2021-11-12T09:09:13-06:00 2020-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2020-01-01 030107360 Brattleboro Retreat BRAT 8022577785 1 Anna Marsh Lane Brattleboro VT 05302 Louis Josephson PhD President & CEO 8022577785 2021-11-12 1 Louis Josephson PhD 999009999 Joseph R Byrne P01289281 2077752387 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Louis Josephson PhD 1 Anna Marsh Lane Brattleboro VT 05302 73554522 0 X www.brattlebororetreat.org X 1834 VT Offering a continuum of care including Inpatient, Partial Hospitalization, Residential and Outpatient Treatment for Children, Adolescents, Adults, and Older Adults throughout the Northeast. 12 11 789 11 337627 0 458146 16184144 72682931 52962587 234624 202829 138638 -16654 73514339 69332906 45077 7350 0 0 51993541 46748551 0 0 0 26918945 24220451 78957563 70976352 -5443224 -1643446 42993541 45056083 23646782 27213457 19346759 17842626 X Inspired by the courage of our patients, the Brattleboro Retreat is dedicated to children, adolescents and adults in their pursuit of recovery from mental illness, psychological trauma and addiction. We are committed to excellence in treatment, advocacy, education, research, and community service. We provide hope, healing, safety and privacy through a full continuum of medical and holistic services delivered by expert caregivers in a uniquely restorative Vermont setting. 0 1 54411174 7350 50963181 Offering a full continuum of care including inpatient and partial hospitalization, residential care for children and adolescents, intensive outpatient services for adults (including treatment for opiate addiction), and traditional outpatient treatment for children, adolescents adults and older adults from throughout the Northeast. Patient Days: Inpatient 25,073, Partial 3,527, Residential 3,319, Outpatient - 19,995 2369123 1988158 Vermont Board of Education Approved school serving children and adolescents in inpatient, residential, and partial hospitalization programs. The curriculum meets the educational, clinical, and behavioral needs of our students as well as the requirements of Vermont's educational standards. Patient School Days 5,749. 56780297 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 55 0 1 789 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VT X Ann Walsh 8022583737 1 Anna Marsh Lane Brattleboro VT 05301 Elizabeth Catlin Board Chair 1.00 0.00 X X 0 0 0 Justin Johnson Vice Chair 1.00 0.00 X X 0 0 0 Adam Grinold Secretary 1.00 0.00 X X 0 0 0 Joseph Pyle Assistant Secretary 1.00 0.00 X X 0 0 0 Christopher Turley Acting Treasurer 1.00 0.00 X X 0 0 0 Kenneth Becker Trustee 1.00 0.00 X 0 0 0 Kate O'Connor Trustee 1.00 0.00 X 0 0 0 Drew Pate MD Trustee 1.00 0.00 X 0 0 0 Thomas Huebner Trustee 1.00 0.00 X 0 0 0 Tonia Wheeler Trustee 1.00 0.00 X 0 0 0 Josh Davis Trustee 1.00 0.00 X 0 0 0 Louis Josephson CEO 40.00 0.00 X X 434260 0 42676 Beth Chague CFO 40.00 0.00 X 67488 0 281 David Burke Past CFO 40.00 0.00 X 12186 0 0 Sandra Jacobs Past Interim CFO 40.00 0.00 X 133000 0 0 Guarav Chawla Chief Medical Officer 40.00 0.00 X 356977 0 23179 Alfred Goldyne Staff Psychiatrist 40.00 0.00 X 272658 0 14094 Karl Jeffries Sr Medical Director 40.00 0.00 X 301230 0 46851 Tracey Kasnow Unit Chief 40.00 0.00 X 268052 0 40645 Lisa Lambert Staff Psychiatrist 40.00 0.00 X 474504 0 6100 2320355 0 173826 66 0 1 0 HP Cummings Construction Co PO Box 239 Woodsville NH 03785 Construction 4241208 Sodexo PO Box 360170 Pittsburgh PA 152516170 Food/Housekeeping Services 3701897 AHSA LLC PO Box 1928 Edmond OK 730831928 Travel Nurse Provider 2581179 Avant Healthcare Professionals PO Box 744554 Atlanta GA 303744554 Travel Nurse Provider 1607033 Barton Associates PO Box 417844 Boston MA 022417844 Travel Physician Provider 1281854 18 31899 14917667 1234578 67557 16184144 Patient Service Revenue 622200 116938091 116938091 Miscellaneous 900099 2813481 2193608 337627 282246 MSO Revenue 622200 987790 987790 Contractual/Char. Adj. 622200 -67776775 -67776775 52962587 123233 123233 98011 105772 -7761 -7761 -7761 4193175 4113579 79596 79596 79596 4620 31899 2265 2355 2355 Joint Venture Earnings 900099 -11248 -11248 -11248 69332906 52331466 337627 479669 X 7350 7350 689891 689891 35903050 31166084 4736966 597244 518446 78798 7048012 5813671 1234341 2510354 2124760 385594 449811 449811 46942 46942 18295 18295 12491378 10052011 2439367 93013 93013 115038 37521 77517 1817587 7410 1810177 24798 13948 10850 375274 203849 171425 