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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
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 1027
WILDER,VT05088 		22-2558708 501(c)3 36,600   FMV   PROGRAM SUPPORT
(2) Alice Peck Day Memorial Hospital
10 ALICE PECK DAY DRIVE
LEBANON,NH03766 		02-0222791 501(c)3 7,500   FMV   PROGRAM SUPPORT
(3) Amoskeag Health
145 HOLLIS STREET
MANCHESTER,NH03101 		02-0458174 501(c)3 13,500   FMV   PROGRAM SUPPORT
(4) BAYLOR COLLEGE OF MEDICINE
PO BOX 301207
DALLAS,TX753031207 		74-1613878 501(c)3 27,625   FMV   CHARITABLE EDUCATIONAL SERVICES
(5) BOSTON MEDICAL CENTER
ONE BOSTON MEDICAL CENTER PLACE
BOSTON,MA02118 		04-3314093 501(c)3 7,288   FMV   CHARITABLE RESEARCH
(6) BOSTON UNIVERSITY
PO BOX 28763
NEW YORK,NY100878763 		04-2103547 501(c)3 88,317   FMV   CHARITABLE RESEARCH
(7) BRIGHAM AND WOMEN'S HOSPITAL INC
75 FRANCIS ST
DEPT OF ORTHOPAEDIC
BOSTON,MA02115 		04-2312909 501(c)3 34,078   FMV   CHARITABLE RESEARCH
(8) CEDARS-SINAI MEDICAL CENTER
6500 WILSHIRE BLVD SUITE 1150
LOS ANGELES,CA90048 		95-1644600 501(c)3 32,855   FMV   CHARITABLE RESEARCH
(9) CENTERSTONE RESEARCH INSTITUTE INC
44 VANTAGE WAY
NASHVILLE,TN372281565 		26-2505456 501(c)3 63,149   FMV   CHARITABLE RESEARCH
(10) Cheshire Medical Center
580 COURT STREET
KEENE,NH03431 		02-0354549 501(c)3 22,339   FMV   PROGRAM SUPPORT
(11) CHILDREN'S HOSPITAL LOS ANGELES
4650 SUNSET BOULEVARD
LOS ANGELES,CA90027 		19-5612191 501(c)3 10,447   FMV   CHARITABLE RESEARCH
(12) CLEVELAND CLINIC FOUNDATION
PO BOX 931562
CLEVELAND,OH441935012 		34-0714585 501(c)3 5,698   FMV   CHARITABLE RESEARCH
(13) COMMONWEALTH OF MASSACHUSETTS
DEPT OF REVENUE
BOSTON,MA022055140 		04-6002284 Section 115 91,588   FMV   EDUCATIONAL SERVICES
(14) COOS COUNTY FAMILY HEALTH SERVICES
133 PLEASANT STREET
BERLIN,NH03570 		02-0350051 501(c)4 7,351   FMV   CHARITABLE PROGRAM SUPPORT
(15) CREARE LLC
16 GREAT HOLLOW RD
HANOVER,NH03755 		02-0259551 For Profit 9,504   FMV   EXPLORATORY/DEVELOPMENTAL RESEARCH
(16) DUKE UNIVERSITY
ACCOUNTS RECEIVABLE LOCKBOX
CHARLOTTE,NC282602651 		56-0532129 501(c)3 5,827   FMV   CHARITABLE EDUCATIONAL SERVICES
(17) Families Flourish Northeast
PO BOX 20
ENFIELD CENTER,NH037489998 		84-4591232 501(c)3 12,091   FMV   PROGRAM SUPPORT
(18) Families in Transition
NEW HORIZONS
199 MANCHESTER STREET
MANCHESTER,NH03103 		02-0475414 501(c)3 9,000   FMV   PROGRAM SUPPORT
(19) FAMILY PLACE INC
319 US ROUTE 5 SOUTH
NORWICH,VT05055 		03-0305264 501(c)4 15,943   FMV   CHARITABLE PROGRAM SUPPORT
(20) Foundation for Healthy Communities (NHHA)
125 AIRPORT ROAD
CONCORD,NH03301 		02-0275078 501(c)3 512,513   FMV   PROGRAM SUPPORT
(21) Girls Incorporated of New Hampshire
1711 SOUTH WILLOW STREET
UNIT 5
MANCHESTER,NH03103 		23-7416090 501(c)3 6,750   FMV   PROGRAM SUPPORT
