate if necessary) ............. 6 193
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 645,888
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 24,093,904 74,843,390
9 Program service revenue (Part VIII, line 2g) ......... 348,577,612 407,746,462
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 94,898 995,284
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 125,967,304 139,794,708
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 498,733,718 623,379,844
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,969,949 3,877,220
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) 318,246,495 346,742,249
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet93,290    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 207,292,227 241,103,374
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 529,508,671 591,722,843
19 Revenue less expenses. Subtract line 18 from line 12....... -30,774,953 31,657,001
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 252,063,565 263,269,510
21 Total liabilities (Part X, line 26)............. 558,937,659 510,349,111
22 Net assets or fund balances. Subtract line 21 from line 20..... -306,874,094 -247,079,601
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2020)
Form 990 (2020)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: WE ADVANCE HEALTH THROUGH RESEARCH, EDUCATION, CLINICAL PRACTICE, AND COMMUNITY PARTNERSHIPS, PROVIDING EACH PERSON THE BEST CARE, IN THE RIGHT PLACE, AT THE RIGHT TIME, EVERY TIME.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 467,772,508 including grants of $ 3,877,220 ) (Revenue $ 544,548,952 )
Dartmouth-Hitchcock Clinic (DHC) is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code (Code) and is exempt from federal income taxes on related income, pursuant to Section 501(a) of the Code. DHC and its subsidiaries form a multispecialty physician practice group which operates throughout New Hampshire and Vermont and provides both medical services to patients and medical education and research. Health care services provided during fiscal year 2021 resulted in 1,340,175 office visits recorded by DHC personnel, with 332,085 unique patients served . The promotion of health through the medical practice activities of DHC provides the basis for the organization's tax-exempt status. DHC operates as an integral component of (and is fully owned by) Dartmouth-Hitchcock Health (D-HH), a New Hampshire not-for-profit corporation organized to support medical organizations like DHC. DHC provides the physician staff to a related affiliate, Mary Hitchcock Memorial Hospital (MHMH, also a fully-owned member of D-HH) and the related sophistication essential for the development and operations of the Hospital as the largest and only teaching hospital in New Hampshire and the designation by the federal government as a rural referral center for northern New England. The shared mission of DHC and MHMH is to advance health through research, education, clinical practice, and community partnerships, providing each person the best care, in the right place, at the right time, every time. Consistent with this mission, and in partnership with MHMH, DHC provides high-quality, cost-effective, comprehensive, and integrated health care to individuals, families, and the communities it serves regardless of a patient's ability to pay. DHC actively supports community-based health care, and promotes the coordination of services among health care providers and social services organizations within the regions it serves. DHC also seeks to work collaboratively with other area health care providers to improve the health status of residents in the region. DHC, MHMH, and Cheshire Medical Center (Cheshire) played key roles in the state-wide federally-funded delivery system reform incentive program (DSRIP) from 2016 - 2021. This NH program was funded from 2016 - 2020, but grant funding was able to be carried over for an additional year of interventions and all work was completed by 31st of December, 2021. Dartmouth-Hitchcock Clinic and Cheshire Medical Center co-sponsored the development of an integrated delivery network which brought health systems, community mental health centers, and social service organizations together to collaborate on improving health for Medicaid beneficiaries with mental health diseases and/or substance use disorders. While DSRIP funding has now expired, this work laid the foundation for ongoing programming and in August 2021, MHMH was awarded a HRSA grant to develop the behavioral workforce in rural New Hampshire. In addition to the alternative payment models and integrated care delivery relationships noted above, DHC has several shared risk contracts with the largest commercial insurance carriers in its market. DHC was responsible for managing the cost of care and health of approximately 100,000 members across these patient populations during fiscal year 2021. The Jack Byrne Center for Palliative & Hospice Care coordinates the clinical, education, and research efforts of DHC and Visiting Nurse alliances around the region. This effort provides much-needed end-of-life care for patients in a clinical setting that meets the needs of patients and their families. Due to increased patient demand in the southern part of New Hampshire, DHC commenced a major construction project to expand the Manchester clinic site to increase patient capacity. The 94,000 square-foot addition includes a state-of-the-art, six-room extended-stay (23-hour) ambulatory surgery center, expanded medical office space to support primary and specialty care outpatient clinics, and a fixed magnetic resonance imaging (MRI) unit, among other uses. The addition opened in the spring of 2021. DHC and MHMH jointly file an annual community benefits report with the State of New Hampshire which outlines the community and charitable benefits DHC and MHMH provide. The complete and updated community benefits reports are available upon request; these reports can also be found on the organization's website. The broad categories used in the community benefit report to summarize the benefits mentioned here include: "financial assistance" (formerly called "charity care"), which represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended June 30, 2021, DHC provided financial assistance to 17,680 patients in the amount of $11,671,808 as measured by gross charges . The cost of providing this care for the year ended June 30, 2020, was $14,971,650. DHC also routinely provides services to Medicaid patients at reimbursement levels that are well below the cost of the care provided. The uncompensated cost of care for Medicaid patients for the year ended June 30, 2021 was $45,943,615 . Community health activities include the cost or value of several different types of programs, including the cost of community-based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include Granite State Fit Kids Health Program for elementary schools, the Women's Health Resource Centers in Lebanon, NH, and Smoking Prevention and Cessation programs. This category also includes financial contributions and the contribution of time and services to community programs, hospitals, and agencies. DHC also provides a significant amount of uncompensated care to its patients that is reported as "provision for bad debts," which is not included in the amounts reported above. For the fiscal year ended June 30, 2021, DHC reported a provision for bad debts of approximately $28,230,228 .
4b (Code:   ) (Expenses $ 27,071,074 including grants of $   ) (Revenue $ 1,117,230 )
As a component of an integrated academic medical center, Dartmouth-Hitchcock Clinic (DHC) provides significant support for academic and research programs through its support of the Geisel School of Medicine at Dartmouth College (GSM). DHC provides support for physicians' unpaid teaching time as part of its community benefit initiatives, consisting of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, DHC provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to Mary Hitchcock Memorial Hospital (MHMH) and GSM. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across New Hampshire, Vermont, and beyond as well as uncompensated costs of academic and medical research activities. During fiscal year 2021, DHC continued the transition of research activities and management from GSM to DHC, under the leadership of the Vice President for Research.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet494,843,582
Form 990 (2020)
Form 990 (2020)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....Click to see attachment
15
Yes
 
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment...........
26
Yes
 
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2020)
Form 990 (2020)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
5,599
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2020)
Form 990 (2020)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
22
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
NH
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletWendy E FieldingOne Medical Center Drive   Lebanon,NH03756 (603) 650-5634
Form 990 (2020)
Form 990 (2020)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Charles G Plimpton MBA
 
Trustee/Secretary/Treasurer
 1.5
.................
2.5 		X   X       0 0 0
(2) Edward H Stansfield III MA
 
Trustee/ Chair
 0.8
.................
2.3 		X   X       0 0 0
(3) Joanne M Conroy MD
 
Trustee, Ex-Officio, CEO
 16.2
.................
39.9 		X   X       1,481,660 0 47,969
(4) Aaron J Mancuso MD
 
Trustee (eff. 6/1/21) / Physician
 28.0
.................
12.0 		X           461,261 0 53,200
(5) Carl W Dobson MD
 
Trustee (Eff. 1/1/21) / Medical Director
 0.8
.................
40.0 		X           0 465,308 55,977
(6) Cherie Holmes MD
 
Trustee (thru 12/31/20)/Physician
 12.0
.................
29.0 		X           526,558 0 45,791
(7) David P Paul
 
Trustee
 0.8
.................
0.8 		X           0 0 0
(8) Duane A Compton PHD
 
Trustee / Ex-Officio
 0.8
.................
1.7 		X           0 0 0
(9) Elof Eriksson MD PhD
 
Trustee
 0.8
.................
0.8 		X           0 0 0
(10) Gary L Freed MD
 
Trustee (Effective 1/1/21) / Physician
 28.0
.................
12.0 		X           764,624 0 29,585
(11) Geraldine Bednash PHD RN FAAN
 
Trustee (Effective 1/1/21)
 0.8
.................
0.8 		X           0 0 0
(12) Jennifer L Moyer MBA
 
Trustee
 0.8
.................
0.8 		X           0 0 0
(13) Jocelyn Chertoff MD
 
VP SRVC LN/DPT CHCR DGNSTC RAD
 12.0
.................
28.0 		X           739,732 0 46,322
(14) Jon Wahrenberger MDFAHAFAC
 
Trustee (thru 12/31/20) / Physician
 12.0
.................
28.0 		X           297,749 0 61,933
(15) JONATHAN HUNTINGTON MD PhD MPH
 