1759641 970244 789397 832437 832437 Provider Tax 2672806 2672806 Miscellaneous Expenses 1822016 669224 1152792 Medical Supplies 933314 933314 Meals 768101 757222 10879 70976352 56780297 14196055 0 X 40510 1708410 931768 5155635 3501642 711923 10903566 7699649 174390 150075 720249 630185 63926335 41341016 19284123 22585319 4831741 3672832 797023 188551 1808529 2553504 42993541 45056083 8627740 10354793 11185977 10371906 597584 57605 3235481 6429153 23646782 27213457 X 13459897 10058073 5886862 7784553 19346759 17842626 42993541 45056083 -1643446 139313 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 19932 19932 0 Part II-B, Line 1: Line 1b relates to a portion of MSO VP's salary in the amount of 11,526. Line 1i includes the portion of AHA and VAHHS dues related to lobbying. 4965555 -1279127 3686428 7094433 389087 2517965 4965555 7046470 47963 7094433 6856675 191951 2156 7046470 9664963 192287 3000575 6856675 1.00000 0.00000 0.00000 0 0 120033 120033 44293830 30762370 13531460 10485114 8741674 1743440 9027358 1836972 7190386 22585319 Cash Surrender Value of Life Insurance Policies and Annuity Contracts 525049 Deferred Compensation 565919 Due from Third-Party Payors 1462536 2553504 Bank Overdraft 218707 Deferred Compensation Obligation 618582 Deferred Provider Relief Funds 3912932 Medicare Accelerated Payments 1678932 6429153 63329312 139313 108037 247350 63081962 6250944 6250944 69332906 64833445 108037 108037 64725408 6250944 6250944 70976352 Part V, Line 4: These funds consist of assets held by a trustee under an indenture agreement and funds set aside by the Board for capital improvements, over which the Board retains control and may, at its discretion, use for other purposes such as short-term operating needs. Part XI, Line 2d - Other Adjustments: Rental Expenses 105,772. Fundraising Expenses 2,265. Part XI, Line 4b - Other Adjustments: Expenses from Discontinued Ops 6,250,944. Part XII, Line 2d - Other Adjustments: Rental Expenses 105,772. Fundraising Expenses 2,265. Part XII, Line 4b - Other Adjustments: Expenses from Discontinued Ops 6,250,944. Ride for Heros 36519 31899 4620 1250 1015 36519 31899 4620 1250 1015 2265 2355 1 1 1 X 1 X 1 1 1 0 1 1 2803754 2803754 0.03950 35479522 26682730 8796792 0.12390 38283276 26682730 11600546 0.16340 122897 122897 0.00170 21705027 16050597 5654430 0.07970 13350 13350 0.00020 21841274 16050597 5790677 0.08160 60124550 42733327 17391223 0.24500 1 0 10458755 16377776 -5919021 X 1 1 1 1 Brattleboro Retreat 1 Anna Marsh Lane Brattleboro VT 05301 www.brattlebororetreat.org 905 X Brattleboro Retreat 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X www.brattlebororetreat.org/info X 1 18 1 www.brattlebororetreat.org/info 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X https://www.brattlebororetreat.org/financial-assistance X https://www.brattlebororetreat.org/financial-assistance X https://www.brattlebororetreat.org/financial-assistance X X X X 1 X 0 X X X X 1 X 0 0 Brattleboro Retreat Part V, Section B, Line 5: Because of its diverse and extensive service area, the Retreat defines its service area at both the county and state levels, and assesses the health needs of both areas. This gives planners a detailed understanding of the needs of the local populations as well as Vermont as a whole. The Community Health Needs Assessment (CHNA) was therefore divided into two phases: Phase I for Windham County and Phase II for the state of Vermont.For Phase I (Windham County), the Retreat partnered with Grace Cottage Hospital and Brattleboro Memorial Hospital to gather and assess both quantitative and qualitative data. The three health care organizations developed a steering committee, made up of representatives from each of the hospitals as well as from the Vermont Department of Health, Brattleboro Office, to guide the qualitative research and collect and analyze the quantitative data. The Windham County CHNA Steering Committee planned and conducted qualitative research, which included a countywide survey and a focus group on health care needs of minority and underserved populations. During the research process, the Steering Committee consulted with Vermont Agency of Human Services District Leadership Team and the Clinical Planning Group of the Vermont Blueprint for Health-Brattleboro Service Area.In Phase II (statewide), the Retreat gathered and assessed quantitative and qualitative data on mental health and addiction in the state of