4A (Expenses $ 1380381588 including grants of $ 9644188) (Revenue $ 1553570776)
"MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IS AN ACUTE AND TERTIARY CARE TEACHING HOSPITAL LOCATED IN LEBANON, NEW HAMPSHIRE. MHMH PROVIDES A BROAD RANGE OF PATIENT SERVICES AND HEALTH-RELATED COMMUNITY SERVICES, CONSISTENT WITH ITS ROLE AS A MAJOR TEACHING HOSPITAL, A TERTIARY CARE REFERRAL HOSPITAL, AND AS A PROSPECTIVE PAYMENT SYSTEM HOSPITAL (AS DEFINED BY CMS). MHMH PROVIDES A FULL RANGE OF SERVICES IN BOTH ACUTE AND CRITICAL MEDICINE, SURGERY, PSYCHIATRY AND REHABILITATION FOR INFANTS, CHILDREN AND ADULTS. DURING FY 2022, MHMH PROVIDED 134,900 ACUTE PATIENT DAYS OF INPATIENT SERVICE AND HAD 25,200 TOTAL ACUTE CARE DISCHARGES, WHILE MHMH'S EMERGENCY ROOM WAS OPEN TO THE PUBLIC 24 HOURS PER DAY, 7 DAYS PER WEEK AND HAD 29,743 DISCHARGES. DARTMOUTH-HITCHCOCK CLINIC (DHC) PROVIDES THE PHYSICIAN STAFF FOR THE HOSPITAL AND THE SOPHISTICATION ESSENTIAL FOR THE DEVELOPMENT 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 MHMH AND DHC 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 DHC, MHMH 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. THROUGH FORMAL AFFILIATIONS AND OTHER CLINICAL COLLABORATIONS, MHMH ALSO SEEKS TO PARTNER WITH OTHER AREA HEALTH CARE PROVIDERS TO IMPROVE THE HEALTH STATUS OF THE REGION. THE JACK BYRNE CENTER FOR PALLIATIVE & HOSPICE CARE COORDINATES MHMH'S CLINICAL, EDUCATIONAL, AND RESEARCH EFFORTS AND VISITING NURSE ALLIANCES AROUND THE REGION TO OFFER MUCH-NEEDED END-OF-LIFE CARE FOR PATIENTS IN A CLINICAL SETTING THAT MEETS THE NEEDS OF PATIENTS AND THEIR FAMILIES. MHMH ALSO CONTINUES TO BUILD ITS TELE-MEDICINE PROGRAM TO PROVIDE CARE ACROSS ITS RURAL REGION AND IN PARTICULAR TO MAKE SPECIALIST CONSULTATION AND CARE AVAILABLE TO CRITICAL ACCESS AND COMMUNITY HOSPITALS. THIS ALLOWS CAREGIVERS AT REMOTE LOCATIONS TO ACCESS SPECIALISTS AT MHMH AND DHC AND TO BRING THEM ""VIRTUALLY"" TO THE PATIENT'S BEDSIDE. MHMH'S CONNECTED CARE CENTER FOR TELE-HEALTH IN LEBANON OFFERS A 24/7 TEAM OF PHYSICIANS, PHARMACISTS, AND NURSES SUPPORTING THE FOLLOWING ACUTE CARE TELE-HEALTH SERVICE LINES: TELE-EMERGENCY, TELE-PHARMACY, TELE-NEUROLOGY, TELE-ICU, TELE-PSYCHIATRY, AND TELE-NEONATOLOGY; OUTPATIENT TELE-URGENT CARE 7 DAYS/WEEK; AND OUTPATIENT VIRTUAL VISITS IN PEDIATRICS AND MORE THAN 30 SPECIALTY SERVICES TO PATIENTS IN 17 CLINICAL LOCATIONS ALONG WITH PATIENT HOMES. MHMH SERVED AS ONE OF THE LEAD ORGANIZATIONS 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. MHMH HAS ALSO PARTNERED WITH COLBY-SAWYER COLLEGE TO PROVIDE NURSING EDUCATION TO BOTH COLBY-SAWYER STUDENTS AND TO MHMH STAFF. MHMH ALSO SPONSORS NUMEROUS TRAINING PROGRAMS THROUGH THE WORKFORCE READINESS INSTITUTE, A DEPARTMENT OF MHMH FOCUSED ON PROVIDING TRAINING PATHWAYS FOR ENTRY-LEVEL STAFF TO GAIN THE NECESSARY EDUCATION AND CERTIFICATIONS TO MOVE INTO HIGHER-PAYING ROLES. ALONG WITH PROVIDING FLU CLINICS TO BRING VACCINATIONS TO AREA COMMUNITIES, MHMH ALSO CREATED A COMMUNITY COVID TESTING AND VACCINATION CENTER DURING THE LATTER PART OF FY '20 WHICH REMAINED ACTIVE THROUGHOUT FY22. ADDITIONALLY, MHMH AND DHC HAVE SERVED BOTH THE STATE OF NEW HAMPSHIRE AND AREA COMMUNITIES AS ""SUBJECT MATTER EXPERTS"" DURING THE COVID PANDEMIC. DURING FY '20, MHMH COMMENCED CONSTRUCTION OF A NEW PATIENT PAVILION, EXPANDING ITS CURRENT IN-PATIENT CAPACITY AT THE LEBANON CAMPUS. (FOR THE PREVIOUS THREE YEARS, MHMH HAS TURNED AWAY ALMOST 2,500 PATIENTS PER YEAR BECAUSE THE HOSPITAL WAS AT FULL CAPACITY DURING THE PATIENTS' TIME OF NEED.) EXPECTED TO BE COMPLETED EARLY IN FY '23, THE PROJECT WILL COST IN EXCESS OF $100 MILLION AND WILL EXPAND IN-PATIENT CAPACITY TO MORE FULLY MEET THE ACUTE-CARE NEEDS OF THE REGION. MHMH AND DHC JOINTLY FILE AN ANNUAL COMMUNITY BENEFITS REPORT WITH THE STATE OF NEW HAMPSHIRE WHICH OUTLINES THE COMMUNITY AND CHARITABLE BENEFITS MHMH AND DHC PROVIDE. THE MOST RECENT COMMUNITY BENEFITS REPORT IS AVAILABLE BY REQUEST. FINANCIAL ASSISTANCE (FORMERLY CALLED ""CHARITY CARE"") 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, 2022, MHMH PROVIDED FINANCIAL ASSISTANCE TO 15,142 PATIENTS IN THE AMOUNT OF $18,315,700 AS MEASURED BY GROSS CHARGES. THE COST OF PROVIDING THIS CARE FOR THE YEAR ENDED JUNE 30, 2021 WAS $15,768,823. MHMH ALSO ROUTINELY PROVIDES SERVICES TO MEDICAID PATIENTS AT REIMBURSEMENT LEVELS THAT ARE BELOW THE COST OF THE CARE PROVIDED. THE COMMUNITY HEALTH ACTIVITIES NOTED 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 PARTNERING WITH THE HEALTHY EATING ACTIVE LIVING NH INITIATIVE, THE WOMEN'S HEALTH RESOURCE CENTER, AND SMOKING PREVENTION AND CESSATION. THIS CATEGORY OF SUPPORT ALSO INCLUDES FINANCIAL CONTRIBUTIONS AND THE CONTRIBUTION OF TIME AND SERVICES TO COMMUNITY PROGRAMS, HOSPITALS AND AGENCIES. MHMH ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO ITS PATIENTS THAT IS REPORTED AS PROVISION FOR BAD DEBT, WHICH IS NOT INCLUDED IN THE AMOUNTS REPORTED ABOVE. DURING THE YEAR ENDED JUNE 30, 2022, THE HOSPITAL REPORTED A PROVISION FOR BAD DEBT OF $58,192,436."

