FY 2006 Community Benefits Report

and

FY 2007 Plan

Mary Hitchcock Memorial Hospital

and

Dartmouth-Hitchcock Clinic

TABLE OF CONTENTS Section I: Introduction / General Background Information ………………. p. 3 Table 1. Number of Patients Receiving Financial Assistance, Medicaid or Medicare / CHAMPUS ………………. p. 3 A. Name and Address of the Chief Executive Officer and

Board Chair ……………………………………….. p. 4 B. Organizational Structure …………………………… p. 4

Section II: Community Benefits Contact Person ………………….. p. 4 Section III: Mission Statement ……………………………………… p. 5 Section IV: Program Information …………………………………… p. 5 Section V: Definition of Community and Population Served ………. p. 5 Section VI: Community Needs Assessment Information ……………. p. 5 Sections VII: Collaboration …………………………………………….. p. 5 Section VIII: Community Benefits Plan for FY 2007 …………………. p. 6 Section IX: FY 2006 Community Benefits Report .............................. p. 8

Table 2. Value of FY 2006 Community Benefits …........ p. 10 Table 3. Uncompensated Costs of Medicaid and Medicare / CHAMPUS ………………………………… p.11 Table 4. Trends in Uncompensated Costs of Medicaid and Medicare / CHAMPUS ……………………………. p. 11

Section X: Attachments

1. MHMH and DHC Boards of Trustees Roster for FY 2006……………… p. 14 2. Map of the D-H Service Area…………………………………………… p. 18 3. Partial List of Community Partners……………………………………… p. 19 4. Dartmouth-Hitchcock Alliance Members……………………………….. p. 25 5. Changes in What Counts as a Community Benefit……………………… p. 26 6. American Hospital Association Pledge…………………………………. p. 27

2

I. INTRODUCTION / GENERAL BACKGROUND INFORMATION Mary Hitchcock Memorial Hospital (MHMH) in Lebanon is New Hampshire’s largest hospital. In Fiscal Year 2006 MHMH had 367 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.* In addition, the Clinic provides primary care in rural communities in Vermont and northern New Hampshire. MHMH, all the Clinic sites, and the Dartmouth Medical School (DMS) faculty and students make up the Dartmouth-Hitchcock (D-H) health care system. The Hospital and Clinic operate jointly through interlocking directorates, strategic planning and management. They share identical missions. The Medical School, which is closely affiliated with the Hospital and Clinic, is focused on medical education and research. This document focuses on the community benefits of Mary Hitchcock Memorial Hospital and the Dartmouth-Hitchcock Clinic, the two entities of the health system whose primary mission is health care. The following table shows the number of people receiving treatment at MHMH and DHC in FY 2006 who received financial assistance (sometimes called “charity care”) and who received subsidized as a result of being insured by Medicaid or Medicare. Table 1. Number of Patients Receiving Financial Assistance, Medicaid or Medicare / CHAMPUS Financial Assistance Medicaid Medicare DHMC / Northern Region 5,400 29,654 43,799DHC Southern Region 6,255 25,562 26,847

* While the community benefits report and plan for Dartmouth-Hitchcock Keene are filed jointly with Cheshire Medical Center, financial assistance from DH Keene is included here.

3

A. Name and Address of the Chief Executive Officer and Board Chair

MHMH DHC

Nancy A. Formella, Acting President Thomas A. Colacchio, President One Medical Center Drive One Medical Center Drive Lebanon, NH 03756-0001 Lebanon, NH 03756-0001 603-650-7422 (phone) 603-650-7647 (phone) 603-650-8765 (fax) 603-650-4220 (fax) nancy.a.formella@hitchcock.org thomas.a.colacchio@hitchcock.org

Alan D. Sessler, M.D. DHC Board Chair Wells Fargo 674 Mayo Clinic 200 First Street, SW Rochester, MN 55905 sessler.alan@mayo.edu

Alfred L. Griggs MHMH Board Chair A.L. Griggs Industries Inc. One Roundhouse Plaza, #302 Northampton, MA 01060 agriggs@choiceonemail.com

B. Organizational Structure

MHMH and DHC bylaws are on file with the FY 2002 Community Benefits Report. Please refer to Attachment 1 for the MHMH and DHC Boards of Trustees Roster for FY 2006. We employed 7,689 people in full and part-time positions. Conservatively, we estimate that 1,550 employees participated in community-benefits activities in FY06. All departments and programs share responsibility for community benefits. Programs are coordinated through the Office of Community Health Improvement and Benefits and reviewed annually by the MHMH and DHC Boards of Trustees.

II. COMMUNITY BENEFITS CONTACT PERSON Name and Title: N. Carr Robertson, MPH Community Health Improvement & Benefits Director Address: Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756-0001 Telephone number: 603-653-1929 e-mail: NCarrR@hitchcock.org

4

III. MISSION STATEMENT The mission statements of MHMH and DHC are one and the same. The Boards of Trustees reaffirmed the statement at their meeting on February 9, 2007.