Vermont. Additionally, qualitative data was collected from community stakeholders across the state of Vermont through an online survey that was widely distributed across the state. During this phase of research, the Retreat consulted with the Vermont Department of Health, the Brattleboro Retreat's Consumer Advisory Council as well as a range of Retreat staff members, including clinical and administrative staff.Once the qualitative and quantitative data were collected and analyzed, planners reviewed the community health needs that emerged as a result of conducting the assessment. They carefully assessed each need, identified the major themes and developed broader priority areas to encompass these needs. Planners carried out this process by focusing only on needs and priority areas that fall within the mission and scope of the Brattleboro Retreat, namely in mental health and addiction treatment, as well as within the Retreat's capacity to make an impact. Planners also worked to identify needs that were supported by quantitative research data OR were identified in the community input process, through either of the surveys or the focus group. Once the planners identified some potential priority areas, they shared the results of the needs assessment as well as the recommended priority areas with the Brattleboro Retreat's Consumer Advisory Council and a group of Retreat staff members that included both clinical and administrative staff from various departments. Brattleboro Retreat Part V, Section B, Line 6a: Brattleboro Memorial Hospital, Grace Cottage Hospital and Brattleboro Retreat Brattleboro Retreat Part V, Section B, Line 11: Based on the data collected in the 2018 CHNA, the Brattleboro Retreat identified three (3) priority areas in which to focus its efforts for the upcoming 2019-2021 reporting period:1. Cooperate with regional providers as part of the Accountable Communities for Health by helping individuals and families receive more timely and effective mental health/addiction treatment and aftercare support through enhanced inter-agency collaboration.2. Increase accessibility to the Retreat's programs and services by improving the cultural competencies of providers and removing barriers that challenge vulnerable populations and people who have been historically underserved by the mental health and addiction treatment system.3. Reduce barriers to treatment and promote fact-based knowledge about mental illness and addiction among healthcare providers and the general public by increasing educational initiatives and supporting campaigns to decrease stigma.In 2020, planners at the Brattleboro Retreat, in consultation with various staff members from across the hospital and the Brattleboro Retreat's Consumer Advisory Committee, delivered on the below items, that are part of the three-year action plan to address these priority areas.CHNA Implementation Plan 2019-2021 (2020 Activities)#1. Cooperate with regional providers as part of the Accountable Communities for Health by helping individuals and families receive more timely and effective mental health/addiction treatment and aftercare support through enhanced inter-agency collaboration.- Continued to staff an office of mental health professionals within the main facility of Blue Cross Blue Shield Vermont (BCBSVT) in Barre, VT. The individuals who staff this office (called Vermont Collaborative Care or VCC) help BCBSVT subscribers integrate mental health care and medical health care.- Continued to participate in the Windham County Consortium on Substance Use (COSU)- a group of regional agencies tasked with studying and intervening in the opioid epidemic.#2. Increase accessibility to the Retreat's programs and services by improving the cultural competencies of providers and removing barriers that challenge vulnerable populations and people who have been historically underserved by the mental health and addiction treatment system.- Continued to provide on-site clinical services at Groundworks Collaborative, Brattleboro's temporary shelters for homeless men, women, and children. This is a service that began in 2015. During the 2020 pandemic, the Retreat continued to provide on-site face-to-face services with some of the community's most vulnerable populations.