4B (Expenses $ 93385645 including grants of $ 0) (Revenue $ 62542063)
AS A COMPONENT OF NEW HAMPSHIRE'S ONLY INTEGRATED ACADEMIC MEDICAL CENTER, MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) PROVIDES THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH (GSM) SUPPORT FOR PHYSICIANS' UNPAID TEACHING TIME AS PART OF ITS COMMUNITY BENEFIT INITIATIVES. THIS SUPPORT CONSISTS OF THE TIME PHYSICIANS SPEND PROVIDING CLINICAL SUPERVISION AND EDUCATION FOR RESIDENTS AND MEDICAL STUDENTS. IN ADDITION, THE HOSPITAL 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 DARTMOUTH-HITCHCOCK CLINIC (DHC) 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.

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WHICH ARE IDENTIFIED THROUGH CHNA.

Schedule H, Part V, Section B, Line 5 Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) AND DARTMOUTH-HITCHCOCK CLINIC (DHC, COLLECTIVELY KNOWN AS D-H) ARE ACTIVELY ENGAGED IN THE DEVELOPMENT OF THE UPPER VALLEY REGIONAL PUBLIC HEALTH ADVISORY COUNCIL AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL (WITH 60+ COMMUNITY REPRESENTATIVES). MEMBERS OF THESE TWO COMMUNITY HEALTH ADVISORY GROUPS HAVE HAD THE OPPORTUNITY TO REVIEW AND COMMENT ON DRAFTS OF DARTMOUTH-HITCHCOCK'S COMMUNITY HEALTH IMPROVEMENT PLAN. THE PLAN DOCUMENT HAS ALSO BEEN CIRCULATED TO PUBLIC HEALTH OFFICIALS IN NEW HAMPSHIRE AND VERMONT FOR THEIR COMMENT. IN ADDITION, DARTMOUTH-HITCHCOCK REPRESENTATIVES SERVE ON NUMEROUS BOARDS, TASK FORCES, MUNICIPAL HEALTH LEADERSHIP AND PLANNING TEAMS, AND OTHER COMMUNITY HEALTH LEADERSHIP ENTITIES IN ORDER TO ENSURE THAT BOTH ORGANIZATIONS PARTICIPATE IN AND BETTER-UNDERSTAND THE NEEDS OF OUR COMMUNITY. MHMH CONTRACTED WITH JOHN SNOW RESEARCH AND TRAINING INSTITUTE/COMMUNITY HEALTH INSTITUTE TO PROVIDE CONSULTATION AND TECHNICAL EXPERTISE TO OUR ASSESSMENT PROCESS. JOHN SNOW RESEARCH AND TRAINING INSTITUTE IS A PUBLIC HEALTH MANAGEMENT CONSULTING AND RESEARCH ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES THROUGHOUT THE WORLD. DURING THE PERIOD FEBURARY THROUGH OCTOBER 2021, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY DARTMOUTH-HITCHCOCK AND ALICE PECK DAY MEMORIAL HOSPITAL IN PARTNERSHIP WITH NEW LONDON HOSPITAL, VALLEY REGIONAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, AND VISITING NURSE & HOSPICE OF VT/NH AND LAKE SUNAPEE VNA. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES, AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. WHILE DARTMOUTH-HITCHCOCK MEDICAL CENTER SERVES AS A TERTIARY REFERRAL MEDICAL CENTER FOR A LARGE, MULTI-STATE AREA, THE GEOGRAPHIC AREA OF INTEREST FOR THE PURPOSES OF THIS ASSESSMENT WAS THE PRIMARY SERVICE AREA OF MARY HITCHCOCK MEMORIAL HOSPITAL REGIONAL HOSPITAL, MT. ASCUTNEY HOSPITAL AND HEALTH CENTER, VISITING NURSE & HOSPICE OF VT/NH, AND ALICE PECK DAY MEMORIAL HOSPITAL. THIS PRIMARY SERVICE AREA WAS DEFINED AS 19 MUNICIPALITIES COMPRISING THE UPPER VALLEY OF NEW HAMPSHIRE AND VERMONT WITH A TOTAL RESIDENT POPULATION OF APPROXIMATELY 70,000 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE PRIMARY SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), POPULATIONS EXPERIENCING HEALTH DISPARITIES OR VULNERABLE TO POOR HEALTH OUTCOMES ARE PRIMARILY DEFINED AS THOSE POPULATIONS FACING SIGNIFICANT INCOME AND SOCIAL DETERMINANTS CHALLENGES, WHICH IN THIS REGION ARE STRONGLY ASSOCIATED WITH NEGATIVE IMPACTS ON HEALTH. ENHANCED EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THESE POPULATIONS THROUGH TARGETED SURVEYS