2023-06-27T15:29:29-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 030266986 Northwestern Medical Center NORT 8025245911 133 Fairfield St St Albans VT 05478 Stephanie Breault CFO 8025245911 2023-06-26 1 Stephanie Breault 999009999 Joseph R Byrne P01289281 2077752387 2023-06-26 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Peter Wright 133 Fairfield St St Albans VT 05478 125846577 0 X www.northwesternmedicalcenter.org X 1977 VT Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 11 10 982 71 0 0 4732300 477513 124050547 121286732 9468245 421575 334844 574533 138585936 122760353 63561 62169 0 0 67098101 60600867 0 0 0 55801518 66573549 122963180 127236585 15622756 -4476232 180177619 166987756 47438080 46304618 132739539 120683138 X Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 0 1 84221710 62169 121838654 Providing inpatient and outpatient services to the general public in a full-service 70-bed hospital. The Hospital publishes an annual report. Please refer to the annual report for additional explanation of the Hospital's programs and achievements. Charity Care - The Hospital provides care to patients who meet certain criteria under its charity care policy. Because the Hospital does not pursue collection or amounts determined to qualify as charity care they are not reported in revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The records include the amount of charges foregone for services and supplies furnished under its charity care policy, the estimated cost of those services and supplies and equivalent service statistics. The following information measures the level of charity care provided during the year ended September 30, 2022.See continuation on Schedule O. Estimated costs and expenses incurred to provide charity care: $913,094Number of charity care patients served: 1,168The Hospital provides health care services to residents of St. Albans, Vermont, and the surrounding area, without regard to the individual's ability to pay for their services. 84221710 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 124 0 1 982 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VT X Stephanie Breault CPA 8025245911 133 Fairfield Street St Albans VT 05478 Jake Holzscheiter President 5.00 0.00 X X 0 0 0 John Casavant Vice President 5.00 0.00 X X 0 0 0 Dawn Bugbee Treasurer 5.00 0.00 X X 0 0 0 Barb Toof Secretary 5.00 0.00 X X 0 0 0 Nick Hadden Member 5.00 0.00 X 0 0 0 Karyn Rocheleau Member 5.00 0.00 X 0 0 0 Corey Parent Member 5.00 0.00 X 0 0 0 Dr Lawrence Sullivan MD Member / OB Physician 40.00 0.00 X 561873 0 37710 Erin Creley Member 5.00 0.00 X 0 0 0 Coleen Kohaut Member 5.00 0.00 X 0 0 0 Matthew Habedank Member 5.00 0.00 X 0 0 0 Dean French Past CEO 40.00 0.00 X 439079 0 32444 Robyn Alvis Past COO 40.00 0.00 X 239696 0 26097 Stephanie Breault CFO 40.00 0.00 X 220780 0 33518 Jonathan Billings COO/Interim CEO 40.00 0.00 X 179268 0 24007 Dr John Minadeo Chief Medical & Quality Officer 40.00 0.00 X 387382 0 35254 Dr Andrew Myrtue MD Orthopedic Physician 40.00 0.00 X 583819 0 5800 Dr Robert Beattie MD Orthopedic Physician 40.00 0.00 X 642634 0 35145 Dr Nathan Mauser MD Orthopedic Physician 40.00 0.00 X 582050 0 15349 Dr Gregory Brophey MD Ophthalmologist 40.00 0.00 X 555511 0 27842 Dr Kahren K Aydinyan MD Physician 40.00 0.00 X 464876 0 7212 4856968 0 280378 123 0 1 0 Shiftwise PO Box 70870 St Paul MN 55170 Traveler Staffing 8564733 Freedom Healthcare Staffing 1851 S Parker Rd Suite 1100 Aurora CO 80014 Traveler Staffing 2988746 University of Vermont Medical Center PO Box 1902 Burlington VT 05402 Various Medical Services 1995826 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Traveler Staffing 1570934 Clinical Colleagues 1121 N Bethlehem Pike Suite 60-234 Spring House PA 19477 Anesthesia Services 1531073 12 39413 400566 37534 477513 Patient Service Revenue 622100 256111955 256111955 Other Operating Revenue 622100 6070452 6070452 Cafeteria 622100 441365 441365 Contractual Allowances/Char. Adj. 622100 -141337040 -141337040 121286732 1439814 1439814 588737 36815 551922 551922 551922 2018718 746 3037703 0 -1018985 746 -1018239 -1018239 32416 39413 11706 20710 20710 1901 0 1901 1901 122760353 121397289 0 885551 X 11951 11951 50218 50218 2217108 1429591 787517 45927497 29614050 16313447 2332186 1503794 828392 6926790 4466394 2460396 3197286 2061610 1135676 447971 288852 159119 105144 67797 37347 142634 91970 50664 13046 13046 167617 167617 30159190 19446646 10712544 173798 112065 61733 579967 373963 206004 2117498 1365363 752135 139064 89668 49396 617285 398026 219259 6351177 4095239 2255938 1696960 1094200 602760 Supplies 14153172 9125965 5027207 Provider Tax 6857254 6857254 0 Miscellaneous Expenses 2426716 1403018 1023698 Dues & Subscriptions 425056 274076 150980 127236585 84221710 43014875 0 X 15139480 11109675 19064044 16913279 9042305 10010921 1980728 2194021 2100976 2197754 142414046 74859849 69585327 67554197 55428246 51101428 1998968 5837545 5906481 180177619 166987756 9545548 10216524 28175042 26581142 1571901 1477811 8145589 8029141 47438080 46304618 X 129041863 117312710 3697676 3370428 132739539 120683138 180177619 166987756 X -4476232 -9790227 2210058 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13046 13046 0 Part II-B, Line 1: Northwestern Medical Center is a member of the Vermont Association of Hospitals and Health Systems and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Northwestern Medical Center and other member organizations in furtherance of their exempt purposes. 