To provide high-quality health care and comfort to the ill, to prevent illness among the well and to advance health care through education, research, community service and the improvement of clinical practice.

IV. PROGRAM INFORMATION

The strategic plan for community benefits and the program narrative were reported in the FY 2003 and FY 2004 reports on file with the NH Attorney General’s Office. We expect to draft a new three – five year plan for community benefits in FY 2007.

V. DEFINITION OF COMMUNITY AND POPULATION SERVED The Hospital and Clinic define their community as New Hampshire and eastern Vermont. Attachment 2 is a map of our clinics, regional specialty practices and the Dartmouth-Hitchcock Medical Center.

VI. COMMUNITY NEEDS ASSESSMENT INFORMATION At D-H community needs-assessment takes place on a variety of schedules. The most recent assessments for Concord, Keene, Manchester, Nashua and the Upper Valley are on file with the NH Attorney General’s office. A copy of the mid-term assessment done in the Upper Valley was filed with the Attorney General’s office as part of the DHMC report for FY 2005. We plan to participate in collaborations to complete needs assessments in the Upper Valley, Concord and Nashua in FY 2008. Manchester is scheduled to complete its next assessment in FY 2009.

VII. COLLABORATION

D-H is an active member in numerous coalitions and has many community partners. See Attachment 3 which lists many of these affiliations.

D-H is also the primary contact for the Dartmouth-Hitchcock Alliance (DHA). The DHA is a group of independently owned and operated hospitals and agencies in Vermont, New Hampshire and western Massachusetts. Member organizations share a commitment to improving the quality, efficiency and availability of health care. For an address list of DHA members see Attachment 4. The contact for the Alliance is Deanna Howard, Vice President Dartmouth-Hitchcock Alliance and Dartmouth-Hitchcock Medical Center. She can be reached at DHMC, One Medical Center Drive, Lebanon NH 03756-0001.

5

VIII. FY 2007 COMMUNITY BENEFITS PLAN

BENEFIT ACTIVITY GOALS OUTCOMES ESTIMATED # OF PEOPLE

I. Access to primary care and specialty health care for low-income people without insurance

Continue to provide financial assistance to patients who cannot afford the cost of services

$ value at cost of financial assistance to D-H patients

5,000 – 6,000 in the northern region

6,000 in the southern region

Continue to provide a 30% discount off charges to all uninsured patients†

Status of program 15,000 to 20,000 in

each region Continue to subsidize Medicaid $ value at cost 25,000 to 30,000 each

region Continue to subsidize Medicare

and CHAMPUS‡$ value at cost 40,000 in the northern

region 25,000 in the southern

region Continue to partner with and

support clinics for uninsured, unemployed and low-income patients

Status of partnerships and support with these clinics

1,500 patients in community health

centers and other clinics for uninsured and poor

people Continue to collaborate to connect

children from needy families with medical homes and to sustain Medicaid in NH for children into the future

Status of these collaborations

15,000

II. Access to coordinated health and social services

Continue to coordinate services for people with HIV/AIDS across agencies and regions through coalitions and clinical education

Summary of collaborations 250 patients and their

families

Partner with Grafton County Senior Citizens Council to provide coordinated health and human services for the elderly

Summary of programs 50 senior citizens

III. Help uninsured low-income people with the cost of prescriptions

Continue to help patients get prescriptions for chronic conditions through DHMC medication assistance programs

Status of DHMC medication assistance programs

1,500 patients

IV. Promote health among the general public

Provide free flu clinics at DHMC in Lebanon

Status of program 5,000 people vaccinated

Respond to bird flu, if necessary Description of response TBD Continue to host and participate

in health fairs Summary of health fairs

15,000 attend Assist schools in teaching health

and integrating health into the curriculum

Summary of FitKids, tobacco and drug prevention education provided to schools, and other K-12 programs

3,500

Promote women's health through activities of the DHMC Women's Health Resource Centers

Summary of classes and other events

15,000

6

TP

† We include this in our plan but recognize the $ value is not a community benefit under New Hampshire law. ‡ Ditto

BENEFIT ACTIVITY GOALS OUTCOMES PEOPLE REACHED

V. Prevention &Treatment of Addiction to Alcohol, Tobacco and Other Drugs (ATOD)

Continue the DHMC Addiction Treatment Program, which offers evaluations and intensive outpatient treatment for substance use disorders

Program status

150 clients and their families

Continue to expand YES, a

collaboration with 3 agencies to provide evidence-based treatment to youth in the Upper Valley

Program status 50 teens and their

families

Continue to use model protocol to address abuse of alcohol, tobacco and other drugs (ATODs) among HIV/AIDS patients

Program status

TBD

Educate K-12 students about the science of addiction and dangers of using ATODs

Status of FitKids, Addiction is a Brain Disease, et. al.