AND VIRTUAL COMMUNITY CONVERSATIONS, MULTIPLE REGIONAL FREE COVID VACCINATION CLINICS, HOMELESS PROGRAMS, AND OTHER COMMUNITY SETTINGS SERVING ECONOMICALLY VULNERABLE RESIDENTS. FINDINGS OF THIS ASSESSMENT HAVE BEEN SHARED WITH PUBLIC HEALTH OFFICIALS IN NH AND VT, AS WELL AS WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY. DURING THIS ASSESSMENT, MARY HITCHCOCK MEMORIAL HOSPITAL USED SURVEYS FROM FEBRUARY 2021 THROUGH SEPTEMBER 2021 TO GENERATE INPUT FROM 1,642 RESIDENTS. SURVEYS WERE MADE AVAILABLE THROUGH PRIMARY CARE CLINICS, FREE CARE CLINICS, ANNUAL TOWN MEETINGS/ELECTIONS, AND NUMEROUS OTHER COMMUNITY LOCATIONS. VISITING NURSES AND OTHERS PROVIDED PRE-PAID MAILERS AND SURVEYS TO HOMEBOUND RESIDENTS. RESIDENTS COMPLETING SURVEYS INCLUDED MEMBERS OF AFRICAN-AMERICAN, HISPANIC, NATIVE AMERICAN, AND ASIAN POPULATIONS. SURVEYS WERE DISTRIBUTED THROUGH REGIONAL HEALTH CLINICS, THE REGION'S SHELTER FOR HOMELESS POPULATIONS; THE REGION'S LOW-INCOME HOUSING TRUST; SENIOR CENTERS; SUBSTANCE USE DISORDER TREATMENT PROGRAMS, DELIVERED DIRECTLY TO RESIDENT HOMES, AND OTHER LOCATIONS WHERE POPULATIONS MOST AFFECTED BY HEALTH DISPARITIES CONGREGATE. MARY HITCHCOCK MEMORIAL HOSPITAL DISSEMINATED THE SURVEY TOGETHER WITH MULTIPLE COMMUNITY ORGANIZATIONS THAT SERVE LOW-INCOME, FRAIL, AND HEALTH DISPARITY POPULATIONS. COMMUNITY PARTNERS PROVIDED ASSISTANCE DISSEMINATING THE SURVEY, INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHOSE MEMBERSHIP INCLUDES COMMUNITY MENTAL HEALTH SERVICES, SUBSTANCE USE SERVICES, MENTAL HEALTH PEER LEADERS, WIC PROVIDERS, SENIOR SERVICES ADVOCATES, SERVICES WORKING WITH PEOPLE WITH PHYSICAL AND DEVELOPMENTAL DISABILITIES, COMMUNITY NURSING, VISITING NURSES, AND OTHER CORE HUMAN SERVICES. IN ADDITION TO ASSISTING IN SURVEY DISSEMINATION, THESE PROVIDERS ADVOCATED FOR UNDERSERVED AND VULNERABLE POPULATIONS IN OUR REGION AS A PART OF THE CHNA PROCESS. DURING THIS CHNA PROCESS, WE MADE RESIDENT SURVEYS WIDELY AVAILABLE TO COMMUNITY RESIDENTS THROUGH PUBLIC LIST SERVES, DIRECT E-MAIL INVITATIONS TO PATIENTS OF OUR PRIMARY CARE CLINICS, SURVEY LINKS ON TOWN WEB SITES AND E-NEWS, EMPLOYEE E-NEWS IN MAJOR EMPLOYERS, AND THROUGH OTHER SYSTEMS THAT PROVIDED WIDESPREAD ACCESS TO OUR SURVEYS. WE PARTNERED CLOSELY WITH ORGANIZATIONS SERVING POPULATIONS AFFECTED BY POVERTY, LACK OF INSURANCE, HOMELESSNESS, BEHAVIORAL HEALTH CONDITIONS, AND SERIOUS AND CHRONIC ILLNESSES IN ORDER TO SURVEY THESE MEMBERS OF POPULATIONS IN OUR COMMUNITY, AND HOSTED MULTIPLE DISCUSSION GROUPS WITH PEOPLE AFFECTED BY POVERTY AND CHRONIC ILLNESS. WE RECOGNIZE THE LIMITATIONS OF OUR ENGAGEMENT OF RACIAL AND ETHNIC MINORITY MEMBERS OF OUR COMMUNITY AND ARE WORKING TO IMPROVE THIS PART OF OUR CHNA PROCESS. THIS POPULATION IS QUITE SMALL: 0.9% OF THE POPULATION OF GRAFTON COUNTY, NH IDENTIFIES AS AFRICAN AMERICAN, 0.4% AS NATIVE AMERICAN, 1.8% AS HISPANIC/LATINO, 3.0% AS ASIAN. 92.1% OF THE MHMH HOSPITAL SERVICE AREA'S RESIDENTS IDENTIFY AS CAUCASIAN. WIDE DISPERSAL OF THIS POPULATION ACROSS A LARGE GEOGRAPHY FURTHER COMPLICATES ENGAGEMENT EFFORTS. HOUSEHOLD MEDIAN INCOME, INSURANCE STATUS, AND OTHER INDICATORS OF POVERTY ARE SIGNIFICANT DRIVERS OF DISPARITY IN OUR REGION. POVERTY RATES RANGE WIDELY BY TOWN, WITH A RANGE BY TOWN OF 2% TO 16% OF HOUSEHOLDS LIVING ON INCOMES BELOW 100% OF FEDERAL POVERTY LEVEL. THESE POPULATIONS FACE NOTABLE HEALTH DISPARITY CONDITIONS ASSOCIATED WITH POVERTY AND OTHER SOCIAL DETERMINANTS OF HEALTH. (CONTINUED PART vi)