1335762 -242224 1093538 1142938 192824 1335762 1145463 -2525 1142938 1144129 1334 1145463 1118351 25778 1144129 0.00000 1.00000 0.00000 1 0 1020531 1020531 89698576 38510448 51188128 46032510 33753928 12278582 5662429 2595473 3066956 67554197 Estimated Third-Party Settlements 4165848 Deferred Compensation 3863293 8029141 114769339 -9790227 2452282 -7337945 122107284 167617 485452 653069 122760353 126825740 0 126825740 167617 243228 410845 127236585 Part V, Line 4: The Organization intends to use the endowment funds in the manner prescribed by the donors. Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swaps 2,452,282. Part XI, Line 4b - Other Adjustments: Depreciation in Beneficial Interest in Perpetual Trusts 242,224. Expenses netted against revenue for financial statement purposes 243,228. Part XII, Line 4b - Other Adjustments: Expenses netted against revenue for financial statement purposes 243,228. Schedule D, Part V, Line 3a(i) The Organization has Beneficial Interest in Trusts which are not held at nor in the possession of the Organization. Jim Bashaw Cancer - Run for Jim 11454 8824 2630 500 Community Partners Golf Tournament 52471 30589 21882 6607 3999 1 7904 7904 600 71829 39413 32416 500 6607 4599 11706 20710 1901 0 1901 1901 0 0 0 0 0 0 1 1 1 X 400.000000000000 1 X 1 1 1 0 0 799035 799035 0.00630 31956414 16361298 15595116 0.12260 32755449 16361298 16394151 0.12890 2235634 1694340 541294 0.00430 62169 62169 0.00050 2297803 1694340 603463 0.00480 35053252 18055638 16997614 0.13370 1 0 21138091 37143584 -16005493 X 1 1 1 1 Northwestern Medical Center 133 Fairfield Street St Albans VT 05478 www.northwesternmedicalcenter.org 930 X X X Northwestern Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X See Part V, Page 8 X X 1 21 1 See Part V, Page 8 0 1 X 400.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X 1 X 0 X X X X 1 X 0 0 Northwestern Medical Center Part V, Section B, Line 5: As part of our 2021/2022 (FY'22) Community Health Needs Assessment, NMC gathered input in a variety of ways including interviews with physicians, providers, and community partners; perspectives from staff and volunteers; discussions with the Incorporators from throughout our service area; patient satisfaction insights; and utilization trend analysis. Significant input, perspective, and prioritization were received through a local group of experts who were asked to validate the direction and findings of the assessment and to establish priority among various identified issues. The composition of this group of community members aligns with the Federal regulations for involvement of community leaders with specified skills or representing specified constituencies and allows for them to use their connections to their neighbors and clientele and insights there in to assist in refining and prioritizing the community health needs. Northwestern Medical Center Part V, Section B, Line 6b: Center for Rural Studies at the University of VermontAbenaki Nation of MissisquoiChamplain Valley Office of Economic OpportunityFranklin County Home Health AssociationNorthwest Counseling and Support ServicesNorthwest Regional Planning CommissionNorthern Tier Center for HealthUnited Way of Northwest VermontVermont Department of Health Northwestern Medical Center Part V, Section B, Line 7d: In addition to making the Community Health Needs Assessment widely available via the hospital website and in response to requests, Northwestern Medical Center provided overviews of the Community Health Needs Assessment to members of the community through presentations at groups such as the NMC Incorporators (150 local members who elect the hospital Board); the Boards of Directors of Northwestern Medical Center, Franklin County Home Health Agency; Northwestern Counseling & Support Services, NOTCH (Northern Tier Centers for Health Federally Qualified Health Centers); and the St. Albans Rotary comprised of business and civic leaders from across the region; and via Health Beat, NMC's public access television show. The priorities of the Community Health Needs Assessment are frequently referenced in other hospital