2022-08-11T09:37:37-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 030266986 Northwestern Medical Center NORT 8025245911 133 Fairfield St St Albans VT 05478 Stephanie Breault CFO 8025245911 2022-08-10 1 Stephanie Breault 999009999 Joseph R Byrne P01289281 2077752387 2022-08-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Dr Dean French 133 Fairfield St St Albans VT 05478 141396773 0 X www.northwesternmedicalcenter.org X 1977 VT Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 11 9 1036 77 0 0 17679125 4732300 99602397 124050547 -243244 9468245 409430 334844 117447708 138585936 91344 63561 0 0 69331212 67098101 0 0 0 50189877 55801518 119612433 122963180 -2164725 15622756 187646355 180177619 71123482 47438080 116522873 132739539 X Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 0 0 79722720 63561 124384717 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, 2021.See continuation on Schedule O. Estimated costs and expenses incurred to provide charity care: $1,158,843Number of charity care patients served: 1,354The 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. 79722720 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 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 1036 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 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 / Past Interim CAO 40.00 0.00 X X 257813 0 240 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 Lawrence Sullivan MD Member / OB Physician 40.00 0.00 X 626660 0 34620 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 Janet McCarthy Past President 5.00 0.00 X X 0 0 0 Leon Berthiaume Past Treasurer 5.00 0.00 X X 0 0 0 Marietta Scholten MD Past Member 5.00 0.00 X 0 0 0 Dean French CEO 40.00 0.00 X 43512 0 2557 Robyn Alvis COO 40.00 0.00 X 245582 0 22360 Stephanie Breault CFO 40.00 0.00 X 137787 0 50363 Jerry Barbini Past Interim CEO 40.00 0.00 X 331812 0 758 Michael Barnum MD Orthopedic Physician 40.00 0.00 X 950991 0 34620 Kahren Aydinyan MD ENT Surgeon 40.00 0.00 X 537217 0 7636 Robert Beattie MD Orthopedic Physician 40.00 0.00 X 688995 0 34587 Nathan Mauser MD Orthopedic Physician 40.00 0.00 X 587664 0 14884 Gregory Brophey MD Ophthalmologist 40.00 0.00 X 647035 0 30203 Jill Berry Bowen Former CEO 0.00 0.00 X 366406 0 12306 5421474 0 245134 107 1 1 1 Shiftwise PO Box 70870 St Paul MN 55170 Traveler Staffing 2833748 University of Vermont Medical Center PO Box 1902 Burlington VT 05402 Various Medical Services 1962187 Clinical Colleagues 1121 N Bethlehem Pike Suite 60-234 Spring House PA 19477 Anesthesia Services 1408829 A Cooper Mechanical Inc 171 Leroy Road Williston VT 05495 Construction Services 815866 CompHealth PO Box 972625 Dallas TX 75397 Traveler Staffing 479509 28 21000 4316212 395088 4732300 Patient Service Revenue 622100 259212937 259212937 Other Operating Revenue 622100 5682258 5682258 Cafeteria 622100 483233 483233 Contractual Allowances/Char. Adj. 622100 -141327881 -141327881 124050547 866582 866582 380584 46414 334170 334170 334170 11179567 185870 2763774 0 8415793 185870 8601663 8601663 1323 649 674 674 138585936 123901484 0 9952152 X 17940 17940 45621 45621 1754063 1105586 648477 53361095 33633498 19727597 2169608 1367504 802104 6232891 3928591 2304300 3580444 2256754 1323690 708407 446509 261898 128042 80705 47337 112534 70930 41604 10632 10632 125560 125560 21605958 13618235 7987723 148368 93516 54852 670987 422923 248064 2006722 1264837 741885 109356 68927 40429 738866 465707 273159 6098074 3843616 2254458 1460097 920299 539798 Supplies 13369457 8426769 4942688 Provider Tax 6152744 6152744 Miscellaneous 1803923 1143715 660208 Minor Equipment 551791 347794 203997 122963180 79722720 43240460 0 X 20004567 15139480 14689810 19064044 179155 9908593 9042305 1930152 1980728 11298026 2100976 144005277 74419950 71558921 69585327 46816710 55428246 6576163 1998968 4684258 5837545 187646355 180177619 17883311 9545548 29729663 28175042 1656484 1571901 21854024 8145589 71123482 47438080 X 112887254 129041863 3635619 3697676 116522873 132739539 187646355 180177619 X 15622756 -734537 1328447 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 720 0 1 9912 10632 0 Part II-B, Line 1: Northwestern Medical Center engages in minimal formal lobbying. NMC's CEO and VP of Community Relations are registered as lobbyists with the Vermont Secretary of State's office for discussions with legislators and other elected officials regarding action on specific legislation and action which impacts the health of the community and the sustainability of the Organization. 