TRUSTEE (thru 5/31/21) / Academics CMO
 40.0
.................
0.5 		X           473,151 0 63,118
(16) KURT K RHYNHART MD
 
TRUSTEE/Divisional Chief of Trauma
 12.0
.................
28.0 		X           501,615 0 49,261
(17) Laura K Landy MBA
 
Trustee
 0.8
.................
1.3 		X           0 0 0
Form 990 (2020)
Form 990 (2020)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Marc B Wolpow JDMBA
 
Trustee
 0.8
.......................1.3 		X           0 0 0
(19) Mark W Begor MBA
 
Trustee
 0.8
.......................0.8 		X           0 0 0
(20) Pamela Thompson MSRNCENP
 
Trustee
 0.8
.......................1.3 		X           0 0 0
(21) Paul P Danos PHD
 
Trustee
 0.8
.......................1.3 		X           0 0 0
(22) Robert A Oden Jr PHD
 
Trustee (thru 12/31/20)
 1.5
.......................2.5 		X           0 0 0
(23) Robert SD Higgins MD
 
Trustee (Effective 1/1/21)
 0.8
.......................0.8 		X           0 0 0
(24) ROBERTA L HINES MD
 
TRUSTEE
 1.5
.......................1.5 		X           0 0 0
(25) Thomas Glynn PHD
 
Trustee (Effective 1/1/21)
 0.8
.......................0.8 		X           0 0 0
(26) Thomas Raffio
 
Trustee
 0.8
.......................0.8 		X           0 0 0
(27) William J Conaty
 
Trustee (thru 12/31/20)
 0.8
.......................1.3 		X           0 0 0
(28) Aimee M Claiborne
 
Chief HR Officer
 12.0
.......................28.0 		    X       0 469,738 59,886
(29) DANIEL P JANTZEN
 
CFO
 15.0
.......................42.0 		    X       0 795,941 60,997
(30) David Gladstone MD
 
CHF CLNCL PHYSCN - RADIOLOGY
 12.0
.......................28.0 		    X       0 380,284 58,544
(31) EDWARD MERRENS
 
Chief Clinical Officer
 12.0
.......................29.0 		    X       739,353 0 47,445
(32) JOHN KACAVAS
 
Chief Legal Officer
 12.0
.......................31.0 		    X       0 727,649 66,274
(33) Maria Padin MD
 
Chief Medical Officer
 12.0
.......................30.0 		    X       552,590 0 70,033
(34) Martin Purcell MBA
 
Chief Information Officer
 12.0
.......................28.0 		    X       0 470,064 55,569
(35) Matthew Haag
 
VP Development
 12.0
.......................28.0 		    X       0 443,871 39,136
(36) Patrick F Jordan III MBA
 
Chief Operating Officer
 15.0
.......................42.0 		    X       0 756,581 59,599
(37) Stephen Leblanc
 
Chief Strategy Officer
 12.0
.......................31.0 		    X       786,125 0 60,997
(38) Susan A Reeves EDDRN
 
Executive VP (medical center)
 12.0
.......................28.5 		    X       0 588,672 39,469
(39) Jeffrey Obrien MHA
 
KEY EMP/ VP CLINICAL OPS
 12.0
.......................28.0 		      X     0 394,484 65,285
(40) Karen Clements RNBSNMSB
 
Chief Nursing Officer
 12.0
.......................28.0 		      X     0 377,597 37,227
(41) Simon Hillier
 
Dept Chair ANESTHESIOLOGY
 12.0
.......................28.0 		      X     622,587 0 61,932
(42) Staci Hermann PHARMDMS
 
CHIEF PHARMACY OFFICER
 12.0
.......................28.0 		      X     0 300,938 29,643
(43) Daniel Stewart MD
 
Physician
 12.0
.......................28.0 		        X   1,231,971 0 63,830
(44) Jock Mccullough MD
 
Staff Physician
 12.0
.......................28.0 		        X   944,510 0 52,449
(45) John Nigriny
 
Staff Physician
 40.0
.......................0 		        X   1,047,379 0 63,333
(46) Lixia Ellis MD
 
Physician
 12.0
.......................28.0 		        X   925,709 0 53,301
(47) Timothy Ryken
 
Staff Physician
 12.0
.......................28.0 		        X   1,165,725 0 63,671
(48) Christine Schon MPA
 
FMR KEY EMP/ VP Ambulatory Care
 20.0
.......................20.5 		          X 373,374 0 53,981
(49) GEORGE T BLIKE MD
 
Former/ Chief Quality & Value Officer
 9.0
.......................22.5 		          X 400,007 0 50,140
(50) Kimberly Troland JD
 
FMR INTRM GC/DEPUTY GEN CNSL
 12.0
.......................28.0 		          X 0 435,801 43,015
(51) Peter D Solberg MD
 
Former key/Chief Health Information Officer
 12.0
.......................28.0 		          X 448,995 0 68,292
(52) Richard I Rothstein MD
 
Former Dept Chair/Srvc LN LDR - MED
 12.0
.......................28.0 		          X 684,402 0 62,209
(53) Sandra Wong MD
 
Former/ SVP SVC LN & Chair of Surgery
 12.0
.......................28.0 		          X 738,701 0 35,913
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 15,907,778 6,606,928 1,875,326
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet1,714
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2020)
Form 990 (2020)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e 56,973,742
f All other contributions, gifts, grants, and similar amounts not included above1f 17,869,648
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 74,843,390
Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 621300 407,746,462 407,746,462    
b
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 407,746,462
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 6,071   -779 6,850
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents 62,932 839,516 6a
b Less: rental expenses 5,110 7,919 6b
c Rental income or (loss) 57,822 831,597 6c
d Net rental income or (loss).......MediumBullet 889,419     889,419
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 994,823   7a
b Less: cost or other basis and sales expenses 5,610   7b
c Gain or (loss) 989,213 0 7c
d Net gain or (loss).........MediumBullet 989,213     989,213
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a CONTRACTED REVENUE 621300 108,758,132 108,111,465 646,667  
b CAFETERIA INCOME 722514 338,902     338,902
c OTHER REVENUE 621300 29,808,255 29,808,255    
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 138,905,289
12 Total revenue. See instructions.....MediumBullet 623,379,844 545,666,182 645,888 2,224,384
Form 990 (2020)
Form 990 (2020)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
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 domestic organizations and domestic governments. See Part IV, line 21 .... 3,618,856 3,618,856
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 241,123 241,123
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 17,241 17,241
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 3,657,597 886,006 2,708,321 63,270
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 1,535,183 567,984 937,179 30,020
7 Other salaries and wages........ 272,329,601 236,274,007 36,055,594  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 20,414,277 17,760,421 2,653,856  
9 Other employee benefits ....... 31,122,120 26,994,417 4,127,703  
10 Payroll taxes ........... 17,683,471 15,338,126 2,345,345  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 662,542   662,542  
c Accounting ........... 317,723   317,723  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 39,889,629 32,287,961 7,601,668 0
12 Advertising and promotion .... 960,550 19,972 940,578  
13 Office expenses ....... 7,531,094 5,575,571 1,955,523  
14 Information technology ...... 7,404,075 740,407 6,663,668  
15 Royalties ..        
16 Occupancy ........... 7,852,513 613,251 7,239,262  
17 Travel ............ 629,932 348,675 281,257  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 33,759 33,363 396  
20 Interest ........... 6,995,669 699,567 6,296,102  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 3,359,495 1,185,655 2,173,840  
23 Insurance ... 11,675,661 3,068,121 8,607,540  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 139,740,050 138,837,876 902,174  
b EQUIP REPAIR & MAINTENANCE 6,996,393 4,785,173 2,211,220  
c ACADEMIC, GME, TEACHING & SUPPORT 2,661,187 2,096,904 564,283  
d RECRUITMENT COSTS 838,918 49,211 789,707  
e All other expenses 3,554,184 2,803,694 750,490 0
25 Total functional expenses. Add lines 1 through 24e 591,722,843 494,843,582 96,785,971 93,290
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2020)
Form 990 (2020)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 6,158,147 1 0
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 45,372,368 4 57,728,406
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
161,724 5 167,353
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 2,047,228 7 1,301,911
8 Inventories for sale or use ............ 679,143 8 630,609
9 Prepaid expenses and deferred charges ......   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 126,405,153
b Less: accumulated depreciation 10b 108,789,966 18,875,363 10c 17,615,187
11 Investments—publicly traded securities . 1,224,488 11 470,236
12 Investments—other securities. See Part IV, line 11 ..... 58,812,630 12 54,894,923
13 Investments—program-related. See Part IV, line 11 .. 1,435,821 13 3,396,090
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 117,296,653 15 127,064,795
16 Total assets. Add lines 1 through 15 (must equal line 33)... 252,063,565 16 263,269,510
Liabilities 17 Accounts payable and accrued expenses ..... 241,810,363 17 262,741,134
18 Grants payable ...   18  
19 Deferred revenue ......... 13,401,173 19 0
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 7,047,317 23 2,516,936
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 296,678,806 25 245,091,041
26 Total liabilities. Add lines 17 through 25.. 558,937,659 26 510,349,111
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... -308,302,368 27 -248,853,383
28 Net assets with donor restrictions ........... 1,428,274 28 1,773,782
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... -306,874,094 32 -247,079,601
33 Total liabilities and net assets/fund balances ........ 252,063,565 33 263,269,510
Form 990 (2020)
Form 990 (2020)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
623,379,844
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
591,722,843
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
31,657,001
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
-306,874,094
5
Net unrealized gains (losses) on investments ...............
5
937,264
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
27,200,228
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
-247,079,601
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2020)
Form 990 (2020)
Additional Data


