DARTMOUTH-HITCHCOCK CLINIC
One Medical Center Drive, Lebanon, NH 03756 www.dartmouth-hitchcock.org

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Organizations Filed Purposes: 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.

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.

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 2020 resulted in 1,470,854 office visits recorded by DHC personnel, with 356,626 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) are playing key coordinating roles in the implementation of CMS'S Delivery System Reform Incentive Payment (DSRIP) Program, better known as a "1115 Waiver." This statewide initiative will integrate and improve behavioral and physical health care. The effort ties together mental health, substance use and disorder treatment, physical health, social needs, housing, transportation, and the criminal justice system to form a coordinated effort that provides care for New Hampshire's most vulnerable residents in the DSRIP. These activities are also an integral part of DHC's and MHMH's efforts at addressing the opioid abuse crisis, which impacts so many patients in DHC's service area. 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 2020. 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 has commenced a major construction project to expand the Manchester Clinic site to increase patient capacity. The 94,000 additional square feet will include 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. DHC files an annual community benefits report with the State of New Hampshire which outlines the community and charitable benefits DHC provides. 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, 2020, DHC provided financial assistance to 23,363 patients in the amount of $16,102,221 as measured by gross charges . The estimated cost of providing this care for the year ended June 30, 2019, was $4,344,664 . 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, 2019 was $31,102,839 . 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, 2020, DHC reported a provision for bad debts of approximately $26,448,136 .

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 2020, DHC continued the transition of research activities and management from GSM to DHC, under the leadership of the Vice President for Research.

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