documents, plans, publications, and presentations as we work to integrate these findings into our efforts to care for our community. Northwestern Medical Center Part V, Section B, Line 11: NMC is addressing the significant needs identified in its most recently conducted CHNA through a variety of initiatives including: Access to healthcare (continuing to increase access to local specialty care services in our community, including cardiology, midwifery, physician medicine & rehab services, inpatient pediatrics, tele-neurology, urology, etc.), Affordability of services and cost of living (continuing to work with our community in implementing the State's value-based care model to reduce health care costs, improving patient experience, increasing equity and improving population health), Safety and Belonging (exploring opportunities for continued alignment and partnership with local public transportation providers; engaging in opportunities to promote community activities and resources that bring people together, foster belonging, and improve the overall quality of life) and Community Gathering and Connectedness (creating safe spaces by having opportunities for modeling our differences as staff, medical staff, and administration drawing guidance from our DEI work, which could include encouraging pronoun usage in our communications, showing support through intentional actions, posting "welcome" in different languages etc.). The Community Health Improvement Plan was developed by recognizing NMC's role as a community hospital in addressing the health needs of the population, as well as developing an understanding of what other organizations are doing to address the needs of the populations we serve. In addition, we restructured our Accountable Community for Health to specifically address systematic issues that are creating barriers to health. NMC's most recent CHNA also addressed several additional items that NMC is working with other community partners to lead the CAIRES Accountable for Health (ACH). The mission of the CAIRES ACH is to design health and service systems together with communities to be equitable, responsibe, and adaptable. Our vision is that Grand Isle and Franklin Counties will be inclusive, self-determined, health communities where everyone is well, safe, nurtured, and respected. To encourage collaboration and reduce the impact hierarchies of systemic oppression have on communities. The structure of the ACH de-centralizes decision making. The ACH is made of three group types with specific purposes and decision-making powers.-The CAIRES Circle is focused on the ongoing sustainability of the ACH and supports collaboration across workgroups.-Workgroups are formed around specific areas of focus and make decisions related to workgroup goals.-The Production Team provides organization and administrative support across the ACH to support the shared vision and mission of the ACH.NMC's Director of Population Health serves on the Production Team and attends the CAIRES Circle with members of NMC's senior leadership team. Members of NMC's Department of Population Health are leading and serving on workgroups, including:1. A Regional Transportation Workgroup2. The Transitions of Care Workgroup3. Youth Health Workgroup4. Outpatient Service Medical Workgroup5. Homeless Healthcare Workgroup Part V, line 10a, Hospital facility's website: https://www.northwesternmedicalcenter.org/about-nmc/hospital-data/community-assessments/ Part V, line 17a, Hospital facility's website: https://www.northwesternmedicalcenter.org/about-nmc/hospital-data/community-assessments/ Part V, line 16a, FAP website: https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/ Part V, line 16b, FAP Application website: https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/ Part V, line 16c, FAP Plain Language Summary website: https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/ 8 1 - Northwestern Medical Center Pediatrics 11 Crest Road St Albans VT 05478 Pediatrics 2 - Northwestern Walk-in Clinic 927 Ethan Allen Hwy Ste 2 Georgia VT 05468 Diagnostic Imaging, Physical Therapy & Urgent Care 3 - Northwestern Georgia Health Center 4178 Highbridge Road Georgia VT 05486 Primary Care 4 - Northwestern Comprehensive Pain 17-19 Catherine Street St Albans VT 05478 Pain Care 5 - Northwestern Ophthalmology 53 Fairfax Road St Albans VT 05478 Ophthalmology 6 - Physical Therapy Services 44 Center Street Enosburg VT 05450 Physical Therapy 7 - Branon's Pools & Spa 248 North Main Street St Albans VT 05478 Physical Therapy 8 - Northwestern Medical Center Pediatrics 12 First Street Swanton VT 05488 Pediatrics Part I, Line 3c: Determining eligibility for free care and/or discounted care is not solely determined by Federal Poverty Guidelines (FPG). Other considerations, such as net