Software ID: 20011424
Software Version: 2020v4.0
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 2
Part II
Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 0 0 8,020,230 24,093,904 74,843,390 106,957,524
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 437,313,420 454,429,030 501,802,116 472,942,824 545,666,182 2,412,153,572
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge           0
6 Total. Add lines 1 through 5 437,313,420 454,429,030 509,822,346 497,036,728 620,509,572 2,519,111,096
7a Amounts included on lines 1, 2, and 3 received from disqualified persons 0 0 0 0 0 0
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. 0 0 0 0 0 0
c Add lines 7a and 7b.. 0 0 0 0 0 0
8 Public support. (Subtract line 7c from line 6.) 2,519,111,096
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
9 Amounts from line 6... 437,313,420 454,429,030 509,822,346 497,036,728 620,509,572 2,519,111,096
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 735,442 770,344 1,008,778 989,972 909,298 4,413,834
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 735,442 770,344 1,008,778 989,972 909,298 4,413,834
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. -172,489 150,042 3,882 4,453 0 -14,112
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. 424,980 425,353 485,850 421,974 338,902 2,097,059
13 Total support. (Add lines 9, 10c, 11, and 12.).. 438,301,353 455,774,769 511,320,856 498,453,127 621,757,772 2,525,607,877
14
Section C. Computation of Public Support Percentage
15
15
99.74 %
16
16
82.92 %
Section D. Computation of Investment Income Percentage
17
17
0 %
18
18
0.18 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in 11a above?
11b
 
 
c
A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2020 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2020 		(iii)
Distributable
Amount for 2020
1 Distributable amount for 2020 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2020:
a From 2015.......  
b From 2016.......  
c From 2017.......  
d From 2018.......  
e From 2019.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2020 distributable amount  
i Carryover from 2015 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2020 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2020 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2020, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2020. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2021. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2016.....  
b Excess from 2017.....  
c Excess from 2018.....  
d Excess from 2019.....  
e Excess from 2020.....  
Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A, Part III, Line 12 Other Income DESCRIPTION - , COLUMN A - 424980.0, COLUMN B - 425353.0, COLUMN C - 485850.0, COLUMN D - 421974.0, COLUMN E - 338902.0, COLUMN F - 2097059.0;
Schedule A (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
Name of organization
Dartmouth-Hitchcock Clinic
  		Employer identification number
22-2519596
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 3
Name of organization
Dartmouth-Hitchcock Clinic
  		Employer identification number

22-2519596
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 4
Name of organization
Dartmouth-Hitchcock Clinic
  		Employer identification number

22-2519596
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2020)
Additional Data


Software ID: 20011424
Software Version: 2020v4.0
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2020

Schedule C (Form 990 or 990-EZ) 2020
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2020


Schedule C (Form 990 or 990-EZ) 2020
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)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
44,114
j
Total. Add lines 1c through 1i ....................................................................................................
44,114
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LINE 1I DHC PAYS DUES TO VARIOUS ORGANIZATIONS RELATED TO ITS EXEMPT MISSION. THE AMOUNT REPORTED UNDER OTHER ACTIVITIES ON LINE 1I REFERS TO THE AMOUNT OF LOBBYING ACTIVITIES IDENTIFIED IN DUES PAYMENTS TO OUTSIDE ORGANIZATIONS.
Schedule C (Form 990 or 990EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, 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" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, 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)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 1,360,094 1,345,817 1,340,985 1,284,444 1,214,414
b Contributions ...       1,105  
c Net investment earnings, gains, and losses 368,174 28,397 61,035 55,436 72,236
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		22,736 14,120 56,203   2,206
f Administrative expenses ....          
g End of year balance ...... 1,705,532 1,360,094 1,345,817 1,340,985 1,284,444
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet41.46 %
c
Term endowment SchDMd Bullet58.54 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .......................
3a(i)
 
No
(ii) Related organizations .......................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ..... 2,505,032 7,215,859 9,720,891
b Buildings ....   72,493,046 64,616,851 7,876,195
c Leasehold improvements   27,567,760 27,559,687 8,073
d Equipment ....   16,623,456 16,613,428 10,028
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 17,615,187
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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) Public Equities Funds		    

(B) Private Equities Funds		    

(C) Hedge Funds		    

(D) Other Secuities		    

(E) INVESTMENT IN CAPTIVE - HAMDEN		 54,894,923 F
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 54,894,923
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)DHC 457(B) PLAN ASSETS 119,186,370
(2)DUE FROM AFFILIATE 4,794,033
(3)OTHER MISC ASSETS 384
(4)ESTIMATED THIRD PARTY SETTLEMENT 3,084,008
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 127,064,795
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 245,091,041
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part X, Line 2 ASC 740 (FIN 48) FOOTNOTE NO ASC 740 (FIN 48) FOOTNOTE WAS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS AS THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT OR SINCE ADOPTION.
Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE RESEARCH AND CLINICAL SUPPORT FOR THE CARDIOTHORACIC SURGERY CHAIR AT DARTMOUTH HITCHCOCK CLINIC
Schedule D (Form 990) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
Central America and the Caribbean 0 0 ,Grant to recipients located in the region   17,241
Central America and the Caribbean 0 0 Investments   61,037,494
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .... 0 0 61,054,735
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 61,054,735
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
Central America and the Caribbean PROGRAM SUPPORT 17,241 CASH      
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
1
3 Enter total number of other organizations or entities .......................MediumBullet
0
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
Schedule F, Part I, Line 2 Procedures for monitoring use of grant funds THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY.
Schedule F, Part I, Line 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE CLINIC PROVIDES UNRESTRICTED PROGRAM SUPPORT FOR CERTAIN FOREIGN ORGANIZATIONS. PROGRAM SUPPORT TO SPECIFIC ORGANIZATIONS IS CHOSEN AND DIRECTED BY THE PHYSICIANS AND/OR RESEARCHERS WORKING DIRECTLY WITH THE CHARITY.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2020
Additional Data