1,500 students

Continue to foster communication

and collaboration across the Upper Valley about prevention and treatment for ATODs

Status of Mapping the Maze, Upper Valley Recovery Celebration, and other collaborative projects

500 people attending,

100 involved in projects

Begin evidence-based screening and intervention for tobacco use across DHMC, starting with pilots in inpatient units, and offer tobacco cessation counseling at DHMC Lebanon

Status of inpatient processes and tobacco cessation counseling

80% of inpatients are screened

VI. Educating Doctors, Nurses and Other Health Care Professionals

Continue to provide clinical education to medical students, residents and medical fellows

Status Number of DMS students and D-H

medical residents and fellows

Keep providing clinical education for other health professions and continuing education programs for all health professionals

Status Number of people receiving clinical

education and number of professionals

receiving on-going education credits

7

IX. FY 2006 COMMUNITY BENEFITS REPORT

GOALS, OBJECTIVES & MEASURES

BENEFIT ACTIVITY GOALS OUTCOMES PEOPLE

REACHED I. Access to primary care and specialty health care for low-income people without insurance

Continue to provide financial assistance to patients who cannot afford the cost of services

The cost of financial assistance to DH patients was $21.9 million

5,600 people in the northern

region and 6,255 people in the

southern region Continue to provide a 30%

discount off charges to all uninsured patients§

The program started 3 months into the fiscal year and discounted $10.1 million from charges to the uninsured patients.

11,087 in the northern region

and 8,916 in the southern region

Continue to subsidize Medicaid $34.5 million at cost 29,654 in the northern region

and 25,562 in the southern

region Continue to subsidize Medicare

and CHAMPUS**$55.6 million at cost 43,799 patients

– northern region only

Continue to partner with and support clinics for uninsured, unemployed and low-income patients

D-H continues to provide clinical services and funding to help support Manchester Community Health Center, Children’s Services, Good Neighbor Clinic, VNA of VT/NH, etc.

Numbers of patients were not available

from all these agencies. We

estimate we reached at least 7,000 patients.

Continue to collaborate to connect children from needy families with medical homes and to sustain Medicaid in NH for children into the future

D-H is actively working with other providers through the Healthy Manchester Leadership Council and other partners across southern New Hampshire.

16,057

II. Access to coordinated health and social services for people with HIV/AIDS

Continue to coordinate services across agencies and regions through coalitions and clinical education

We work with HIV/AIDS collaboratives in New Hampshire and Vermont, including the Greater Manchester AIDS Project and the Southern NH HIV/AIDS Task Force.

388 patients and

their families

Continue to solicit grants and raise funds to pay for health and social services for people with HIV/AIDS

The program continues to be supported by grants, with $175,000 in costs provided by D-H.

Same as above

III. Help uninsured low-income people with the cost of prescriptions

Continue to help patients get prescriptions for chronic conditions through DHMC medication assistance programs

D-H continues to help patients apply for financial assistance from drug companies to cover the cost of prescription medicines. Medicare D reduced the need in FY 2006.

1,714 patients

were helped

§ We include this in our plan but recognize the $ value is not a community benefit under New Hampshire law. ** Ditto

8

BENEFIT ACTIVITY GOALS OUTCOMES PEOPLE REACHED

IV. Promote health among the general public

Provide free flu clinics at DHMC in Lebanon

D-H offered 3 free flu shot clinics. 7,223 people were vaccinated

Respond to bird flu, if necessary We did not have an outbreak of bird flu.

Not Applicable

Continue to host and participate in health fairs

We led or participated in many health fairs, including the Health Manchester Health Fair, the Nashua Community Health & Wellness Fair, and the Women’s Health Forum

12,000+people attended these

events

Assist schools in teaching health and integrating health into the curriculum

We continued to provide FitKids in 4th grade reaching 26 schools, Addiction is a Brain Disease to 7th grades in four schools, Great Issues in Medicine students from 5 schools. We also visited classrooms in grades K-12 as requested.

4,000+ students

Promote women's health through activities of the DHMC Women's Health Resource Centers

These programs continue to thrive and support women’s health through libraries, events and classes.

21,400 people were reached through these

programs V. Prevention &Treatment of Addiction to Alcohol, Tobacco and Other Drugs (ATOD)

Continue the DHMC Addiction Treatment Program, which offers evaluations and intensive outpatient treatment for substance use disorders

The Intensive Outpatient Program, a 90-day evidence-based program, is becoming well established – while operating at a loss of more than $200,000 a year. It is closely linked with the buprenorphine clinic, which is also fairly new and treats opiate addiction through a combination of a new medication and therapy.

The IOP assessed 106

clients, and enrolled 105

into the program. 42

completed the program.

The buprenorphine

clinic treated 46 clients, 25 of

them remain in the program.

Continue and expand YES, a collaboration with 3 agencies to provide evidence-based treatment to youth in the Upper Valley

YES struggled to find a qualified program coordinator – few candidates applied. This delayed bringing the program up to speed.