(22) Good Neighbor Health Clinic
70 NORTH MAIN STREET
WHITE RIVER JCT,VT05001 		03-0346949 501(c)3 28,500   FMV   PROGRAM SUPPORT
(23) Grafton County Senior Citizens Council
PO BOX 433
LEBANON,NH03766 		23-7248316 501(c)3 10,500   FMV   PROGRAM SUPPORT
(24) Granite United Way
22 CONCORD STREET
FLOOR 2
MANCHESTER,NH03101 		02-6006033 501(c)3 12,000   FMV   PROGRAM SUPPORT
(25) HARVARD UNIVERSITY
HARVARD MED-CME
BOSTON,MA021170825 		04-2103580 501(c)3 8,483   FMV   CHARITABLE EDUCATIONAL SERVICES
(26) HIVHCV Resource Center
2 BLACKSMITH ST
LEBANON,NH03766 		22-3104237 501(c)3 6,000   FMV   PROGRAM SUPPORT
(27) JSI Research & Training Institute Inc
501 SOUTH STREET 2ND FL
BOW,NH03304 		04-2679824 501(c)3 6,000   FMV   PROGRAM SUPPORT
(28) MAINE MEDICAL CENTER
22 BRAMHALL STREET
PORTLAND,ME04102 		01-0211494 501(c)3 141,442   FMV   CHARITABLE PROGRAM SUPPORT
(29) MAPS COUNSELING SERVICES
23 CENTRAL SQUARE SUITE 300
KEENE,NH03431 		02-0312473 501(c)3 48,642   FMV   CHARITABLE PROGRAM SUPPORT
(30) MASSACHUSETTS GENERAL HOSPITAL
100 CHARLES RIVER PLAZA STE 600
BOSTON,MA021142792 		04-2697983 501(c)3 58,882   FMV   CHARITABLE RESEARCH
(31) MAYO CLINIC
PO BOX 4003
ROCHESTER,MN55905 		41-6011702 501(c)3 7,055   FMV   CHARITABLE RESEARCH
(32) MEDICAL UNIVERSITY OF SOUTH CAROLINA
COLLEGE OF NURSING AT P BONHAM
CHARLESTON,SC29407 		57-6000722 Section 115 96,973   FMV   EDUCATIONAL SERVICES
(33) MICHIGAN STATE UNIVERSITY
GRANTS CONTRACT ADMINISTRATION
EAST LANSING,MI48824 		38-6005984 Section 115 7,231   FMV   EDUCATIONAL SERVICES
(34) Monadnock Family Services
17 93RD ST
ACCOUNTS RECEIVABLE DEPT
KEENE,NH03431 		02-6012230 501(c)3 8,406   FMV   PROGRAM SUPPORT
(35) Mt Ascutney Hospital and Health Center
289 COUNTY ROAD
WINDSOR,VT05089 		03-0183721 501(c)3 30,000   FMV   PROGRAM SUPPORT
(36) New Hampshire Charitable Foundation
37 PLEASANT STREET
CONCORD,NH03301 		02-6005625 501(c)3 18,000   FMV   PROGRAM SUPPORT
(37) New Hampshire Hunger Solutions Inc
PO BOX 3477
CONCORD,NH03301 		22-2936618 501(c)3 7,500   FMV   PROGRAM SUPPORT
(38) NEW HAMPSHIRE LEGAL ASSISTANCE
117 NORTH STATE STREET
CONCORD,NH03301 		02-0300897 501(c)3 22,252   FMV   CHARITABLE PROGRAM SUPPORT
(39) New London Hospital
273 COUNTY ROAD
NEW LONDON,NH03257 		02-0222171 501(c)3 10,831   FMV   PROGRAM SUPPORT
(40) NEW YORK UNIVERSITY
NYU RORY MEYERS COL OF NURSING
NEW YORK,NY10010 		13-5562308 Section 115 6,431   FMV   EDUCATIONAL SERVICES
(41) NH Triple Play LLC
ONE LINE DRIVE
MANCHESTER,NH03101 		32-0153852 501(c)3 26,700   FMV   PROGRAM SUPPORT
(42) NORTH COUNTRY HEALTH CONSORTIUM INC
262 COTTAGE STREET
LITTLETON,NH03561 		02-0503184 501(c)3 5,683   FMV   CHARITABLE PROGRAM SUPPORT
(43) NORTHWESTERN UNIVERSITY
DEPT OF MEDICAL SOCIAL SERVICES