Software ID: 20011424
Software Version: 2020v4.0




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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number
22-2519596
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) Advance Transit
PO BOX 6834
4 WASHINGTON AVENUE
SCARBOROUGH,MN040706834 		22-2558708 501(c)3 34,377   FMV   PROGRAM SUPPORT
(2) Alice Peck Day Memorial Hospital
ATTN MATTHEW HARRIS
10 ALICE PECK DAY DRIVE
LEBANON,AZ03766 		02-0222791 501(c)3 7,250   FMV   PROGRAM SUPPORT
(3) American Cancer Society
2 COMMERCE DRIVE
SUITE 110
BEDFORD,NH03110 		13-1788491 501(c)3 11,455   FMV   PROGRAM SUPPORT
(4) Amoskeag Health
145 HOLLIS STREET
MANCHESTER,NH03101 		02-0458174 501(c)3 14,500   FMV   PROGRAM SUPPORT
(5) ATRIUM HEALTH
CAROLINAS HEALTHCARE SYSTEM
c/o THERAPEUTIC RESEARCH DEV
CHARLOTTE,NC282601979 		56-0529945 501(c)3 5,074   FMV   CHARITABLE RESEARCH
(6) BAYLOR COLLEGE OF MEDICINE
PO BOX 301207
DALLAS,TX753031207 		74-1613878 501(c)3 31,783   FMV   CHARITABLE EDUCATIONAL SERVICES
(7) BOSTON UNIVERSITY
ROOM 2B02
NEW YORK,NY100878763 		04-2103547 501(c)3 85,075   FMV   CHARITABLE RESEARCH
(8) BRIGHAM AND WOMEN'S HOSPITAL INC
75 FRANCIS ST
BOSTON,MA02115 		04-2312909 501(c)3 61,271   FMV   CHARITABLE RESEARCH
(9) CEDARS-SINAI MEDICAL CENTER
6500 WILSHIRE BLVD SUITE 1150
SPONSORED RESEARCH FUNDS ADMIN
LOS ANGELES,CA90048 		95-1644600 501(c)3 57,456   FMV   CHARITABLE RESEARCH
(10) CENTERSTONE RESEARCH INSTITUTE INC
44 VANTAGE WAY
NASHVILLE,TN37228 		26-2505456 501(c)3 74,090   FMV   CHARITABLE RESEARCH
(11) Cheshire Medical Center
580 COURT STREET
KEENE,WI03431 		02-0354549 501(c)3 123,207   FMV   PROGRAM SUPPORT
(12) CHILDREN'S HOSPITAL
PO BOX D-3053
300 LONGWOOD AVENUE
BOSTON,MA02115 		04-2774441 501(c)3 9,937   FMV   CHARITABLE RESEARCH
(13) CHILDREN'S HOSPITAL LOS ANGELES
4650 SUNSET BOULEVARD
13123 EAST 16TH AVE BOX 010
LOS ANGELES,CA90027 		19-5612191 501(c)3 7,035   FMV   CHARITABLE RESEARCH
(14) CLEVELAND CLINIC FOUNDATION
PO BOX 931562
9500 EUCLID AVE
CLEVELAND,OH44195 		34-0714585 501(c)3 13,725   FMV   CHARITABLE RESEARCH
(15) COMMONWEALTH OF MASSACHUSETTS
DEPT OF REVENUE
CHILD SUPPORT ENF DIVISION
BOSTON,MA022055140 		04-6002284 STATE OF MA 46,304   FMV   EDUCATIONAL SERVICES
(16) CREARE LLC
16 GREAT HOLLOW RD
HANOVER,NH03755 		02-0259551   6,386   FMV   CHARITABLE RESEARCH
(17) DUKE UNIVERSITY
ACCOUNTS RECEIVABLE LOCKBOX
2400 PRATT AVE STE 9100-RM9314
CHARLOTTE,NC27710 		56-0532129 501(c)3 5,828   FMV   CHARITABLE EDUCATIONAL SERVICES
(18) Families Flourish Northeast
PO BOX 20
ENFIELD CENTER,NH03801 		84-4591232 501(c)3 13,350   FMV   CHARITABLE PROGRAM SUPPORT
(19) Families in Transition
199 MANCHESTER STREET
MANCHESTER,NH03103 		02-0475414 501(c)3 13,231   FMV   PROGRAM SUPPORT
(20) FAMILY PLACE INC
319 US ROUTE 5 SOUTH
NORWICH,VT05055 		03-0305264 501(c)4 15,140   FMV   CHARITABLE PROGRAM SUPPORT
(21) Foundation for Healthy Communities (NHHA)
125 AIRPORT ROAD
CONCORD,NH03301 		02-0275078 501(c)3 424,885   FMV   PROGRAM SUPPORT
(22) Good Neighbor Health Clinic
70 NORTH MAIN STREET
WHITE RIVER JCT,OH05001 		03-0346949 501(c)3 18,850   FMV   PROGRAM SUPPORT
(23) Grafton County Senior Citizens Council
ATTN ROBERTA BERNER
PO BOX 433
LEBANON,AZ03766 		23-7248316 501(c)3 5,220   FMV   PROGRAM SUPPORT
(24) Granite United Way
22 CONCORD STREET
FLOOR 2
MANCHESTER,NH03101 		02-6006033 501(c)3 11,600   FMV   PROGRAM SUPPORT
(25) Greater Manchester Chamber of Commerce
54 HANOVER STREET
MANCHESTER,WI03101 		02-0161920 501(c)3 5,000   FMV   PROGRAM SUPPORT
(26) HARVARD UNIVERSITY
HARVARD MED-CME
PO BOX 825
BOSTON,MA021170825 		04-2103580 501(c)3 5,227   FMV   CHARITABLE EDUCATIONAL SERVICES
(27) Headrest Inc
PO BOX 74008204
CHICAGO,MN606748204 		23-7256865 501(c)3 12,035   FMV   PROGRAM SUPPORT
(28) HIVHCV Resource Center
2 BLACKSMITH ST
LEBANON,NH03766 		22-3104237 501(c)3 7,250   FMV   PROGRAM SUPPORT
(29) Listen Community Services
60 HANOVER ST
LEBANON,WI03766 		23-7225952 501(c)3 5,800   FMV   PROGRAM SUPPORT
(30) MAPS COUNSELING SERVICES
19 FEDERAL STREET
KEENE,NH03431 		02-0312473 501(c)3 7,655   FMV   CHARITABLE PROGRAM SUPPORT
(31) MASSACHUSETTS GENERAL HOSPITAL
100 CHARLES RIVER PLAZA STE 600
DEVELOPMENT OFFICE
BOSTON,MA021142792 		04-2697983 501(c)3 129,890   FMV   CHARITABLE RESEARCH
(32) MAYO CLINIC
13400 EAST SHEA BOULEVARD
PO BOX 603644
ROCHESTER,MN55903 		41-6011702 501(c)3 5,920   FMV   CHARITABLE RESEARCH
(33) MEDICAL UNIVERSITY OF SOUTH CAROLINA
COLLEGE OF NURSING AT P BONHAM
CHARLESTON,SC29407 		57-6000722 STATE OF SC 85,368   FMV   EDUCATIONAL SERVICES
(34) MEMORIAL SLOAN-KETTERING CANCER CENTER
PO BOX 27084
NEW YORK,NY100876352 		13-1924236 501(c)3 9,710   FMV   CHARITABLE RESEARCH
(35) MICHIGAN STATE UNIVERSITY
GRANTS CONTRACT ADMINISTRATION
ROOM 360
EAST LANSING,MI48824 		38-6005984 STATE OF MI 7,694   FMV   EDUCATIONAL SERVICES
(36) Monadnock Family Services
17 93RD ST
ACCOUNTS RECEIVABLE DEPT
KEENE,NJ03431 		02-6012230 501(c)3 85,450   FMV   PROGRAM SUPPORT
(37) Mt Ascutney Hospital and Health Center
ATTN MARTHA COLBURN
289 COUNTY ROAD
WINDSOR,AZ05089 		03-0183721 501(c)3 7,250   FMV   PROGRAM SUPPORT
(38) New Hampshire Business Committee for the Arts
155 DOW STREET
SUITE 402
MANCHESTER,NJ03101 		02-0397596 501(c)3 7,500   FMV   PROGRAM SUPPORT
(39) New Hampshire Charitable Foundation
215 MYRTLE STREET
MANCHESTER,NH031044354 		02-6005625 501(c)3 17,400   FMV   PROGRAM SUPPORT
(40) New Hampshire Coalition Against Domestic Violence
215 MYRTLE STREET
MANCHESTER,NH031044354 		02-0360151 501(c)3 5,800   FMV   PROGRAM SUPPORT
(41) New Hampshire Women's Foundation
18 LOW AVENUE
SUITE 205
CONCORD,GA03301 		02-0495092 501(c)3 5,075   FMV   PROGRAM SUPPORT
(42) New London Hospital
PFS- POSTING CLERKS
273 COUNTY RD
NEW LONDON,CA03257 		02-0222171 501(c)3 31,598   FMV   PROGRAM SUPPORT
(43) OHIO STATE UNIVERSITY
OFFICE OF SPONSORED PROGRAMS
1960 KENNY ROAD
COLUMBUS,OH43210 		31-6025986 STATE OF OH 5,227   FMV   EDUCATIONAL SERVICES
(44) OPEN SKY COMMUNITY SERVICES
4 MANN STREET
WORCESTER,MA01602 		04-2587863 501(c)3 7,732   FMV   CHARITABLE PROGRAM SUPPORT
(45) OREGON CLINIC PC
847 NE 19TH AVENUE
SUITE 300
PORTLAND,OR97232 		93-1127856   11,931   FMV   CHARITABLE RESEARCH
(46) OREGON HEALTH & SCIENCE UNIVERSITY
PO BOX 575
PORTLAND,OR97207 		93-1176109 501(c)3 22,275   FMV   CHARITABLE EDUCATIONAL SERVICES
(47) PROVIDENCE CENTER
528 NORTH N MAIN STREET
PROVIDENCE,RI02860 		05-0316969 501(c)3 44,716   FMV   CHARITABLE RESEARCH
(48) PUBLIC HEALTH COUNC OF THE UPPER VALLEY