15 teen-agers

Continue to use model protocol to address use of alcohol, tobacco and other drugs (ATODs) among HIV/AIDS patients

Implementing the technology proved difficult, requiring consultants to write several versions of the software. The program did not begin to work until the end of the fiscal year.

Not Applicable

Educate K-12 students about the

science of addiction and dangers of using ATODs

FitKids and Addiction is a Brain Disease continue to grow, reaching more schools and students.

2,250 students

Continue to foster communication

and collaboration across the Upper Valley about prevention and treatment for ATODs

Mapping the Maze continues to grow - a committee of the Maze has formed a tobacco coalition. The Upper Valley Recovery Celebration also continues to grow and be held annually.

400 - 500 people attend events, participate on

projects or ask to receive

information. Begin evidence-based screening

and intervention for tobacco use across DHMC, starting with pilots in inpatient units, and offer tobacco cessation counseling at DHMC Lebanon

By the end of the fiscal year we had trained clinicians, created a way to track the tobacco use and intervention in the electronic record and had begun to provide tobacco cessation services through the Norris Cotton Cancer Center.

200 Clinicians were trained

9

BENEFIT ACTIVITY GOALS OUTCOMES PEOPLE REACHED

VI. Educating Doctors, Nurses and Other Health Care Professionals

Continue to provide clinical education to medical students, residents and medical fellows

D-H is an academic medical center where clinicians work closely with Dartmouth Medical School to train residents and fellows in their specialties.

296 medical students, 335

medical residents

Provide clinical education to other

health professionals and also continuing education for all health professionals.

As an academic medical center our commitment is to all health professions and their need for clinical education and continuing education.

5,000 – 7,500 doctors, nurses, technicians and

other health professionals

(We cannot track individuals

across programs)

The following tables summarize the value of D-H community benefits for FY 2006 and show trends in the cost of subsidizing government insurance programs. What counts as a community benefit has been evolving over time and is moving toward a national standard. But community benefit laws are state laws, so there are requirements unique to each state. Table 2 provides the dollar value of D-H community benefits. It is important to bear in mind that most of these values are related to activities, for instance, providing medical treatment to patients who cannot pay for the services, rather than to cash. The total value of the D-H report went up considerably in FY 2006 – because beginning this year we are counting the cost of subsidizing Medicaid as a benefit. For more information on changes in what counts from 2005 to 2006, see Attachment 5. TABLE 2. Value of FY 2006 Community Benefits Uncompensated Medicaid $34,508,700Cost of Financial Assistance to Patients $21,916,523Support for Medical & Other Professional Education* $13,086,443In-kind Support for Research & Other Grants $1,757,258All Other Community Health Activities $6,383,542TOTAL Community Benefits Value $77,652,466

For the past five years the report has included a table on the value of subsidies for Medicaid, Medicare and CHAMPUS subsidies. These tables were distinct from the community benefits value that the state tracks – but related. These subsidies provide financial support to government programs and to patients who qualify for the programs. Table 3 looks at these subsidies for FY 2006, and Table 4 looks at the trend in the cost of these subsidies over time.

10

TABLE 3. Uncompensated Costs of Medicaid and Medicare / CHAMPUS Uncompensated Medicaid $34,508,700Uncompensated Medicare/CHAMPUS $55,617,838TOTAL SUBSIDY FOR GOV. INSURANCE $90,126,538

TABLE 4. Trends in Uncompensated Costs of Medicaid and Medicare / CHAMPUS

2002 2003 2004 2005 2006$40 million $52 million $71 million $79 million $90 million

11

12

Section X. Attachments

Attachment 1

MARY HITCHCOCK MEMORIAL HOSPITAL DARTMOUTH-HITCHCOCK CLINIC

BOARDS OF TRUSTEES AND OFFICERS 2006

Emily R. Baker, MD DHC Trustee One Medical Center Drive Lebanon, NH 03756

603/650-8370 (o) emily.r.baker@hitchcock.org

Stephen P. Barba (Gail) MHMH/DHC Trustee DHC Board Vice-Chair #5 Ridgewood Lane Concord, NH 03301

603/535-3268 (o) 603/236-1446 (c) 603/228-4274 (h) 603-255-4221(f) sbarba@plymouth.edu Mary Hill, Admin Assistant 603/535-2722 mhhill@plymouth.edu.