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. 1142938 192824 1335762 1145463 -2525 1142938 1144129 1334 1145463 1118351 25778 1144129 1054571 63780 1118351 0.00000 1.00000 0.00000 1 0 1020532 1020532 88679447 36090424 52589023 49091913 35824382 13267531 5213385 2505144 2708241 69585327 Estimated Third-Party Settlements 1986913 Deferred Compensation 4684496 Interest Rate Swaps 1319919 Third Party Accelerated Payments 154261 8145589 139054935 -734537 1329096 594559 138460376 125560 125560 138585936 122838269 649 649 122837620 125560 125560 122963180 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: Special Event Expenses 649. Unrealized Gain on Interest Rate Swaps 1,135,623. Appreciation in Beneficial Interest in Perpetual Trusts 192,824. Part XII, Line 2d - Other Adjustments: Special Event Expenses 649. 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. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments.LIST 74 _ 22325bd - 03/29/21 10:34 AM Worksheet Schedule F - Activities Per Regionwp 990 1998968 0 0 0 0 0 0 1998968 0 1998968 0 0 1 0 0 0 Part III Accounting Method: 1 1 1 X 400.000000000000 1 X 1 1 1 0 0 963424 963424 0.00780 30565976 17813873 12752103 0.10370 31529400 17813873 13715527 0.11150 3719993 2950535 769458 0.00630 75869 75869 0.00060 3795862 2950535 845327 0.00690 35325262 20764408 14560854 0.11840 1 0 22203928 37909332 -15705404 X 1 1 1 1 Northwestern Medical Center 133 Fairfield Street St Albans VT 05478 www.northwesternmedicalcenter.org 914 X X X Northwestern Medical Center 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Page 8 X X 1 18 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 1 X 0 X X X X 1 X 0 0 Northwestern Medical Center Part V, Section B, Line 5: As part of our 2018/19 (FY'19) 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 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: the RiseVT community campaign to embrace healthy lifestyles; the modernization of the NMC Emergency Department; the expansion of access to and integration of addiction services; continuation and strengthening of partnerships for local mental health care and advocacy for proper inpatient mental health care infrastructure at the state level; continued emphasis on tobacco prevention and cessation with expansion to address vaping; support of community-based efforts related to suicide (including the Afterglow Awareness & Fundraising event for Northwestern Counseling & Support Services); support of community-based efforts related to sexual and domestic abuse (including the Laurie's House and Voices Against Violence); support of community-based efforts related to food insecurity (including Healthy Roots, Northwest Family Foods, and Martha's Kitchen); and other strategies aligning with awareness, education, resource allocation, and collaboration. All of the top priorities identified are being addressed in some fashion by the hospital.NMC's most recent CHNA also addressed additional items that impact the community but were not ranked as top priorities, including: Prevention & Wellness Education, Access and Affordability of Care, Cancer, Physical Activity, Dental Care, Alcohol Use, Chronic Pain Management, ACES (Adverse Childhood Experiences) & Trauma, Diabetes, Housing, Transportation, Heart Disease, Parent Education/Support, Accidents, Stroke, Health Equity, Women's Health, Alzheimer's, and Kidney Disease. The prevention messaging of NMC's RiseVT community campaign to embrace healthy lifestyles extends to many of these. Many of these are also addressed through NMC's Primary Care, Pediatrics, and other medical specialty practices. NMC's support of the United Way of Northwest Vermont and other important community partners also helps address these important but not top priority items. NMC's actions in these areas are tracked through normal operations rather than through the CHNA action plan which is focused on the top priorities. The hospital does not intend to develop a CHNA implementation plan for these lower ranked needs for the following reasons: 1. Actions required are beyond the mission of NMC;2. NMC can be more effective applying its resources to higher priority needs;3. The Hospital does not possess the expertise necessary for substantive positive improvement;4. Actions contemplated for implementation fall more appropriately to the responsibility of others;5. Other than providing encouragement, implementation efforts for some needs require appropriate actions by individuals modifying their personal habits rather than a response by an organization or the Hospital; and6. The best use of NMC resources is to focus on resolving or improving higher priority needs rather than attempting to respond to everything with small, perhaps ineffective, efforts. 