ONE COURT STREET
SUITE 378
LEBANON,NH03766 		75-2991608 501(c)3 32,926   FMV   CHARITABLE PROGRAM SUPPORT
(49) RECTOR & VISITORS OF UNIV OF VIRGINIA
JOHN W STEINKE
PO BOX 801355
CHARLOTTESVILLE,VA229081355 		54-6001796 STATE OF VA 8,269   FMV   EDUCATIONAL SERVICES
(50) REGENTS OF THE UNIVERSITY OF CALIFORNIA
UCSD CAMPUS MAIN DEPOSITORY
9500 GILMAN DRIVE MC 0009
LOS ANGELES,CA920930009 		94-3067788 STATE OF CA 10,528   FMV   EDUCATIONAL SERVICES
(51) REGENTS OF UNIV OF MICHIGAN
DEPT OF PATHOLOGY BILLING
2800 PLYMOUTH ROAD
ANN ARBOR,MI48109 		38-6006309 STATE OF MI 42,070   FMV   EDUCATIONAL SERVICES
(52) RESEARCH INSTITUTE AT NATIONWIDE CHILDRE
PO BOX 781653
140 OLD ORANGEBURG ROAD BLDG 35
DETROIT,MI48278 		31-6056230 501(c)3 10,147   FMV   CHARITABLE RESEARCH
(53) RHODE ISLAND HOSPITAL
PO BOX 373
PROVIDENCE,RI02901 		05-0258954 501(c)3 20,768   FMV   CHARITABLE RESEARCH
(54) SEATTLE CHILDREN'S HOSPITAL
PO BOX 24728
SEATTLE,WA981240728 		91-0564748 501(c)3 29,504   FMV   CHARITABLE RESEARCH
(55) SEVEN COUNTIES SERVICES INC
10101 LINN STATION ROAD
2491 WEHRLE DRIVE
LOUISVILLE,KY40223 		31-0939757 501(c)3 63,832   FMV   CHARITABLE RESEARCH
(56) SINAI HOSPITAL OF BALTIMORE INC
2401 W BELVEDERE AVENUE
BALTIMORE,MD21215 		52-0486540 501(c)3 14,463   FMV   CHARITABLE RESEARCH
(57) Southeast Vermont Transit Inc
5830 NW 163RD STREET
MIAMI LAKES,WI33014 		03-0353976 501(c)3 8,700   FMV   PROGRAM SUPPORT
(58) SOUTHWESTERN COMMUNITY SERVICES INC
63 COMMUNITY WAY
63 COMMUNITY WAY
KEENE,NH03431 		02-6013808 501(c)3 11,564   FMV   CHARITABLE PROGRAM SUPPORT
(59) STANFORD UNIVERSITY
3145 PORTER DRIVE
PALO ALTO,CA94305 		94-1156365 501(c)3 15,924   FMV   CHARITABLE EDUCATIONAL SERVICES
(60) Sullivan County
14 MAIN STREET
NEWPORT,NH03773 		02-6000870 Sullivan County 18,850   FMV   PROGRAM SUPPORT
(61) TLC FAMILY RESOURCE CENTER
PO BOX 1098
CLAREMONT,NH03743 		52-2439830 501(c)3 8,590   FMV   CHARITABLE PROGRAM SUPPORT
(62) Tri-Valley Transit
DEPT 106091
PO BOX 150502
HARTFORD,VT061150502 		03-0335768 501(c)3 8,193   FMV   PROGRAM SUPPORT
(63) TRUSTEES OF DARTMOUTH COLLEGE
CASHIERS OFFICE / AR
DARTMOUTH COLLEGE
HANOVER,NH03755 		02-0222111 501(c)3 563,925   FMV   CHARITABLE EDUCATIONAL SERVICES
(64) TRUSTEES OF THE UNIV OF PENNSYLVANIA
THE WHARTON SCHOOL
LOCKBOX 9726
PHILADELPHIA,PA191789726 		23-1352685 STATE OF PA 15,652   FMV   EDUCATIONAL SERVICES
(65) Twin Pines Housing Trust
226 HOLIDAY DRIVE
SUITE 20
WHITE RIVER JCT,NH05001 		22-2809527 501(c)3 11,600   FMV   PROGRAM SUPPORT
(66) United Way of Greater Nashua
20 BROAD STREET
NASHUA,NH03064 		02-6015642 501(c)3 5,800   FMV   PROGRAM SUPPORT
(67) UNIVERSITY OF ALABAMA AT BIRMINGHAM
GRANTS CONTRACTS ACCOUNTING
ATTN CYNTHIA HELMS
BIRMINGHAM,AL352941210 		63-6005396 STATE OF AL 174,788   FMV   EDUCATIONAL SERVICES
(68) UNIVERSITY OF ARIZONA
1303 E UNIVERSITY BLVD
TUCSON,AZ857190521 		74-2652689 STATE OF AZ 5,346   FMV   EDUCATIONAL SERVICES
(69) UNIVERSITY OF COLORADO
UCHSC DNA DIAGNOSTIC LAB
MAIL STOP 8313 PO BOX 6511
AURORA,CO80045 		84-6000555 STATE OF CO 20,747   FMV   EDUCATIONAL SERVICES
(70) UNIVERSITY OF MARYLAND
ACCOUNTING AND COMPLIANCE
220 ARCH STREET OFFICE LEVEL 2
BALTIMORE,MD212011531 		52-6002033 STATE OF MD 56,489   FMV   EDUCATIONAL SERVICES
(71) UNIVERSITY OF NEBRASKA MEDICAL CTR
985100 NEBRASKA MED CTR
OMAHA,NE681985045 		47-0491233 STATE OF NE 9,744   FMV   EDUCATIONAL SERVICES
(72) UNIVERSITY OF PITTSBURGH
FORBES ALLIES BUILDING STE 300
3109 FORBES AVENUE
PITTSBURGH,PA15213 		25-0965591 STATE OF PA 25,676   FMV   EDUCATIONAL SERVICES
(73) UNIVERSITY OF ROCHESTER
SCHOOL OF NURSING
EDVANTAGE ATTN REGISTRATION
ROCHESTER,NY14642 		16-0743209 501(c)3 56,532   FMV   CHARITABLE EDUCATIONAL SERVICES
(74) UNIVERSITY OF WASHINGTON
GRANT CONTRACT ACCOUNTING
12455 COLLECTIONS DRIVE
CHICAGO,IL60693 		91-6001537 STATE OF WA 32,102   FMV   EDUCATIONAL SERVICES
(75) Upper Valley Community Nursing Project
PO BOX 1302
LEBANON,MN03766 		83-1224873 501(c)3 5,800   FMV   PROGRAM SUPPORT
(76) Upper Valley Haven
713 HARTFORD AVE
WHITE RIVER JCT,OH05001 		03-0277908 501(c)3 24,831   FMV   PROGRAM SUPPORT
(77) VINFEN CORPORATION
950 CAMBRIDGE ST
CAMBRIDGE,MA02141 		04-2632219 501(c)3 11,037   FMV   CHARITABLE PROGRAM SUPPORT
(78) VIRGINIA COMMONWEALTH UNIVERSITY
BOX 843035
RICHMOND,VA23219 		54-6001758 STATE OF VA 11,441   FMV   EDUCATIONAL SERVICES
(79) Vital Communities
195 NORTH MAIN STREET
WHITE RIVER JCT,NH05001 		03-0355283 501(c)3 7,250   FMV   PROGRAM SUPPORT
(80) Waypoint
PO BOX 448
MANCHESTER,MN031050448 		02-0222164 501(c)3 8,700   FMV   PROGRAM SUPPORT
(81) WEILL MEDICAL COLLEGE OF CORNELL UNIV
ATTN CORNELL ECHO 2001
NEW YORK,NY10021 		13-1623978 501(c)3 36,332   FMV   CHARITABLE EDUCATIONAL SERVICES
(82) West Central Behavioral Health
ATTN SUELLEN GRIFFIN
9 HANOVER STREET
LEBANON,AZ03766 		22-2645978 501(c)3 36,339   FMV   PROGRAM SUPPORT
(83) WEST VIRGINIA UNIVERSITY RESEARCH CORPOR
ONE WATERFRONT PLACE
4TH-FLOOR - PO BOX 6001
MORGANTOWN,WV265066001 		55-0665758 STATE OF WV 9,553   FMV   EDUCATIONAL SERVICES
(84) Willing Hands Enterprises
198 CHURCH STREET
NORWICH,NH05055 		20-2204811 501(c)3 8,990   FMV   PROGRAM SUPPORT
(85) Women's Information Service of the Upper Valley
PO BOX 685
CONCORD,NH03301 		02-0346512 501(c)3 5,800   FMV   PROGRAM SUPPORT
(86) YALE UNIVERSITY
ATTN HILMEL AYUSO EMERG MED
464 CONGRESS AVE SUITE 260
NEW HAVEN,CT06519 		06-0646973 501(c)3 9,505   FMV   CHARITABLE EDUCATIONAL SERVICES
(87) YMCA of Greater Nashua
33 WEST STREET
LEBANON,VT03766 		02-0222250 501(c)3 9,375   FMV   PROGRAM SUPPORT
(88) HITCHCOCK FOUNDATION
ONE MEDICAL CENTER DRIVE
LEBANON,NH03756 		02-0222139 501(c)3 204,960   FMV   Program support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
68
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
20
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) Awards and Educational Assistance 32 211,071   FMV  
(2) Patient Assistance 1305 30,052   FMV  
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH AWARD ESTABLISHED BY DARTMOUTH-HITCHCOCK CLINIC (DHC) HAS WRITTEN GUIDELINES AND PROCEDURES. AWARD PAYMENTS ARE PROCESSED IN ACCORDANCE WITH THE SPECIFIC TERMS OF EACH AWARD. THE DARTMOUTH INSTITUTE SCHOLARSHIPS (TDI) ARE PAID DIRECTLY TO DARTMOUTH COLLEGE ON BEHALF OF THE INDIVIDUALS RECEIVING THE AWARD. THE COORDINATORS OF THE PROGRAMS ARE RESPONSIBLE FOR ASSURING THAT ALL TERMS ARE MET, INCLUDING PROPER DOCUMENTATION OF EXPENSES WITH RECEIPTS.
Schedule I (Form 990) 2020