Stephen F. Christy (Donna) MHMH/DHC Trustee Mascoma Savings Bank 67 North Park Street Lebanon, NH 03766 2000

603/448-3650 (o) 603/448-2427 (h) 603/448-1470 (f) stephen.christy@mascomabank.com

Thomas A. Colacchio, M.D. (Marie) DHC Trustee DHC President One Medical Center Drive Lebanon, NH 03756

603/650-7647 (o) 603/650-4220 (f) 802/649-5220 (h) thomas.a.colacchio@hitchcock.org

John C. Collins (Helene) DHC Trustee DHC Treasurer and Secretary One Medical Center Drive Lebanon, NH 03756

603/650-5326 (o) 603/650-7440 (f) 603/643-0365 (h) john.c.collins@hitchcock.org

Lawrence J. Dacey, MD (Linda) DHC Trustee One Medical Center Drive Lebanon, NH 03756 2003

603/646-8537 (o) lawrence.j.dacey@hitchcock.org

Carol J. Descoteaux, CSC, Ph.D. MHMH/DHC Trustee Sisters of Holy Cross 377 Island Road Manchester, NH 03109

603/622-9504 (o) 603/622-6818 (h) joyousong@hotmail.com (personal) cdcsc@srsofholycross.com (work)

13

14

William H. Edwards, M.D. DHC Trustee One Medical Center Drive Lebanon, NH 03756

603/650-5828 (o) william.h.edwards@hitchcock.org

Nancy A. Formella, MSN, RN (John) Acting President MHMH Trustee One Medical Center Drive Lebanon, NH 03756

603/650-8830 (o) nancy.formella@hitchcock.org

Robert C. Fuehrer (Sharon) MHMH/DHC Trustee MHMH Board Secretary 819 Bayley-Hazen Road-P.O. Box 15 Peacham, VT 05862

802/592-3326 (h) 802/592-3911 (f) bobandsharon@pivot.net

Michael J. Goran, MD MHMH/DHC Trustee BDC Advisors, LLC P.O. Box 144 156 Arch Rock Road The Sea Ranch, CA 95497-0144

707/884-9926 (o) 707/326-2743 (c) 707/785-1938 (h) 707/884-9906 (hf) mgoran@bdcadvisors.com

Wayne G. Granquist (Deborah) MHMH/DHC Trustee MHMH Board Vice-Chair P. O. Box 111, 74 Piper Hill Road Weston, VT 05161-0111

802/824-4100 (h) 802/824-4482 (f) wgranquist@mindspring.com

Alfred L. Griggs (Sally) MHMH/DHC Trustee MHMH Board Chair One Roundhouse Plaza, #302 Northampton, MA 01060

413/586-2922 (o) 413/584-4511 (h) 413/586-4423 (f) agriggs@choiceonemail.com

Alan C. Keiller (Joanne) MHMH/DHC Trustee MHMH Board Treasurer 85422 Dudley Chapel Hill, NC 27517 120 South Knob Hill Road West Windsor, VT 05089

919/932/7227 (h NC) 802/484-3940 (h VT) sienawine@aol.com P.O. Box 193 Brownsville, VT 05037

15

Jennie L. Norman (William Walker) MHMH/DHC Trustee 145 Eastside Road Harrisville, NH 03450

603/27-3731 jnorman@macmillin.comMacMillin 17 Elm Street P.O. Box 626, Keene, NH 03431

J. Brian Quinn (Allie) MHMH/DHC Trustee Chair, DH Assembly of Overseers 20 Low Road Hanover, NH 03755 112 Little Pierre Fraser, CO 80442

603/646-2515 (o) 603/643-2980 (h) 603/646-1308 (f) j.brian.quinn@dartmouth.edu 970/6-8571 (CO) (H & F)

Carolyn H. Sands MHMH/DHC Trustee 56 Farr Road Lebanon, NH 03766

603/448-0585 (h) kayosands@yahoo.com

Alan D. Sessler, M.D. (Martha) MHMH/DHC Trustee DHC Board Chair Wells Fargo 674 Mayo Clinic 200 First Street, SW Rochester, MN 55905

507/266-6866 (o) 507/282-0044 (h) 507/284-0291 (f) sessler.alan@mayo.edu

Richard S. Shreve (Shelly) MHMH Trustee P.O. Box 172 Orford, NH 03777

603/53-9090 (h) 603/46-9323 (o) richard.s.shreve@dartmouth.edu Physical Address: 22 Morey House Drive

Hugh C. Smith, MD (Aynsley) MHMH/DHC Trustee Mayo Clinic/Siebens 12th Floor Department of Administration 200 First Street SW Rochester, MN 55905

507/284-2984 (o) hcsmith@mayo.edutreuter.tricia@mayo.edu (Tricia, Assistant)

Stephen P. Spielberg, MD, PhD (Laurel) MHMH/DHC Trustee Dean, Dartmouth Medical School HB 7060 Hanover, NH 03755

603/650-1574 (o) stephen.p.spielberg@dartmouth.edu

Donald E. Watson (Karen) MHMH Trustee President, DHMC Auxiliary Board 44 Brickhouse Lane White River Jct., VT 05001

802/295-3907 (h) kardon.watson@valley.net

Diana J. Weaver (John) MHMH/DHC Trustee 118 Old Hickory Lane Versailles, KY 40383

859/873-2532 (h) 859/338-4799 (cell) djweaver@compuaid.com

William W. Wyman (Rosalie) MHMH/DHC Trustee 4 North Balch Street Hanover, NH 03755