Schedule H, Part V, Section B, Line 6a Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING FEBRUARY 2021 -OCTOBER 2021, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO PARTNERED WITH NEIGHBORING HOSPITALS AND ORGANIZATIONS INCLUDING VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL, MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER, VISITING NURSE & HOSPICE OF VT/NH AND LAKE SUNAPEE VNA. USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION.

Schedule H, Part V, Section B, Line 6b Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. DURING FEBRUARY 2021 -OCTOBER 2021, IN ADDITION TO WORKING WITH DARTMOUTH-HITCHCOCK CLINIC, MHMH WORKED CLOSELY WITH THE MEMBER ORGANIZATIONS OF THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY (60+ MEMBER ORGANIZATIONS) AND GREATER SULLIVAN COUNTY PUBLIC HEALTH ADVISORY COUNCIL TO DISSEMINATE SURVEYS, SERVE AS KEY INFORMANTS, AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT

Schedule H, Part V, Section B, Line 7 Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE NEEDS ASSESSMENT WAS DISTRIBUTED TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE REGION INCLUDING THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY, WHICH IS A MEMBERSHIP GROUP OF REGIONAL NON-PROFIT, MUNICIPAL, SAFETY, HUMAN SERVICE, AND PUBLIC HEALTH ORGANIZATIONS. IT IS ALSO AVAILABLE FROM THE ORGANIZATION UPON REQUEST AND IS POSTED ON THE MHMH WEB PAGE (HTTPS://WWW.DARTMOUTH-HITCHCOCK.ORG/SITES/DEFAULT/FILES/2022-05/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF)

Schedule H, Part V, Section B, Line 11 Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH IS INCREASING COMMUNITY BENEFITS SPENDING TO ADDRESS IDENTIFIED COMMUNITY NEEDS BASED ON THE MOST RECENT CHNA IN AREAS OF TRAUMA AND VIOLENCE, SOCIAL DETERMINANTS OF HEALTH, IMPROVING ACCESS TO HEALTH CARE, AND NEEDS OF OLDER ADULTS, AS WELL AS MAINTAINING ONGOING INVESTMENTS IN BEHAVIORAL HEALTH AND SUBSTANCE USE NEEDS, STRENGTHENING FAMILIES AND CHILDREN, AND CANCER CARE AND TREATMENT. IN FY 2022, MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT STRATEGIES WERE CONSISTENT WITH THE INTENTIONS IDENTIFIED IN OUR FY2019 AND FY2022 COMMUNITY HEALTH IMPROVEMENT PLANS. AREAS WERE ANALYZED AND MHMH RESPONDED BY INCREASING INVESTMENTS, MAINTAINING SIMILAR LEVELS OF INVESTMENTS FOR SERVICES AND INITIATIVES, OR LIMITING INVESTMENT IN AREAS WHERE OTHER COMMUNITY ORGANIZATIONS ALREADY PROVIDE LEADERSHIP AND SERVICES TO ADDRESS THE NEED, AND/OR WHERE THE IDENTIFIED NEED IS SIGNIFICANTLY OUTSIDE THE MISSION/SERVICES/SCOPE OF MHMH. MARY HITCHCOCK MEMORIAL HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT PLAN IS A 3-YEAR DOCUMENT IDENTIFYING ANTICIPATED INVESTMENTS AND ACTIVITIES THAT IT WILL TAKE TO ADDRESS NEEDS IDENTIFIED IN THE MOST RECENT UPPER VALLEY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). WITH THE ONSET OF COVID-19 IN FEBRUARY-MARCH 2020, MHMH HAS ADDED AND PRIORITIZED COVID-19 DRIVEN COMMUNITY NEEDS TO OUR OTHER CHNA PRIORITIES. THIS HAS INCLUDED PROVIDING SIGNIFICANT FUNDING AND STAFF SUPPORT TO HELP COMMUNITY FOOD SUPPORT PROGRAMS, BEHAVIORAL HEALTH PROVIDERS, NURSING HOMES, AND OTHER COMMUNITY ORGANIZATIONS ADAPT TO AND MAINTAIN BASIC SOCIAL SERVICES SAFELY DURING THE PANDEMIC.

Schedule H, Part V, Section B, Line 13 Facility 1, 1
Facility 1, 1 - MARY HTCHCOCK MEMORIAL HOSPITAL. PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF MHMH.