Additional Data


Software ID: 20011424
Software Version: 2020v4.0


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Joanne M Conroy MD
 
Trustee, Ex-Officio, CEO 		(i)

(ii)		 1,325,265
-------------
0 		0
-------------
0 		156,395
-------------
0 		27,315
-------------
0 		20,654
-------------
0 		1,529,629
-------------
0 		0
-------------
0
2Jocelyn Chertoff MD
 
VP SRVC LN/DPT CHCR DGNSTC RAD 		(i)

(ii)		 669,871
-------------
0 		0
-------------
0 		69,861
-------------
0 		27,315
-------------
0 		19,007
-------------
0 		786,054
-------------
0 		0
-------------
0
3Cherie Holmes MD
 
Trustee (thru 12/31/20)/Physician 		(i)

(ii)		 482,870
-------------
0 		0
-------------
0 		43,688
-------------
0 		27,315
-------------
0 		18,476
-------------
0 		572,349
-------------
0 		0
-------------
0
4Jon Wahrenberger MDFAHAFAC
 
Trustee (thru 12/31/20) / Physician 		(i)

(ii)		 272,759
-------------
0 		0
-------------
0 		24,990
-------------
0 		27,315
-------------
0 		34,618
-------------
0 		359,682
-------------
0 		0
-------------
0
5KURT K RHYNHART MD
 
TRUSTEE/Divisional Chief of Trauma 		(i)

(ii)		 461,521
-------------
0 		0
-------------
0 		40,094
-------------
0 		25,140
-------------
0 		24,121
-------------
0 		550,876
-------------
0 		0
-------------
0
6JONATHAN HUNTINGTON MD PhD MPH
 
TRUSTEE (thru 5/31/21) / Academics CMO 		(i)

(ii)		 439,781
-------------
0 		0
-------------
0 		33,370
-------------
0 		21,615
-------------
0 		41,503
-------------
0 		536,269
-------------
0 		0
-------------
0
7Carl W Dobson MD
 
Trustee (Eff. 1/1/21) / Medical Director 		(i)

(ii)		 0
-------------
406,538 		0
-------------
39,000 		0
-------------
19,770 		0
-------------
14,250 		0
-------------
41,727 		0
-------------
521,285 		0
-------------
0
8Gary L Freed MD
 
Trustee (Effective 1/1/21) / Physician 		(i)

(ii)		 700,698
-------------
0 		0
-------------
0 		63,926
-------------
0 		21,615
-------------
0 		7,970
-------------
0 		794,209
-------------
0 		0
-------------
0
9Aaron J Mancuso MD
 
Trustee (eff. 6/1/21) / Physician 		(i)

(ii)		 451,814
-------------
0 		0
-------------
0 		9,447
-------------
0 		12,969
-------------
0 		40,231
-------------
0 		514,461
-------------
0 		0
-------------
0
10Richard I Rothstein MD
 
Former Dept Chair/Srvc LN LDR - MED 		(i)

(ii)		 636,624
-------------
0 		0
-------------
0 		47,778
-------------
0 		27,315
-------------
0 		34,894
-------------
0 		746,611
-------------
0 		0
-------------
0
11Kimberly Troland JD
 
FMR INTRM GC/DEPUTY GEN CNSL 		(i)

(ii)		 0
-------------
389,097 		0
-------------
0 		0
-------------
46,704 		0
-------------
21,615 		0
-------------
21,400 		0
-------------
478,816 		0
-------------
0
12Aimee M Claiborne
 
Chief HR Officer 		(i)

(ii)		 0
-------------
420,621 		0
-------------
0 		0
-------------
49,117 		0
-------------
21,615 		0
-------------
38,271 		0
-------------
529,624 		0
-------------
0
13DANIEL P JANTZEN
 
CFO 		(i)

(ii)		 0
-------------
694,897 		0
-------------
0 		0
-------------
101,044 		0
-------------
27,315 		0
-------------
33,682 		0
-------------
856,938 		0
-------------
0
14Patrick F Jordan III MBA
 
Chief Operating Officer 		(i)

(ii)		 0
-------------
707,368 		0
-------------
0 		0
-------------
49,213 		0
-------------
21,615 		0
-------------
37,984 		0
-------------
816,180 		0
-------------
0
15JOHN KACAVAS
 
Chief Legal Officer 		(i)

(ii)		 0
-------------
609,953 		0
-------------
0 		0
-------------
117,696 		0
-------------
27,315 		0
-------------
38,959 		0
-------------
793,923 		0
-------------
0
16Stephen Leblanc
 
Chief Strategy Officer 		(i)

(ii)		 683,250
-------------
0 		0
-------------
0 		102,875
-------------
0 		27,315
-------------
0 		33,682
-------------
0 		847,122
-------------
0 		0
-------------
0
17EDWARD MERRENS
 
Chief Clinical Officer 		(i)

(ii)		 662,631
-------------
0 		0
-------------
0 		76,722
-------------
0 		27,315
-------------
0 		20,130
-------------
0 		786,798
-------------
0 		0
-------------
0
18Maria Padin MD
 
Chief Medical Officer 		(i)

(ii)		 467,964
-------------
0 		45,000
-------------
0 		39,626
-------------
0 		27,315
-------------
0 		42,718
-------------
0 		622,623
-------------
0 		0
-------------
0
19Susan A Reeves EDDRN
 
Executive VP (medical center) 		(i)

(ii)		 0
-------------
553,593 		0
-------------
250 		0
-------------
34,829 		0
-------------
0 		0
-------------
39,469 		0
-------------
628,141 		0
-------------
0
20Martin Purcell MBA
 
Chief Information Officer 		(i)

(ii)		 0
-------------
420,780 		0
-------------
0 		0
-------------
49,284 		0
-------------
27,315 		0
-------------
28,254 		0
-------------
525,633 		0
-------------
0
21David Gladstone MD
 
CHF CLNCL PHYSCN - RADIOLOGY 		(i)

(ii)		 0
-------------
326,374 		0
-------------
0 		0
-------------
53,910 		0
-------------
27,315 		0
-------------
31,229 		0
-------------
438,828 		0
-------------
0
22Matthew Haag
 
VP Development 		(i)

(ii)		 0
-------------
375,989 		0
-------------
38,660 		0
-------------
29,222 		0
-------------
21,615 		0
-------------
17,521 		0
-------------
483,007 		0
-------------
0
23GEORGE T BLIKE MD
 
Former/ Chief Quality & Value Officer 		(i)

(ii)		 344,982
-------------
0 		0
-------------
0 		55,025
-------------
0 		27,315
-------------
0 		22,825
-------------
0 		450,147
-------------
0 		0
-------------
0
24Christine Schon MPA
 
FMR KEY EMP/ VP Ambulatory Care 		(i)

(ii)		 341,947
-------------
0 		0
-------------
0 		31,427
-------------
0 		27,315
-------------
0 		26,666
-------------
0 		427,355
-------------
0 		0
-------------
0
25Peter D Solberg MD
 
Former key/Chief Health Information Officer 		(i)