603/643-9700 (o/h) 603/643-2254 (f) 603/667-1351 (c) billwyman@verizon.net

Robert H. Young (Victoria) MHMH/DHC Trustee 77 Grove Street Rutland, VT 05701

802/747-5596 (o) 802/747-2183 (f) 802/459-3336 (h) byoung@cvps.com

Assistant Treasurer: Richard H. Showalter Senior Vice President, Finance Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756 Richard.H.Showalter@hitchcock.org603-650-5668 (o) Administrative Support: Kimberley A. Gibbs Executive Assistant to the President Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756 Kim.gibbs@hitchcock.org603-650-7422 (o) 603-650-8765 (f) Revised: 7/06

16

Attachment 2

Berlin

Colebrook

Lancaster

Littleton

Plymouth

Canaan

Bedford

Milford Keene

Hudson

Randolph

Windsor

Brattleboro

LEGEND

Dartmouth-Hitchcock Regional ClinicDartmouth-Hitchcock Clinic Division

Nashua

Concord

Walpole

Jaffrey

Winchester

91

Dartmouth Hitchcock Medical Center and Health System

2006

89

91

3

New London

Lyndonville

Dartmouth-Hitchcock Medical Center

Dartmouth-Hitchcock Alliance Organization

Barre

Northampton

White River Jct.

Montpelier

Merrimack

Outreach

Peterborough

Dover

RochesterRutland

Springfield

Claremont

Hanover

Warren

Woodsville

Newport

91

Burlington

Lebanon

Manchester

Boston

89

89

93

93

93 St. Johnsbury

Newington

Wolfeboro Woodstock

Bennington

Lyme

17

Attachment 3

Partial List of DHMC Community Partners, FY'2006††

Access Rx Accreditation Council for Graduate Medical Education (ACGME) ACORN Adoptive Families for Children, Inc., Keene, NH Adult Tutorial Program of Southern Grafton County Advance Transit Albert Schweitzer Fellowship Alcoholics Anonymous

Alice Peck Day Memorial Hospital Alzheimer’s Association of VT & NH American Academy of Orthopaedic Surgeons American Academy of Pediatrics American Board of OB/GYN Competency Task Force American Board of Orthopaedic Surgery American Cancer Society American College of Healthcare Executives in NH Regents American College OB/GYN American Healthcare Foundation American Heart Association American Lung Association American Organization of Nurse Executives American Orthopaedic Association American Orthopaedic Society for Sports Medicine American Red Cross American Stroke Association AONE Patient Care Delivery Systems Task Force Bi-State Coalition For Community Health Improvement Brookside Health & Rehab Bugbee Senior Center Camp Lochearn for Girls Canaan Police CareNet Carter Community Building Association (CCBA) Casey Family Services Casting for Recovery Central Vermont Hospital Central Vermont Medical Center Chelsea Health Center Child and Family Services Child Health Services Board City of Lebanon

Claremont District Court Claremont School District Colby-Sawyer College College of American Pathologists Community Sports Organization Cooley Dickinson Health Care Corp C0-0P Food Stores (Hanover & Lebanon) Cradle & Crayon, Inc. CROP

18

†† Community Partners are non-profit agencies and grassroots groups with whom we collaborate to improve community health.

19

Crossroads Academy Crotched Mountain Dartmouth Center on Addiction, Recovery & Education (DCARE) Dartmouth Childcare Project Dartmouth College Dartmouth College Health Awareness Program

Dartmouth-Hitchcock Alliance Dartmouth-Hitchcock Medical Center DHMC Outpatient Falls Risk Reduction Task Force David’s House Dothan Brook School Doulas of North America Dresden Athletic Advisory Board Emergency Nurses Association Endometriosis Association Endowment for Health Enfield Police Department The Family Place Fannie CLAC, Lebanon, NH Foundation for Healthy Communities Gastroenterology Nurses Association Global Health Cares Good Beginnings Good Neighbor Health Clinic Goose Pond Association

Grafton County Corrections Grafton County Senior Citizen Council Grafton/Sullivan Child Advocacy Center Planning Committee

Grantham Village School Greater Lebanon Chamber of Commerce Greater Manchester Association of Social Service Agencies Greater Manchester Family YMCA Greater Nashua Healthy Community Collaborative Greater Nashua Home Visiting Collaborative Green Acres Partnership Hannah House Hanover Area Chamber of Commerce Hanover High School Youth in Action Hanover Improvement Society Hanover Juvenile Diversion Program Hanover Recreation Department Hanover School District Hanover Terrace HealthCare Hanover Water Company Hartford High School Hartford Vermont Brownie Troop 669 Hartford Vermont School District Headrest Healthcare Human Resource Association of New Hampshire

Health Care & Rehabilitation Services of Southeastern Vermont (HCRS) Healthy Manchester Leadership Committee Heritage United Way Hole in the Woods Ranch Camp Hospice of the Upper Valley HUB South Royalton, Vermont Health Clinic Indian River Nursery School Indian River School Interplast, Inc. Keene State College Kendal at Hanover