CHICAGO,IL60611 		36-2167817 501(c)3 6,393   FMV   CHARITABLE EDUCATIONAL SERVICES
(44) OREGON CLINIC PC
847 NE 19TH AVENUE
PORTLAND,OR97232 		93-1127856 501(c)3 14,061   FMV   CHARITABLE RESEARCH
(45) OREGON HEALTH & SCIENCE UNIVERSITY
PO BOX 575
PORTLAND,OR97207 		93-1176109 501(c)3 39,240   FMV   CHARITABLE EDUCATIONAL SERVICES
(46) PUBLIC HEALTH COUNC OF THE UPPER VALLEY
ONE COURT STREET
LEBANON,NH03766 		75-2991608 501(c)3 38,653   FMV   CHARITABLE PROGRAM SUPPORT
(47) REGENTS OF THE UNIVERSITY OF CALIFORNIA
UCSD CAMPUS MAIN DEPOSITORY
LOS ANGELES,CA900741539 		94-3067788 Section 115 18,425   FMV   EDUCATIONAL SERVICES
(48) RESEARCH INSTITUTE AT NATIONWIDE CHILDRE
PO BOX 781653
DETROIT,MI482781653 		31-6055230 501(c)3 78,682   FMV   CHARITABLE RESEARCH
(49) RHODE ISLAND HOSPITAL
PO BOX 373
PROVIDENCE,RI02901 		05-0258954 501(c)3 10,129   FMV   CHARITABLE RESEARCH
(50) SEATTLE CHILDREN'S HOSPITAL
PO BOX 24728
SEATTLE,WA981240728 		91-0564748 501(c)3 28,837   FMV   CHARITABLE RESEARCH
(51) SEVEN COUNTIES SERVICES INC
10401 LINN STATION RD
LOUISVILLE,KY40223 		31-0939757 501(c)3 54,093   FMV   CHARITABLE RESEARCH
(52) SINAI HOSPITAL OF BALTIMORE INC
2401 W BELVEDERE AVENUE
BALTIMORE,MD21215 		52-0486540 501(c)3 10,352   FMV   CHARITABLE RESEARCH
(53) Southeast Vermont Transit Inc
706 ROCKINGHAM ROAD
ROCKINGHAM,VT05101 		03-0353976 501(c)3 9,000   FMV   PROGRAM SUPPORT
(54) Southwestern Community Services
63 COMMUNITY WAY
KEENE,NH03431 		02-6013808 501(c)3 7,800   FMV   PROGRAM SUPPORT
(55) STANFORD UNIVERSITY
430 BROADWAY STREET MC6342
REDWOOD CITY,CA94063 		94-1156365 501(c)3 12,831   FMV   CHARITABLE RESEARCH
(56) Sullivan County
14 MAIN STREET
NEWPORT,NH03773 		02-6000870 Sullivan County 12,000   FMV   PROGRAM SUPPORT
(57) THE OHIO STATE UNIVERSITY
OFFICE OF SPONSORED PROGRAMS
COLUMBUS,OH43210 		31-6025986 Section 115 13,930   FMV   EDUCATIONAL SERVICES
(58) TLC FAMILY RESOURCE CENTER
PO BOX 1098
CLAREMONT,NH03743 		52-2439830 501(c)3 13,071   FMV   CHARITABLE PROGRAM SUPPORT
(59) Tri-Valley Transit
dba ACTR AND STSI
297 CREEK ROAD
MIDDLEBURY,VT05753 		03-0335768 501(c)3 24,563   FMV   PROGRAM SUPPORT
(60) TRUSTEES OF DARTMOUTH COLLEGE
CASHIERS OFFICE / AR
HANOVER,NH03755 		02-0222111 501(c)3 708,987   FMV   CHARITABLE EDUCATIONAL SERVICES
(61) TRUSTEES OF THE UNIV OF PENNSYLVANIA
THE WHARTON SCHOOL
PHILADELPHIA,PA191789726 		23-1352685 Section 115 11,001   FMV   EDUCATIONAL SERVICES
(62) Turning Point Recovery Center of
SPRINGFIELD VT
7 MORGAN STREET
SPRINGFIELD,VT05156 		04-3803952 501(c)3 6,000   FMV   PROGRAM SUPPORT
(63) Twin Pines Housing Trust
226 HOLIDAY DRIVE
SUITE 20
WHITE RIVER JCT,VT05001 		22-2809527 501(c)3 42,000   FMV   PROGRAM SUPPORT
(64) UNIV SYSTEM OF NEW HAMPSHIRE
5 CHANELL DRIVE