(ii)		 423,124
-------------
0 		0
-------------
0 		25,871
-------------
0 		27,315
-------------
0 		40,977
-------------
0 		517,287
-------------
0 		0
-------------
0
26Sandra Wong MD
 
Former/ SVP SVC LN & Chair of Surgery 		(i)

(ii)		 679,177
-------------
0 		0
-------------
0 		59,524
-------------
0 		21,615
-------------
0 		14,298
-------------
0 		774,614
-------------
0 		0
-------------
0
27Karen Clements RNBSNMSB
 
Chief Nursing Officer 		(i)

(ii)		 0
-------------
349,699 		0
-------------
250 		0
-------------
27,648 		0
-------------
21,615 		0
-------------
15,612 		0
-------------
414,824 		0
-------------
0
28Staci Hermann PHARMDMS
 
CHIEF PHARMACY OFFICER 		(i)

(ii)		 0
-------------
277,779 		0
-------------
0 		0
-------------
23,159 		0
-------------
12,959 		0
-------------
16,684 		0
-------------
330,581 		0
-------------
0
29Simon Hillier
 
Dept Chair ANESTHESIOLOGY 		(i)

(ii)		 569,192
-------------
0 		0
-------------
0 		53,395
-------------
0 		27,315
-------------
0 		34,617
-------------
0 		684,519
-------------
0 		0
-------------
0
30Jeffrey Obrien MHA
 
KEY EMP/ VP CLINICAL OPS 		(i)

(ii)		 0
-------------
366,117 		0
-------------
0 		0
-------------
28,367 		0
-------------
27,315 		0
-------------
37,970 		0
-------------
459,769 		0
-------------
0
31Lixia Ellis MD
 
Physician 		(i)

(ii)		 906,029
-------------
0 		0
-------------
0 		19,680
-------------
0 		11,400
-------------
0 		41,901
-------------
0 		979,010
-------------
0 		0
-------------
0
32Jock Mccullough MD
 
Staff Physician 		(i)

(ii)		 858,543
-------------
0 		0
-------------
0 		85,967
-------------
0 		27,315
-------------
0 		25,134
-------------
0 		996,959
-------------
0 		0
-------------
0
33Daniel Stewart MD
 
Physician 		(i)

(ii)		 1,126,597
-------------
0 		0
-------------
0 		105,374
-------------
0 		21,615
-------------
0 		42,215
-------------
0 		1,295,801
-------------
0 		0
-------------
0
34John Nigriny
 
Staff Physician 		(i)

(ii)		 962,629
-------------
0 		0
-------------
0 		84,750
-------------
0 		21,615
-------------
0 		41,718
-------------
0 		1,110,712
-------------
0 		0
-------------
0
35Timothy Ryken
 
Staff Physician 		(i)

(ii)		 1,072,353
-------------
0 		0
-------------
0 		93,372
-------------
0 		21,615
-------------
0 		42,056
-------------
0 		1,229,396
-------------
0 		0
-------------
0
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part II NOTE REGARDING COMPENSATION SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY DHC AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY D-H ON BEHALF OF ITS EMPLOYEES.
Schedule J, Part I, Line 3 ESTABLISHING COMPENSATION CEO The process for determining compensation of the CEO is the responsibility of the Compensation Committee of Dartmouth Hitchcock Health (DHH). The compensation committee consists of the Chairperson of the Board and three or more members of the board who are elected by the board, acting upon the recommendation of the chairperson and are not employees of DHH, a related organization or a subsidiary organization of a related organization. The compensation committee determines the compensation of the CEO of DHC within ranges established by the board.
Schedule J, Part I, Line 1a Health or social club dues or initiation fees THE ORGANIZATION HAS IN PLACE A MANAGEMENT SELF DEVELOPMENT PLAN (MSDP) DESIGNED TO PROMOTE PROFESSIONAL AND PERSONAL DEVELOPMENT. THE MSDP IS CAPPED AT 2% OF GROSS PAY AND MAY BE UTILIZED FOR EXPENSES SUCH AS PROFESSIONAL DUES, MEETINGS AND SEMINARS, TUITION REIMBURSEMENT, AND OTHER MISCELLANEOUS ITEMS THAT PROMOTE PROFESSIONAL KNOWLEDGE. THE MONIES MAY ALSO BE USED FOR UP TO A 50% REIMBURSEMENT OF THE COST OF A FITNESS/WELLNESS PROGRAM DESIGNED TO MAINTAIN THE HEALTH OF MANAGEMENT PERSONNEL. ALL EXPENSES ARE SUBMITTED FOR APPROVAL BEFORE REIMBURSEMENT.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Dartmouth Hitchcock Clinic (DHC) and Mary Hitchcock Memorial Hospital (MHMH) sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC and MHMH to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen to new participants in 1998. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization. THE FOLLOWING INDIVIDUALS HAVE A SPLIT DOLLAR LIFE PLAN ARRANGEMENT AND RESPECTIVE EMPLOYER PREMIUMS: DANIEL JANTZEN $135,240 STEPHEN LEBLANC $61,630 RICHARD ROTHSTEIN $105,722
Schedule J (Form 990) 2020

Additional Data


Software ID: 20011424
Software Version: 2020v4.0
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
(1) Stephen Leblanc
  		Officer Split Dollar Life   X 0 61,630   No Yes   Yes  
(2) Richard Rothstein
  		Former Officer Split Dollar Life   X 0 105,723   No Yes   Yes  
Total ...............Small Bullet $ 167,353
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2020
Schedule L (Form 990 or 990-EZ) 2020
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Amy Stansfield
  		Family member of Trustee Ed Stansfield 189,213 Employment Compensation   No
(2) Patrick J O'Brien
  		Family member of Trustee Jeff O'Brien 51,301 Employment compensation   No
(3) James Ebert
  		Family member of an officer Maria Padin 58,000 Employment compensation   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0