worth, other financial obligations, and outstanding medical bills are reviewed in addition to income. Part I, Line 7g: Subsidized health services includes the Medicare shortfall from physician practices that are not included in the Hospital's cost reporting reflected on Part III, Line 7. Part III, Line 4: See pages 8-12 of the attached audited financial statements. Part III, Line 8: The cost was determined using the cost to charge ratio.The Medicare shortfall of $16,005,494 reported on line 7 of Part III, does not represent all Medicare services provided by the Hospital, as required by IRS instructions. When taking all Medicare services into account, the Hospital calculated a different Medicare shortfall using an internal costing methodology. Part III, Line 9b: During the collection process, financial assistance, a payment plan or a discount may be offered to the patient, if appropriate, and in accordance with established hospital policy. Part VI, Line 2: In alignment with the Federal mandate, Northwestern Medical Center conducted a comprehensive Community Health Needs Assessment in 2022. This document was formally approved by the Hospital's Board of Directors at their May 6, 2022 meeting, placing it in the Hospital's 2022 Fiscal Year. This document replaces the previous Community Health Needs Assessment which was approved in the Hospital's 2019 Fiscal Year.Five top priorities were identified: BIPOC; Healthy & affordable food; Affordability of Healthcare; Reliable Transportation and Environmental, Physical and Emotional Safety - and action plans have been created to help address each of these priorities. The current (and previous) assessment is available free of charge on the Hospital website and the Hospital's Community Relations Office is available to provide free printed copies as requested. Part VI, Line 3: The Hospital uses a variety of methods of communication to inform and educate patients about its financial assistance program. For example, information related to financial assistance and charity care is available on the Hospital's website and patient portal, included on the back of patient statements, posted on signs at registration areas, and patients may speak on the phone with a collection specialist. The Hospital's financial assistance program is also widely publicized within the community, including published information regularly placed in the local newspaper and information brochures displayed at local United Way and Department of Health offices. Part VI, Line 4: The Hospital serves the greater Franklin and Grand Isle counties in northwestern Vermont. The service area consists of approximately 56,000 people and the area is primarily rural and agricultural in nature with some light industry. Part VI, Line 5: The Hospital maintains an open medical staff and a community based Board of Directors. The Hospital's Board of Directors is elected by the Hospital's Board of Incorporators, which consists of approximately 150 local residents. The Hospital created and funds a program known as The Center for Health and Wellness, which is committed to a collaborative approach to community health improvement. 1 Howard Center Inc 208 Flynn Avenue Suite 3J Burlington VT 05401 030179433 501(c)(3) 11000 0 Support programs complimentary to the Hospital's exempt purpose. 1 0 Scholarships 3 6000 Bashaw Grants 88 44218 Part I, Line 2: All grants are periodically reviewed for compliance with NMC's grant policy. Assistance is given with appropriate management approval for the benefit of 501(c)(3) public charities, government agencies and individuals whom have been determined to meet the criteria of need stated in NMC's grant policy. Special purpose grants, such as scholarships, are sent directly to educational institutions or loan agencies. After the approval process has been completed by management, request for grant payment is submitted to Finance to release the grant funds according to the required information and approval provided. 1 X X X 0 0 0 0 0 0 0 1 0 Dr Robert Beattie MD Orthopedic Physician 593134 0 30000 0 19500 0 4333 0 30812 0 677779 0 0 0 Dr Lawrence Sullivan MD Member / OB Physician 523290 0 38583 0 0 0 5800 0 31910 0 599583 0 0 0 Dr Nathan Mauser MD Orthopedic Physician 562550 0 0 0 19500 0 5800 0 9549 0 597399 0 0 0 Dr Andrew Myrtue MD Orthopedic Physician 583819 0 0 0 0 0 5800 0 0 0 589619 0 0 0 Dr Gregory Brophey MD Ophthalmologist 506011 0 30000 0 19500 0 5800 0 22042 0 583353 0 0 0 Dr Kahren K Aydinyan MD Physician 336367 0 109009 0 19500 0 5800 0 1412 0 472088 0 0 0 Dean French Past CEO 439079 0 0 0 0 0 5800 0 26644 0 471523 0 0 0 Dr John Minadeo Chief Medical & Quality Officer 367882 0 0 0 19500 0 5800 0 29454 0 422636 0 0 0 Robyn Alvis Past COO 239696 0 0 0 0 0 4896 0 21201 0 265793 0 0 0 Stephanie Breault CFO 220780 0 0 0 0 0 