Schedule H, Part V, Section B, Line 13 Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. MHMH HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY.

Schedule H, Part V, Section B, Line 16 Facility 1, 1
Facility 1, 1 - MARY HITCHCOCK MEMORIAL HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON MHMH'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. MHMH PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. MHMH CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, MHMH POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. MHMH SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, MHMH CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME.

Schedule H, Part V, Section A FACILITY INFORMATION
THE HOSPITAL HAS A SECOND CANCER TREATMENT CENTER LOCATED IN SAINT JOHNSBURY, VERMONT. THIS LOCATION IS REGISTERED UNDER THE SAME LICENSE AS THE ORGANIZATION'S MAIN CAMPUS LOCATED IN LEBANON, NEW HAMPSHIRE.

Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG
MHMH USES THE FPG GUIDELINES IN DETERMINING THE INITIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED. IN ADDITION, MHMH ALLOWS FOR CATASTROPHIC ASSISTANCE CONSIDERATION BASED ON A CALCULATION OF 10% OF TWO YEARS INCOME PLUS 10% OF AMOUNT OVER SHELTERED ASSETS. IF THE PROJECTED OR CURRENT SELF-PAY BALANCE IS GREATER THAN THIS CALCULATION, THE SELF-PAY BALANCE IS REDUCED TO THE SUM OF 10% OF TWO YEARS INCOME PLUS 10% OF ASSETS. EACH HOUSEHOLD IS ALLOWED CERTAIN SHELTERED ASSETS WHICH ARE NOT USED WHEN CALCULATING HOUSEHOLD INCOME OR ASSETS. SAVINGS IS SHELTERED UP TO 100% OF FPL BASED ON FAMILY SIZE, EQUITY IN PRIMARY RESIDENCE UP TO $200,000 UP TO 55 AND $250,000 FOR AGED 55 AND OLDER, AND A RETIREMENT SHELTER OF UP TO $100,000 IN RETIREMENT ASSETS AS LONG AS IT IS EMPLOYER BASED CONTRIBUTIONS IF WORKING OR IRA IF SELF-EMPLOYED. IF A PATIENT IS RETIRED, PRIOR RETIREMENT ACCOUNTS WOULD BE INCLUDED AS A SHELTERED ASSET.

Schedule H, Part I, Line 6a COMMUNITY BENEFITS REPORT
MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND FILES A CONSOLIDATED COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW HAMPSHIRE. FOR PURPOSES OF IRS FORM 990, SCHEDULE H, ONLY MARY HITCHCOCK MEMORIAL HOSPITAL NUMBERS WERE USED. ALL AMOUNTS RELATING TO DHC WERE EXCLUDED. THE NEW HAMPSHIRE COMMUNITY BENEFITS REPORT FILED FOR FISCAL YEAR 2022, DHC AND MHMH COMBINED, TOTALED $311,313,876.

Schedule H, Part V, Section B, Line 5 PERSONS WHO REPRESENT BROAD INTERESTS OF COMMUNITY SERVED CONT
DURING OUR ASSESSMENT PROCESS, MHMH MADE SPECIFIC EFFORTS TO CONTACT AND RECEIVE INPUT FROM MEMBERS OF INCOME-VULNERABLE POPULATIONS, INCLUDING: *SURVEYS DISTRIBUTED AT A COVID VACCINATION CLINIC DESIGNATED FOR MEMBERS OF THE BIPOC COMMUNITY * VIRTUAL DISCUSSION GROUP WITH PEOPLE RECEIVING MEDICATION ASSISTED TREATMENT FOR OPIATE USE DISORDER (JANUARY 25, 2021). * VIRTUAL DISCUSSION GROUP WITH ADULTS WHO REGULARLY ACCESS FOOD VIA LOCAL FOOD SHELVES (1/26/2021). * VIRTUAL DISCUSSION GROUP WITH PEOPLE IDENTIFYING AS HAVING COMPLEX HEALTH CONDITIONS (1/26/2021.) * VIRTUAL DISCUSSION GROUP WITH COMMUNITY HEALTH WORKERS SERVING CHRONICALLY ILL, AND OTHERWISE VULNERABLE OLDER ADULTS IN REGIONAL TOWNS (1/26/2021.) * VIRTUAL DISCUSSION GROUP WITH RECOVERY COACHES SERVING PEOPLE WITH SUBSTANCE USE DISORDER (1/27/2021.) *VIRTUAL DISCUSSION GROUP WITH MEMBERS OF THE COMMUNITY AGES 65+ RECEIVING SERVICES FROM THE LAKE SUNAPEE VISITING NURSE ALLIANCE (1/28/2021). * WORKING WITH THE GOOD NEIGHBOR HEALTH CLINIC AND MASCOMA COMMUNITY HEALTH CENTER TO DISSEMINATE SURVEYS TO PATIENTS WHO ARE UNINSURED AND LOW-INCOME. DISSEMINATING SURVEYS AT THE UPPER VALLEY HAVEN (SHELTER); LISTEN COMMUNITY SERVICES (BASIC NEED SUPPORT, FOOD SHELF, AND COMMUNITY DINNERS); TO PARENTS OF CHILDREN IN DARTMOUTH-HITCHCOCK AND ALICE PECK DAY'S PEDIATRICS CLINICS; VIA WOMEN, INFANTS, AND CHILDREN'S CLINICS; THROUGH GRAFTON COUNTY SENIOR CITIZENS COUNCIL (HOME-DELIVERED MEALS AND CONGREGATE MEALS); THROUGH VISITING NURSE AND HOSPICE OF VT AND NH (HOME-VISITING PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FOR SENIORS WITH COMPLEX HEALTH NEEDS); AND THROUGH OTHER COMMUNITY ORGANIZATIONS SERVING PEOPLE AFFECTED BY POVERTY AND POOR HEALTH. IN FY21 MHMH STAFF WORKED CLOSELY WITH UPPER VALLEY STRONG AND GREATER SULLIVAN STRONG, RAPID-FORMING COMMUNITY RESPONSE COALITIONS EACH WITH 50+ COMMUNITY ORGANIZATION MEMBERS, TO SHARE INFORMATION ASSESS COMMUNITY NEEDS ABOUT REAL TIME IMPACTS OF COVID-19, INCLUDING SHARING INFORMATION ABOUT PREVENTION, RISK REDUCTION, VACCINATIONS, AND IMPACT OF COVID-19 ON COMMUNITY SOCIAL SAFETY NEW ORGANIZATIONS, HELPING TO COORDINATE COMMUNITY RESPONSE AND KEEP CRITICAL COMMUNITY SERVICES OPEN AND FUNCTIONING DESPITE COVID-19 RELATED COMMUNITY DISRUPTIONS.