20

Ladies First of VT Lake Sunapee Region Visiting Nurse Association La Leche League of the Upper Valley

Lebanon City & Parks Lebanon College Lebanon High School

Lebanon Human Services Lebanon Kiwanis Club Lebanon Police Department Lebanon Recreation Department Lebanon Riverside Rotary Club Lebanon Rotary Club Lebanon School District Lebanon Senior Center Let No Woman Be Overlooked Licensed Dietitians Board Lifeline National Advisory Board Listen

Lyme Police Department Manchester Asthma Coalition Manchester Community Health Center Manchester Health Dept/Health Leadership Council Manchester Immunization Coalition – MIGHTY Manchester Regional Committee on Aging Manchester Visiting Nurse Association Mapping the Addiction Maze Network March of Dimes – National, New Hampshire and Vermont Mascoma Clinic Mascoma Savings Bank Mascoma School District Mascoma Valley Health Initiative Maternal Child Health Committee Mayor’s Task Force on Cancer Medicare Coverage Advisory Committee (MCAC) – Baltimore, MD The Mental Health Center of Greater Manchester Merriam Graves Medical Products Mid-Vermont Christian School Mt. Ascutney Prevention Partnership Nashua Regional Cancer Center Nashua Tobacco Free Coalition National Alliance on Mental Illness (NAMI) National American Physical Therapy Association National Board for Certification in Occupational Therapy National Committee for Quality Assurance Spine Care National Highway Traffic Safety Administration National Hospice Organization National Institute of Health AIDS Data Monitoring & Safety Board National Institutes of Health Program Project Grant Advisory Board National Quality Forum National WHRC New Beginnings – Belknap County Crisis Center New Beginnings of the Upper Valley New England College New England Organ Bank New Futures New Hampshire Academy of Family Physicians New Hampshire Association of Diabetes Educators

New Hampshire Association of Women’s Health, Obstetric & Neonatal Nurses New Hampshire Attorney General’s Office New Hampshire Attorney General’s Task Force on Child Abuse

21

New Hampshire Board of Medicine New Hampshire Brain Injury and Stroke Conference New Hampshire Breast Cancer Coalition New Hampshire Charitable Foundation New Hampshire Child Fatality Review Team New Hampshire Community Technical College New Hampshire Cooperative Extension Service New Hampshire DCYF NH Department of Alcohol & Drug Abuse Prevention & Recovery New Hampshire Department of Health and Human Services

New Hampshire Department of Justice/Charitable Trusts Division New Hampshire District Council

New Hampshire Division of Health and Human Services/Claremont Regional Office

New Hampshire Division of Health and Human Services/Concord New Hampshire Early Hearing Detection & Intervention Advisory Committee New Hampshire Emergency Medical & Trauma Services New Hampshire EMS Medical Control Board New Hampshire Endowment for Health New Hampshire Falls Risk Reduction Task Force New Hampshire Foundation for Healthy Communities New Hampshire Health & Education Authority Board New Hampshire Healthcare Quality Assurance Commission New Hampshire Healthy Kids New Hampshire Hospital Association New Hampshire Immunization Advisory Committee New Hampshire Leadership Team – National Standards Campaign on Domestic Violence New Hampshire Lithotripter Center, Inc. New Hampshire Medical Care Advisory Committee New Hampshire Medicare Advisory Committee New Hampshire Medical Society New Hampshire Minority Health Coalition New Hampshire Newborn Metabolic Screening Program New Hampshire Occupational Therapy Governing Board New Hampshire Office of Allied Health Professionals New Hampshire Organization of Nurse Leaders New Hampshire Society of Pathologists New Hampshire State Emergency Management Agency

New Hampshire Technical Institute New Hampshire Vaccine Association New Hampshire/Vermont Hospital Ethics Committee Network New London Hospital North Country Hollistic Group Northeastern Vermont Area Health Education Center (AHEC) Northeast Health Care Quality Foundation Northern New England ALS Society Northern New England Perinatal Quality Improvement Project Northern New England Poison Center Norwich Affordable Housing Norwich Fast Squad Norwich University Nursing Child Assessment Satellite Training (NCAST) Opera North

Orford Police Department OSIP Elderly Housing Group - Newbury, Vermont Ottauquechee Community Partnership Overeaters Anonymous Pastoral Counseling Services Board Pemi-Valley Habitat for Humanity (Plymouth, NH)

22

PLAG – Parents, Families & Friends of Lesbians & Gays Support Group Planned Parenthood of Northern New England Planned Parenthood of the Upper Valley Prevent Child Abuse (VT) Psycho-social OB High Risk Patients Coordination of Services Ray Helfer Society Red Cross of Central Vermont & NH Restless Leg Syndrome Support Group, Alice Peck Day Memorial Hospital Richmond Middle School River Valley Health Club Romano Circle Rotary District 7850 – Organ & Tissue Donor Awareness Program RSVP of Upper Valley Rural Health Advisory Council Second Growth Service Link of Grafton County SHARE (Infant Loss)