CONCORD,NH03301 		02-6000937 Section 115 19,870   FMV   EDUCATIONAL SERVICES
(65) UNIVERSITY OF ALABAMA AT BIRMINGHAM
GRANTS CONTRACTS ACCOUNTING
BIRMINGHAM,AL352940109 		63-6005396 Section 115 55,432   FMV   EDUCATIONAL SERVICES
(66) UNIVERSITY OF COLORADO
OFFICE OF GRANTS/CONTRACTS-F428
DENVER,CO802910238 		84-6000555 Section 115 10,280   FMV   EDUCATIONAL SERVICES
(67) UNIVERSITY OF MARYLAND
ACCOUNTING AND COMPLIANCE
BALTIMORE,MD212011531 		52-6002033 Section 115 49,070   FMV   EDUCATIONAL SERVICES
(68) UNIVERSITY OF MIAMI
DEPARTMENT OF PATHOLOGY
ATLANTA,GA303845776 		59-2695890 Section 115 6,704   FMV   EDUCATIONAL SERVICES
(69) UNIVERSITY OF NEBRASKA MEDICAL CTR
985100 NEBRASKA MED CTR
OMAHA,NE681985100 		47-0491233 Section 115 6,693   FMV   EDUCATIONAL SERVICES
(70) UNIVERSITY OF PITTSBURGH
FORBES ALLIES BUILDING STE 300
PITTSBURGH,PA15213 		25-0965591 Section 115 69,630   FMV   EDUCATIONAL SERVICES
(71) UNIVERSITY OF UTAH
GRANTS CONTRACTS ACCOUNTING
SALT LAKE CITY,UT841129020 		87-6000525 Section 115 8,215   FMV   EDUCATIONAL SERVICES
(72) UNIVERSITY OF WASHINGTON
GRANT CONTRACT ACCOUNTING
CHICAGO,IL60693 		91-6001537 Section 115 10,899   FMV   EDUCATIONAL SERVICES
(73) Upper Valley Community Nursing Project
PO BOX 1302
LEBANON,NH03766 		83-1224873 501(c)3 6,000   FMV   PROGRAM SUPPORT
(74) Upper Valley Haven
713 HARTFORD AVE
WHITE RIVER JCT,VT05001 		03-0277908 501(c)3 22,500   FMV   PROGRAM SUPPORT
(75) VANDERBILT UNIVERSITY MEDICAL CENTER
VUMC FINANCE DEPT 1236
DALLAS,TX753121236 		35-2528741 501(c)3 18,466   FMV   CHARITABLE EDUCATIONAL SERVICES
(76) VIRGINIA COMMONWEALTH UNIVERSITY
800 E Leigh Street Suite 3200
RICHMOND,VA23219 		54-6001758 Section 115 15,025   FMV   EDUCATIONAL SERVICES
(77) Vision for Creative Housing Solutions
8 SUNRISE FARM LANE
ENFIELD,NH03748 		80-0868234 501(c)3 7,500   FMV   PROGRAM SUPPORT
(78) Vital Communities
195 NORTH MAIN STREET
WHITE RIVER JCT,VT05001 		03-0355283 501(c)3 7,500   FMV   PROGRAM SUPPORT
(79) West Central Behavioral Health
85 MECHANIC STREET
SUITE C2-1
LEBANON,NH03766 		22-2645978 501(c)3 15,000   FMV   PROGRAM SUPPORT
(80) Willing Hands Enterprises
198 CHURCH STREET
NORWICH,VT05055 		20-2204811 501(c)3 9,450   FMV   PROGRAM SUPPORT
(81) Women's Information Service of the Upper Valley
38 BANK STREET
LEBANON,NH03766 		02-0346512 501(c)3 6,000   FMV   PROGRAM SUPPORT
(82) Hitchcock Foundation
One Medical Center Drive
LEBANON,NH03756 		02-0222139 501(c)3 236,380   FMV   PROGRAM SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
79
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
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 26 264,333   FMV  
(2) Patient Assistance 1377 44,481   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) 2021



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