Schedule H, Part I, Line 7g Subsidized Health Services
The organization did not include any subsidized health service costs attributable to a physician clinic on part I, line 7G.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
21526799

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The costing methodology used to calculate the amounts reported was a cost-to-charge ratio derived from worksheet 2, ratio of patient care to cost-to-charges.

Schedule H, Part II Community Building Activities
Community building activities include expenses related to coalitions such as ones that address regional public health networks, improvement in systems of care for substance use and mental health disorders, prevention of substance abuse, falls reduction for older adults, and prescription drug misuse. It also includes investments in regional public transportation and affordable housing initiatives and workforce training initiatives that enable unemployed and marginally employed persons to access careers in our hospital, other health care settings, and other regional employers.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
BASED ON ACCOUNTING GUIDANCE, BAD DEBT IS RECORDED AS A REDUCTION TO NET PATIENT REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
The hospital is unable to estimate accurately the amount of bad debt expense attributable to patients eligible for financial assistance. Although a portion of bad debt expense may be related to patients who would qualify for charity care, a reportable figure cannot be reasonably estimated.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
MHMH IS INCLUDED IN THE DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. AS A RESULT OF ACCOUNTING CHANGES (ASC 606), BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. THEREFORE, THERE IS NO SEPARATE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
MHMH HAS A CREDIT AND COLLECTION POLICY THAT ADDRESSES THE PROCEDURES FOR PATIENTS WHO QUALIFY FOR REDUCED-COST CARE. THE POLICY PROHIBITS USING EXTRAORDINARY COLLECTION PRACTICES OR PLACING AMOUNTS WITH COLLECTION AGENCIES. IF A FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENT HAS A BALANCE FOR WHICH THEY ARE RESPONSIBLE AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE STANDARD PRACTICES ARE FOLLOWED AS OUTLINED IN THE D-H CREDIT AND COLLECTIONS POLICY.

Schedule H, Part V, Section B, Line 16a FAP website
1 - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16a URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
1 - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16b URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
The costing methodology used to calculate the amounts reported as Medicare shortfalls was derived from the Internal Revenue Service's Worksheet B as provided for Part III calculations. MHMH had revenues of $116,259,904 and costs of $161,157,914 for services not included on the Medicare Cost Report (Ambulance Services, Laboratory and other fee screens, and Medicare Part C & D services) MHMH incurred a net loss of $44,898,010 on the provision of these services. Because of the central role of the organization in serving the healthcare needs of its community and the demographic characteristics of the community served, it is likely that a portion of the Medicare shortfall should be considered community benefit expenditure. MHMH has not identified a specific amount of Medicare shortfall that should be reported as such.