4506 0 29012 0 254298 0 0 0 Jonathan Billings COO/Interim CEO 179268 0 0 0 0 0 3657 0 20350 0 203275 0 0 0 Part I, Line 7 Robert Beattie, Gregory Brophey, Kahren K. Aydinyan, Highest Compensated Employees, and Lawrence Sullivan, Board Member, received bonuses from an incentive compensation plan. A Vermont Educational & Health Building Financing Agency 237154467 NoneAvail 2016-06-01 35000000 Refund 2012A Bond and New Capital Projects 0 0 0 A 8256672 35000000 235906 17429519 17334575 2017 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 1 People's United Bank 12.000000000000 1 0 0 0 1 A 1 Form 990, Part III, line 3 On May 2, 2022, Northwestern Primary Care and Georgia Health Center transitioned from being hospital-employed practices to Northern Tier Center for Health (NOTCH). This transition will allow NMC to focus our resources on high quality acute hospital care, specialty care and emergency care for our community. NOTCH is a Federally Qualified Health Center that provides primary care services at multiple sites throughout our region. Form 990, Part V, Line 13a VT Form 990, Part VI, Section A, line 6 The organization has a maximum of 150 members, elected at the annual meeting from a slate of candidates nominated by the Nominating Committee. Other candidates for membership may be nominated from the floor at the annual meeting. Any person whose term as a Corporation Director has expired shall automatically become a member if that person consents to become a member. Form 990, Part VI, Section A, line 7a The membership elects a presiding membership officer, an alternate presiding membership officer and a membership secretary. Said officers are designated as Chair, Vice Chair and Recording Secretary of the membership. Form 990, Part VI, Section B, line 11b The entire Form 990 is provided to the full Board of Directors for review. The Board has the opportunity to ask questions and the Board votes on giving Administration approval to file the return in advance. Form 990, Part VI, Section B, line 12c Each Board Member and each member of the management team completes an annual statement attesting that they have received a copy of the policy and that they have read and understand it and will comply with it. Each person also completes a conflict of interest survey to identify potential conflicts and relevant financial interests. Each person also provides a listing of immediate family members, including spouse, children, grandchildren, parents, siblings, and any other person(s) living in their household. All disclosures are reviewed; determination of conflicts for Board Members are voted on by the remaining Board Members and determination of conflicts by the management staff is voted on by the senior leadership team. Those with conflicts are not allowed to participate in discussion and/or votes related to the conflict. A full copy of the policy can be provided upon request. Form 990, Part VI, Section B, line 15 Beginning in December 2020, the CEO is now an employee of Northwestern Medical Center. Respective contracts, including compensation, are approved by the Board of Directors on an annual basis. Form 990, Part VI, Section C, line 19 Northwestern Medical Center does not formally make its governing documents and conflict of interest policy available to the public. Financial information is available to the public through the annual tax return filing, annual Medicare and Medicaid cost report filing, and financial data published by the Green Mountain Care Board and available on the Hospital's website, as well as summarized financial information and statistics published in the Hospital's annual report distributed to local communities and published on the Hospital's website. Form 990, Part IX, line 11g Other Professional Services: Program service expenses 17,005,410. Management and general expenses 9,367,744. Fundraising expenses 0. Total expenses 26,373,154. Maintenance Contracts: Program service expenses 2,441,236. Management and general expenses 1,344,800. Fundraising expenses 0. Total expenses 3,786,036. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northwestern Medical Center 133 Fairfield St. St. Albans, VT 05478 EIN: 03-0266986 Northwestern Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swaps 2,452,282. Depreciation in Beneficial Interest in Perpetual Trusts -242,224. Northwestern Occupational Health LLC 133 Fairfield Street St Albans VT 05478 030360669 Medical rehabilitative and urgent care services VT 0 0 Northwestern Medical Center Northwestern Medical Center Auxiliary Inc 133 Fairfield St St Albans VT 05478 030278425 Promotion and Support of Northwestern Medical Center VT 501(c)(3) Line 12a, I Northwestern Medical Center 1 Charitable Remainder Trust (2) Trust VT Northwestern Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0