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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Return Reference Explanation
Form 990, Part VI, Line 1a Delegate broad authority to a committee The DARTMOUTH-HITCHCOCK CLINIC (DHC) board has a Governance Committee who has the authority/responsibility of the DHC Board to ensure that DHC continues to fulfill its central mission and vision. This committee has authority to act on behalf of the full Board when the need arises. Members include the following who are all members of the governing board: Edward H. Stansfield, III, MA (Board Chair and Chair of Governance Committee) Jennifer L. Moyer, MBA (Chair - Talent Development and Compensation Committee) Roberta L. Hines, MD (Chair - Research and Education Committee) Charles G. Plimpton, MBA (Chair- Finance Committee) Pamela A. Thompson, MS, RN, CENP, FAAN (Chair - Value Committee) Ex Officio member: Dr. Joanne Conroy (CEO)
Form 990, Part VI, Line 6 Classes of members or stockholders DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D- HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF DARTMOUTH-HITCHCOCK CLINIC (DHC). D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING THE POWER TO CONFIRM THE ELECTION OF MEMBERS OF DHC'S BOARD OF TRUSTEES AND THE POWER TO APPROVE SIGNIFICANT GOVERNANCE, FINANCIAL AND OPERATIONAL DECISIONS OF DHC'S TRUSTEES.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders IN ADDITION TO RESERVED POWERS, DARTMOUTH-HITCHCOCK HEALTH (D-HH) SHALL HAVE THE AUTHORITY TO TAKE ACTIONS TO ESTABLISH, MANAGE, AND GOVERN THE SYSTEM AS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN FURTHERANCE OF DHC'S MISSION. THESE POWERS INCLUDE BUT ARE NOT LIMITED TO ITEMS SUCH AS THE ABILITY TO APPROVE, DISAPPROVE, OR MODIFY ALL MATERIAL GOVERNANCE, PROGRAMMATIC, AND FINANCIAL DECISIONS OF DHC'S BOARD OF TRUSTEES, TO APPOINT OR REMOVE A MEMBER OF DHC'S BOARD OF TRUSTEES, ASSESS DHC A MONETARY AMOUNT FOR THE PAYMENT OF THE EXPENSES OF D-HH, APPROVE DHC'S BUDGET, APPROVE THE BORROWINGS OR DISPOSITIONS OF ASSETS BY DHC, APPROVE KEY STRATEGIC RELATIONSHIPS, APPROVE THE ELIMINATION OR ADDITION OF ANY MATERIAL HEALTH CARE SERVICE OR PROGRAM, AND OTHER AUTHORITY TO TAKE ACTION ON BEHALF OF DHC.
Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORMS 990 AND 990-T ARE REVIEWED BY THE DIRECTOR OF FINANCIAL COMPLIANCE, VICE PRESIDENT OF CORPORATE FINANCE, AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. ONCE THE RETURN HAS BEEN FULLY PREPARED, A FINAL 990 AND 990-T IS SENT TO EACH BOARD MEMBER AND TIME IS ALLOCATED FOR COMMENTS AND RESPONSES PRIOR TO OFFICIAL FILING OF THE FORMS.
Form 990, Part VI, Line 12c Conflict of interest policy THE DARTMOUTH-HITCHCOCK CLINIC (DHC) BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. DARTMOUTH-HITCHCOCK HEALTH'S COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL INVOLVED MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION FOR THE CEO IS EVALUATED BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS AND NATIONAL DATA BENCHMARKING. THE TALENT DEVELOPMENT AND COMPENSATION COMMITTEE, ALONG WITH INDEPENDENT TRUSTEES, APPROVE THE FINAL COMPENSATION IN CONSULTATION WITH THE INDEPENDENT THIRD PARTY FIRM'S RECOMMENDATIONS AND SUGGESTIONS. THIS PROCESS WAS CONTEMPORANEOUSLY DOCUMENTED AND LAST UNDERTAKEN IN 2021.
Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR OFFICERS AND KEY EMPLOYEES ARE EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA, ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS, WITH THE LAST FORMAL PROCESS IN 2021. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. THE PROCESS DESCRIBED ABOVE TO ESTABLISH COMPENSATION WAS USED FOR THE FOLLOWING POSITIONS: Chief Financial Officer, Chief Strategy Officer, Chief Clinical Officer, Chief Legal Officer, Chief Human Resources Officer, Chief Operating Officer, Chief Nursing - Executive, Chief Nursing Officer, Chief Pharmacy Officer, Chief Quality & Value Officer, Department Chair - Anesthesia, Department Chair - Pathology, and similar positions.
Form 990, Part VI, Line 19 Required documents available to the public DHC'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE NEW HAMPSHIRE SECRETARY OF STATE. CERTAIN FINANCIAL INFORMATION IS DISCLOSED THROUGH THE COMMUNITY BENEFITS ANNUAL REPORT. THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST EITHER IN ELECTRONIC OR HARD COPY FORM.
Form 990, Part VII, Section A, Line 1a, Column (B) AVERAGE HOURS PER WEEK AS PART OF DARTMOUTH-HITCHCOCK CLINIC'S (DHC) AND MARY HITCHCOCK MEMORIAL HOSPITAL'S (MHMH) AFFILIATION AGREEMENT, THE TWO ORGANIZATIONS SHARE OFFICERS. AS SUCH, THE AVERAGE HOURS PER WEEK ARE ALLOCATED BETWEEN THE TWO ORGANIZATIONS ON THEIR FORM 990'S EVEN THOUGH COMPENSATION REPORTED IN PART VII IS BASED ON THE ENTITY ISSUING THE W-2. IN ADDITION, CERTAIN OFFICERS SPEND TIME ON DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH MHMH AND DHC, ALONG WITH TWO SUPPORTING ORGANIZATIONS: DARTMOUTH-HITCHCOCK MEDICAL CENTER (DHMC) AND HAMDEN RISK RETENTION GROUP (HAMDEN). CERTAIN OFFICERS ALSO SPEND TIME ON RELATED ENTITIES, INCLUDING ALICE PECK DAY MEMORIAL HOSPITAL (APD), WINDSOR HOSPITAL CORPORATION (DBA MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER) (MAHHC), MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION, HISTORIC HOMES OF RUNNEMEDE, CHESHIRE MEDICAL CENTER (CHESHIRE), CHESHIRE HEALTH FOUNDATION, CHESHIRE HEALTH SERVICES, THE NEW LONDON HOSPITAL ASSOCIATION (NLH), VISITING NURSE ASSOCIATION & HOSPICE OF VT AND NH (VNA), AND THE HITCHCOCK FOUNDATION (THC).
Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS DARTMOUTH-HITCHCOCK CLINIC (DHC) IS PART OF THE DARTMOUTH-HITCHCOCK HEALTH (D-HH) SYSTEM, WHICH INCLUDES DHC, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH), AND ITS SUBSIDIARIES. MHMH RECEIVED AUTHORITY FROM THE INTERNAL REVENUE SERVICE TO ACT AS DHC'S PAY AGENT AND IMPLEMENTED THIS PROCESS AT THE BEGINNING OF FISCAL YEAR 2010. ALL EXPENSES ARE PAID DIRECTLY BY MHMH AND REIMBURSED BY DHC. MHMH MANAGES ALL REQUIRED IRS REPORTING RELATED TO THESE DISBURSEMENTS.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Column (A) STATEMENT OF FUNCTIONAL EXPENSES MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC) OPERATE UNDER AN AFFILIATION AGREEMENT AS DIRECTED BY DARTMOUTH-HITCHCOCK HEALTH (D-HH), THE SOLE CORPORATE MEMBER OF BOTH ENTITIES. DUE TO THE INTEGRATED OPERATING STRUCTURE, RELATED MISSION, AND CLOSE RELATIONSHIP OF DHC AND MHMH, EXPENSES ARE SHARED BETWEEN THE TWO ENTITIES. ALL EXPENSES REPORTED WITHIN THIS FORM 990 ARE DHC'S SHARE OF EXPENSES AS DESIGNATED BY THE AFFILIATION AGREEMENT.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances PENSION RELATED AND OTHER CHARGES - 27222964; NET ASSET RELEASED FROM RESTRICTED - -22736;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Dartmouth-Hitchcock Clinic
 
Employer identification number

22-2519596
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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
(1) RENAISSANCE PSYCHIATRY OF NEW ENGLAND
ONE MEDICAL CENTER DRIVE
LEBANON,NH03756
81-3076466 		PSYCHIATRY SERVICES NH 180,074 392,820 D-HC
 










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 entity?
Yes No
(1)MARY HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVE

LEBANON,NH03756
02-0222140 		HOSPITAL NH 501(c)(3) 3 D-HH
 
 
No
(2)HITCHCOCK FOUNDATION
ONE MEDICAL CENTER DRIVE

LEBANON,NH03756
02-0222139 		HeaLTH CaRE ReSeaRCH NH 501(c)(3) 7 DHC
 
Yes
 
(3)HAMDEN ASSURANCE RISK RETENTION GROUP INC
30 MAIN STREET STE 330

BURLINGTON,VT05401
20-8530788 		SELF INSURANCE VT 501(c)(3) Type I DHC
 
Yes
 
(4)DARTMOUTH-HITCHCOCK HEALTH
ONE MEDICAL CENTER DRIVE

LEBANON,NH03756
26-4812335 		PARENT ORGANIZATION NH 501(c)(3) 7 NA
 
 
No
(5)THE NEW LONDON HOSPITAL ASSOCIATION INC
273 COUNTY ROAD

NEW LONDON,NH03257
02-0222171 		HOSPITAL NH 501(c)(3) 3 D-HH
 
 
No
(6)WINDSOR HOSPITAL CORPORATION
289 COUNTY ROAD

WINDSOR,VT05089
03-0183721 		HOSPITAL VT 501(c)(3) 3 D-HH
 
 
No
(7)CHESHIRE MEDICAL CENTER
580 COURT STREET

KEENE,NH03431
02-0354549 		HOSPITAL NH 501(c)(3) 3 D-HH
 
 
No
(8)ALICE PECK DAY MEMORIAL HOSPITAL
10 ALICE PECK DAY DRIVE

LEBANON,NH03766
02-0222791 		HOSPITAL NH 501(c)(3) 3 D-HH
 
 
No
(9)Visiting Nurse Association AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC
88 Prospect Street

White River Junction,VT05001
03-6006494 		HOSPICE VT 501(c)(3) 10 D-HH
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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 V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) POMPANOOSUC INVESTMENT CORPORATION

ONE MEDICAL CENTER DRIVE
LEBANON,NH03756
02-0352330 		REAL ESTATE HOLDING NH DHC
  		C Corporation -124 75,632 100 % Yes  
(2) HAMDEN ASSURANCE CO LTD

 
 
98-0121409 		LIABILITY INSURANCE BD DHC
  		C Corporation 0 50,383,987 70.2 % Yes  










Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
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, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Hitchcock Foundation

 O 302,215 FMV
(2) Hitchcock Foundation

 Q 52,724 FMV
(3) HAMDEN ASSURANCE RISK RETENTION GROUP INC

 M 5,542,222 FMV
(4) Hitchcock Foundation

 S 114,397 FMV
(5) Hitchcock Foundation

 B 204,960 FMV
(6) Hitchcock Foundation

 C 13,027 FMV
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2020

Additional Data


Software ID: 20011424
Software Version: 2020v4.0