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
1 - MARY HITCHCOCK MEMORIAL HOSPITAL: Line 16c URL: https://www.dartmouth-hitchcock.org/patients-visitors/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH HITCHCOCK CLINIC (COLLECTIVELY REFERRED TO AS DARTMOUTH-HITCHCOCK (D-H)) SHARE COMMON BOARD MEMBERS AND OPERATE UNDER AN AFFILIATION AGREEMENT. D-H PERFORMS A JOINT COMMUNITY NEEDS ASSESSMENT AND FILES A CONSOLIDATED COMMUNITY BENEFITS REPORT. DARTMOUTH-HITCHCOCK PARTICIPATES WITH OTHER HEALTH CARE CHARITABLE TRUSTS AND COMMUNITY PARTNERS IN EACH OF OUR SERVICE AREAS TO COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENTS. DURING FY2022, MHMH PARTNERED WITH ALICE PECK DAY MEMORIAL HOSPITAL, TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. WE ALSO WORKED TOGETHER WITH NEIGHBORING HOSPITALS, INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CARE, VALLEY REGIONAL HOSPITAL, NEW LONDON HOSPITAL , AND VISITING NURSE & HOSPICE OF VT & NH TO USE SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENTS TOOLS AND APPROACH, TO ALLOW COMPARABILITY OF HEALTH DATA ACROSS A WIDER GEOGRAPHIC REGION. COLLECTIVELY D-H AND PARTNERED HOSPITALS HIRED COMMUNITY HEALTH INSTITUTE/JOHN SNOW RESEARCH AND TRAINING INSTITUTE, A PUBLIC HEALTH CONSULTING FIRM, TO PROVIDE TECHNICAL ASSISTANCE AND ANALYSIS RELATED TO OUR COMMUNITY HEALTH NEEDS ASSESSMENTS. THE NEEDS ASSESSMENT INCLUDED REVIEWING SELECTED SERVICE AREA DEMOGRAPHICS; PUBLIC HEALTH DATA AVAILABLE THROUGH NH AND VT HEALTH DEPARTMENTS, HOSPITAL DISCHARGE DATA, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND YOUTH RISK BEHAVIOR SURVEYS; FOCUS GROUPS WITH EMPLOYERS AND WITH COMMUNITY MEMBERS RECEIVING SERVICES AT REGIONAL SAFETY NET SERVICE ORGANIZATIONS; ELECTRONIC SURVEYS OF PROFESSIONAL HEALTH AND SOCIAL SERVICE PROVIDERS; AS WELL AS PAPER AND ELECTRONIC CONVENIENCE SURVEYS OF COMMUNITY RESIDENTS. FINDINGS OF THE FY2022 COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AT 2 LARGE VIRTUAL COMMUNITY MEETING (80+ TOTAL STAKEHOLDERS) HOSTED IN CONCERT WITH THE PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY AND OTHERS FOR FURTHER COMMENTS AND FEEDBACK. THE FINDINGS WERE ALSO REVIEWED IN 16 DEPARTMENT MEETINGS WITHIN MHMH INCLUDING MORE THAN 50 STAFF. ADDITIONALLY, MHMH COMMUNITY HEALTH STAFF PARTICIPATE IN OR LEAD MULTIPLE COMMUNITY COALITIONS AND PROJECTS CONNECTING US TO A WIDE ARRAY OF COMMUNITY-BASED HEALTH, MUNICIPAL, SCHOOL, SERVICE ORGANIZATION, REGIONAL PLANNING AND STATE PUBLIC HEALTH STAKEHOLDERS. WE REGULARLY REVIEW EMERGING NH & VT STATE HEALTH DATA; QUANTITATIVE AND QUALITATIVE DATA FROM LOCAL SOURCES (NEWSPAPERS, REGIONAL PLANNING OFFICES, COMMUNITY FORUMS), AND CONVERSATIONS WITH COMMUNITY PARTNERS TO IDENTIFY CONCERNS THAT ARE EMERGING, INTENSIFYING, OR ARE THE SOURCE OF LOCAL ATTENTION SINCE THE LAST CHNA WAS CONDUCTED.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
ALL UNINSURED INPATIENTS, SAME DAY SURGERY, OBSERVATION, AND EMERGENCY DEPARTMENT PATIENTS ARE PRO-ACTIVELY SCREENED USING PAPER AND/OR AN AUTOMATED TOOL TO IDENTIFY POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. IN ADDITION, SPECIFIC OUTPATIENT ACTIVITIES DEEMED TO HAVE A HIGHER RATE OF NEED ARE SCREENED AS PART OF REGULAR PROTOCOL. IF A PATIENT APPEARS TO BE ELIGIBLE, ON-SITE FINANCIAL COUNSELORS ASSIST THE PATIENT IN COMPLETING THE APPROPRIATE PAPERWORK/APPLICATIONS AND PROVIDE INSTRUCTION REGARDING HOW TO COMPLETE THE QUALIFICATION PROCESS. IN SOME CASES A FINANCIAL COUNSELOR WILL ACT ON BEHALF OF THE PATIENT, AT THEIR SIGNED CONSENT, IN ORDER TO COMPLETE THE APPLICATION PROCESS (FOR EXAMPLE, IN NEW HAMPSHIRE A PATIENT MUST BE PHYSICALLY PRESENT AT THE DISTRICT OFFICE). IF A PATIENT DOESN'T QUALIFY FOR SPECIFIC PROGRAMS, THEY ARE ALSO CONSIDERED FOR FINANCIAL ASSISTANCE AS PART OF THEIR SCREENING. FOR OUTPATIENT SERVICES THAT ARE NOT ROUTINELY SCREENED, STAFF INTERACTING WITH PATIENTS ARE INSTRUCTED TO PROVIDE EITHER A FINANCIAL ASSISTANCE APPLICATION OR CONTACT INFORMATION FOR A FINANCIAL COUNSELOR WHEN A PATIENT EXPRESSES THEIR INABILITY TO MAKE PAYMENT. EVERY APPLICATION IS SCREENED FOR COMPLETED INCOME AND ASSET DOCUMENTATION. APPLICATIONS ARE ALSO SCREENED TO ASSURE THERE ARE NO OTHER POTENTIAL OPTIONS OF FEDERAL, STATE, OR LOCAL PROGRAMS. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY.