SOAR – Students Offering Aid and Relief Southeast State Correctional Facility

South Woodstock Community Club Speare Memorial Hospital Springfield Hospital Springfield Prevention Coalition State of New Hampshire Foundation for Healthy Communities State of Vermont Program for Quality in Health Care Sullivan County Community Coalition Sunapee Middle School

Surveillance & Prevention Advisory Board of the New Hampshire Office of Community and Public Health (OCPH)

TIAA-CRF Advisory Council Ticonderoga, NY, Women's Health Center Together in Health, "Natural Medicine Newsletter" Town of Hanover (Trustee of Trusts) Trails for Life Robert Wood Johnson Grant Group Tuberous Sclerosis Alliance Tufts University Tunbridge School Turning Point Club Twin Pines Housing Trust Board Twin State Regional Winter Special Olympics United Developmental Services United Healthcare National Musculoskeletal Scientific Advisory Board United States Consumer Product Safety Commission University of Connecticut PharmD Program University of New Hampshire University of Vermont Upper Valley Business and Education Partnership Upper Valley Child & Family Services Upper Valley Fatherhood Network Upper Valley Habitat for Humanity Upper Valley Haven Upper Valley Hostel Upper Valley Housing Coalition Upper Valley Lady Magic AAU Youth Basketball Upper Valley Land Trust Upper Valley Prevention Partnership Upper Valley Special Olympics Upper Valley Substance Abuse Foundation Upper Valley Support Group Upper Valley Teacher Institute

Upper Valley Town Health Inspectors Upper Valley Trails Alliance Upper Valley Transportation Management Association Upper Valley United Way Valley Regional Hospital Valley & Wheelock Terrace Vermont Bioterrorism Planning Committee Vermont Blueprint for Health Vermont Chapter International Executive Housekeepers Association (IEHA) Vermont Children's Aid Society Vermont Coalition of Clinics for the Uninsured Vermont DCYF Vermont Department of Corrections Vermont Department of Health / Alcohol & Drug Abuse Programs Vermont Department of WIC Program Vermont Emergency Nurses Association Vermont Ethics Network Vermont Health Resource Allocation Plan Advisory Committee Vermont Institute of Natural Sciences

Vermont Drug Court Vermont Medicaid Advisory Board Vermont National Guard Vermont Physicians Clinic Community Advisory Board Vermont Program for Quality in Health Care VHA Health Foundation Visiting Nurse Association & Hospice of VT & NH, Inc. Vital Communities Volunteer Optometric Service to Humanity (VOSH) West Central Behavioral Health WIC of Sullivan, Cheshire, and Grafton, NH, Counties Willow Grove Home WinCycle

Windsor County Court Diversion Windsor County Partners

Windsor High School (VT) WISE Woodstock Elementary School WorldKids Foundation

23

Attachment 4

Dartmouth-Hitchcock Alliance - FY 2006

Central Vermont Medical Center, Inc. 130 Fisher Road, P. O. Box 547 Barre, VT 05641 Cooley Dickinson Health Care Corporation 30 Locust Street, PO Box 5001 Northampton, MA 01061-5001 Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon, NH 03756

Mt. Ascutney Hospital & Health Center 289 County Road Windsor, VT 05089 New London Hospital 273 County Road New London, NH 03257

Northeastern Vermont Regional Hospital, Inc. 1315 Hospital Drive, P.O. Box 905 St. Johnsbury, VT 05819-9210

Upper Connecticut Valley Hospital 181 Corliss Lane Colebrook, NH 03576 Valley Regional Healthcare, Inc. 243 Elm Street Claremont, NH 03743

Visiting Nurse Association & Hospice of VT & NH 331 Olcott Drive, Suite U1 White River Junction, VT 05001-9263

Weeks Medical Center 173 Middle Street Lancaster, NH 03584

West Central Behavioral Health 2 Whipple Place Lebanon, NH 03766

24

Attachment 5

Changes to What Counts as a Community Benefit The major changes from last year to this year in what counts are related to payment in lieu of taxes and Medicaid. New national guidelines removed payment in lieu of taxes. Medicaid subsidies have counted in the national guidelines in the past, but New Hampshire was resistant to the idea until recently. 2005 2006 Payment in Lieu of Taxes Yes No Medicaid No Yes

Please note that Medicare / CHAMPUS did not count in the past, do not count now and are not likely to count in the future. This is because many hospitals break even or make money on Medicare / CHAMPUS.

25

Attachment 6

American Hospital Association Pledge

In accordance with a pledge to the American Hospital Association, Dartmouth-Hitchcock (D-H) is attaching this information to its Community Benefits Report filed with the state of New Hampshire: In Fiscal Year 2006 bad debt totaled $31.3 million and was so reported on the D-H Statement of Operations.

26