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 7, 9-13, and 17-18 of the attched audited financial statements. Part III, Line 8: The cost was determined using the cost to charge ratio.The Medicare shortfall of $15,705,404 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 2019. This document was formally approved by the Hospital's Board of Directors at their May 1, 2019 meeting, placing it in the Hospital's 2019 Fiscal Year. This document replaces the previous Community Health Needs Assessment which was approved in the Hospital's 2016 Fiscal Year.Seven top priorities were identified: Mental Health; Substance Abuse; Obesity; Suicide; Domestic/Sexual Assault; Food Insecurities; and Smoking & Vaping - 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) 11250 Support programs complimentary to the Hospital's exempt purpose. St Albans Recreation Department PO Box 867 St Albans VT 05478 St. Albans, VT 6690 Town Forest fundraising. 2 0 Scholarships 5 15000 Bashaw Grants 67 30621 Part I, Line 2: All assistance is given to either 501(c)(3) public charities, governmental units and their affiliates or individuals. All grants/scholarships are reviewed by management and if/when approved, a grant request for payment is submitted to Finance with required information and approval signatures. 1 X X X 1 0 0 0 0 0 0 1 1 0 Michael Barnum MD Orthopedic Physician 889116 0 42375 0 19500 0 5700 0 28920 0 985611 0 0 0 Robert Beattie MD Orthopedic Physician 616895 0 52500 0 19600 0 4333 0 30254 0 723582 0 0 0 Gregory Brophey MD Ophthalmologist 541901 0 85384 0 19750 0 5700 0 24503 0 677238 0 0 0 Lawrence Sullivan MD Member / OB Physician 538795 0 87815 0 50 0 5700 0 28920 0 661280 0 0 0 Nathan Mauser MD Orthopedic Physician 568114 0 0 0 19550 0 5700 0 9184 0 602548 0 0 0 Kahren Aydinyan MD ENT Surgeon 390380 0 127337 0 19500 0 5700 0 1936 0 544853 0 0 0 Jill Berry Bowen Former CEO 147485 0 0 0 218921 0 4299 0 8007 0 378712 0 0 0 Jerry Barbini Past Interim CEO 326291 0 0 0 5521 0 0 0 758 0 332570 0 0 0 Robyn Alvis COO 244532 0 0 0 1050 0 5005 0 17355 0 267942 0 0 0 Dawn Bugbee Treasurer / Past Interim CAO 254909 0 0 0 2904 0 0 0 240 0 258053 0 0 0 Stephanie Breault CFO 137537 0 0 0 250 0 23691 0 26672 0 188150 0 0 0 Part I, Line 4a Jill Berry Bowen, Former CEO, received severance in the amount of $214,702 during calendar year 2020. Part I, Line 7 Michael Barnum, Robert Beattie, Gregory Brophey, Kahren Aydinyan, Highest Compensated Employees, and Lawrence Sullivan, Board Member, received bonuses from an incentive compensation plan. Part I, Line 8 Dean French, CEO, received a sign-on bonus of $10,000 pursuant to a contract subject to the initial contract exception described in Reg. Section 53.4958-4(a)(3). Form 990, Part VII, Line 5: Jill Berry Bowen, Former CEO, Jerry Barbini, Past Interim CEO, and Dawn Bugbee, Treasurer / Past Interim CAO, were compensated by a third party, Quorum Health Resources (QHR), for services rendered to Northwestern Medical Center. These individuals received the following compensation (including deferred compensation and nontaxable benefits) from QHR: Jill Berry Bowen - $378,712 Jerry Barbini - $332,570 Dawn Bugbee - $258,053 A Vermont Educational & Health Building Financing Agency 237154467 NoneAvail 2016-06-01 35000000 Refund 2012A Bond and New Capital Projects 0 0 0 A 6650977 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 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 The Past Interim CEO was not an employee of Northwestern Medical Center. He was an employee of Quorum Health Resources and the respective contracts, including compensation, were approved by the Board of Directors on an annual basis. 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 Fees: Program service expenses 11,247,387. Management and general expenses 6,597,111. Fundraising expenses 0. Total expenses 17,844,498. Maintenance Contracts: Program service expenses 2,370,848. Management and general expenses 1,390,612. Fundraising expenses 0. Total expenses 3,761,460. 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 1,135,623. Appreciation in Beneficial Interest in Perpetual Trusts 192,824. Northwestern Occupational Health LLC 133 Fairfield Street St Albans VT 05478 030360669 Medical rehabilitative and urgent care services VT 1370 2022757 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 (6) 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