Schedule H, Part VI, Line 7 State filing of community benefit report
NH

Schedule H, Part VI, Line 4 Community information
THE ORGANIZATION DEFINES ITS SERVICE REGION AS NEW HAMPSHIRE AND EASTERN VERMONT, WITH THE LARGEST PRESENCE IN A 19-TOWN HOSPITAL SERVICE AREA REGION ADJOINING LEBANON, NEW HAMPSHIRE, SITE OF DARTMOUTH-HITCHCOCK MEDICAL CENTER WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC'S MAIN NORTHERN CLINIC. THE 19-TOWN HOSPITAL SERVICE AREA REGION HAS A POPULATION OF 70,000 PEOPLE, WITH TOWNS RANGING IN POPULATION FROM 200-14,000 PEOPLE. THESE TOWNS ARE GENERALLY CONSIDERED RURAL, THOUGH THE HANOVER, AND LEBANON, NH AND HARTFORD, VT COMMUNITIES ARE CONSIDERED TO BE A MICROPOLITAN AREA. AMONG THE REGION'S 19 TOWNS, MEDIAN HOUSEHOLD INCOME VARIES WIDELY, FROM $50K-$120K ANNUALLY 17.5% OF THE POPULATION IS OVER THE AGE OF 65; 11% OF CHILDREN LIVE IN HOUSEHOLDS WHOSE MEDIAN HOUSEHOLD INCOME IS LESS THAN 100% OF FEDERAL POVERTY LEVEL, 26.8% OF CHILDREN LIVE IN HOUSEHOLDS WITH INCOME LESS THAN 200% OF FEDERAL POVERTY LEVEL; 1.5% OF THE REGION'S RESIDENTS HAVE LIMITED ENGLISH PROFICIENCY; AND 7.1% LACKED HEALTH INSURANCE. 11.8% OF NH RESIDENTS AND 24.9% OF VERMONT RESIDENTS ARE MEDICAID BENEFICIARIES. THE REGION IS SERVED BY MHMH AND BY ALICE PECK DAY MEMORIAL HOSPITALS. THERE ARE NO FEDERALLY QUALIFIED HEALTH CENTERS OPERATING WITHIN THE REGION THOUGH ONE REGIONAL COMMUNITY HEALTH CLINIC IS PURSUING THIS STATUS. THE GOOD NEIGHBOR HEALTH CLINIC, IN HARTFORD, VT, OFFERS CARE TO UNINSURED COMMUNITY MEMBERS. TWO MINOR CIVIL DIVISIONS IN OUR REGION, DORCHESTER NH AND PIERMONT NH, ARE CONSIDERED MEDICALLY UNDERSERVED AREAS. MHMH SERVES THE GENERAL POPULATION WITH A WIDE RANGE OF SERVICES. IN ADDITION TO GENERAL HOSPITAL POPULATIONS, THE ORGANIZATION PROVIDES SERVICES TO PATIENTS WITH HIGHLY-SPECIALIZED NEEDS THAT ARE NOT AVAILABLE ELSEWHERE IN NEW HAMPSHIRE. MHMH IS THE STATE'S ONLY TERTIARY REFERRAL CENTER, PROVIDES THE STATE'S ONLY COMPREHENSIVE CANCER CENTER (NORRIS COTTON CANCER CENTER ~ NCCC), OPERATES THE ONLY LEVEL I TRAUMA CENTER IN NEW HAMPSHIRE, OPERATES THE ONLY COMPREHENSIVE CHILDREN'S HOSPITAL AND ACCREDITED PEDIATRIC TRAUMA CENTER IN NEW HAMPSHIRE (CHILDREN'S HOSPITAL AT DARTMOUTH - CHAD), HOSTS THE ONLY LEVEL IV NEONATAL INTENSIVE CARE NURSERY AND ONE OF TWO PEDIATRIC INTENSIVE CARE UNITS IN NEW HAMPSHIRE, AND OPERATES THE ONLY HELICOPTER TRANSPORT SERVICE IN THE STATE. AS SUCH, THE SERVICE POPULATION IS BOTH THE GENERAL PUBLIC SEEKING PRIMARY HEALTH CARE SERVICES AS WELL AS RESIDENTS WITH UNIQUE AND HIGHLY-SPECIALIZED HEALTH CARE NEEDS.

Schedule H, Part VI, Line 5 Promotion of community health
MHMH supports organizations and initiatives that further health by strengthening and developing key community capacities to address identified community health needs. This Includes hosting or leading community partnerships to address substance misuse and treatment and to improve public health; providing funding for child and adult oral health initiatives, and participation of our staff in other partnerships including the outpatient Falls Prevention Task Force, the Transportation Management Association, and the Upper Valley workforce Housing Coalition. In addition, MHMH operates health education and support Services such as a Women's Health Resource Center, the Aging Resource Center, and a Health Education Center. MHMH uses cash contributions, contracted services, and in kind Contribution of staff time and expertise, to support these strategies which improve community health. At MHMH's Lebanon, NH campus, the hospital extends professional staff privileges to qualified and appropriate physicians who are employees of Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and Dartmouth College, who also hold a faculty appointment at Geisel School of Medicine. Mary Hitchcock's Trustees annually set strategic priorities for the institution and approve operating and capital budgets which support improvements, patient care, medical education, and research. Examples of these investments include the development of Mary Hitchcock's Patient Safety and Training Center; ongoing quality and patient safety initiatives; purchases of new and emerging medical technologies; support translational research, and medical education. Of The 21 voting members of the MHMH Board of Trustees at FY22 end, 15 are neither Contractors nor employees of MHMH.

Schedule H, Part VI, Line 6 Affiliated health care system
COMMUNITY BENEFITS ARE PROVIDED BY THE DARTMOUTH HITCHCOCK HEALTH CARE SYSTEM, WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, AND OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IN LEBANON IS NEW HAMPSHIRE'S LARGEST HOSPITAL. IN FISCAL YEAR 2022 MHMH HAD 396 LICENSED INPATIENT BEDS. THE DARTMOUTH-HITCHCOCK CLINIC (DHC) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE WITH A NETWORK OF PROVIDERS ACROSS NEW HAMPSHIRE AND VERMONT. WHILE DHC'S MAIN OFFICES ARE LOCATED IN LEBANON, THE CLINIC ALSO HAS MULTI-SPECIALTY PRACTICES IN MANCHESTER, NASHUA, CONCORD, AND KEENE, NH AREAS AS WELL AS BENNINGTON, VT. IN ADDITION, THE CLINIC PROVIDES PRIMARY CARE IN RURAL COMMUNITIES IN VERMONT AND NORTHERN NEW HAMPSHIRE. THE HOSPITAL AND CLINIC OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING AND MANAGEMENT AND SHARE IDENTICAL MISSIONS. THE MEDICAL SCHOOL, WHICH WORKS CLOSELY WITH THE HOSPITAL AND CLINIC, IS FOCUSED ON MEDICAL EDUCATION AND RESEARCH.