- Kurt White, LICSW, LADC presented at the Brattleboro Museum and Art Center. "In Sight: What the Unseen are Holding for Society," to help inform and educate local community members about the specific needs of homeless populations, specifically in the Windham County community. (Sept. 10, 2020). Presentation for https://youtu.be/gqd6ofnNUOM - Renewed work with consultant Dr. Nnamdi Pole, professor at Smith College, toward establishing a Diversity, Equity and Inclusion Committee (work began in 2020, committee established in 2021). - In 2020, due to the COVID-19 pandemic, the Retreat's outpatient programs began using telehealth services for clients in a significantly robust way. These interventions and services, which previously required face to face contact, increased acces#3: Reduce barriers to treatment and promote fact-based knowledge about mental illness and addiction among healthcare providers and the general public by increasing educational initiatives and supporting campaigns to decrease stigma.- Continued to support our Stand Up to Stigma community awareness campaign through community events, advertising, website, promotional items, etc.- Continued hosting and participating in a Consumer Advocacy Group that meets on a monthly basis with Retreat clinicians and administrators. Goal is to ensure that Retreat programs and services are meeting the needs of consumers and are being delivered in ways that accommodate the perspectives and experiences of patients.- Kurt White, LICSW, LADC and Zachary Wigham, MSW, presented "Homelessness: Innovative Community Interventions, with partners from local medical and homeless shelter services, for the Brattleboro Retreat Mid-winter Luncheon Series (Feb. 25, 2020).- Kurt White, LICSW, LADC and Zachary Wigham, MSW, presented at the American Group Psychotherapy Association about community collaboration to provide therapeutic supports in a local jobs program for vulnerable adults "Putting Groups to Work: Group Psychotherapy in a Community Vocational Setting. (Feb. 29, 2020). - Continued to provide Rapid Access to MAT (medication assisted treatment) with Brattleboro Memorial Hospital (BMH), and Turning Point of Windham County to help people in active withdrawal from opioids receive MAT quickly while at the BMH emergency department.- Kurt White, LICSW, LADC spoke at Brattleboro Museum and Arts Center (BMAC).- Brattleboro Retreat continued its partnership with the Ticket to Work program (America Works) in 2020 with the ongoing goal of helping clients who are recovering from opioid addiction to search for and secure employment.- Continued participation with Project CARE, a community coalition led by the Brattleboro Police Department that includes Habit Opco, Brattleboro Memorial Hospital, Turning Point, HCRS, and Groundworks. The goal of this coalition is to improve community relations with local law enforcement and to explore ways to better integrate the police in efforts to get help for people psychiatric and addiction issues. The Brattleboro Retreat's criteria for prioritizing and addressing community health needs was based on the following: an identified priority or concern in community input process; consistent with quantitative research data; within the Brattleboro Retreat's capacity to impact; consistent with the Brattleboro Retreat's mission; and a need where community partners exist. Some needs emerged in the research findings that the Brattleboro Retreat has not prioritized in this health needs assessment.In Phase I of the CHNA, BMH and Grace Cottage Hospital identified a number of medical health needs in their CHNA. Given that the Retreat is a specialty mental health and addictions treatment hospital that does not provide medical services to the general public, the Retreat will not address these medical health needs. Through qualitative research with the communities served, the Retreat learned that a number of socioeconomic challenges exist for the community, including the need for more employment opportunities, affordable housing, public transportation and social services. These socioeconomic needs do not fall within the mission or programs of the Retreat; however, the Retreat supports several initiatives aimed at increasing economic and educational opportunities in the community. The Brattleboro Retreat is active in Southeastern Vermont Economic Development Strategies (SeVEDS), The Brattleboro Area Chamber of Commerce, and The Rotary Club of Brattleboro. The Retreat is also an active supporter of United Way of Windham County and matches employee contributions dollar for dollar in the United Way Employee Giving Campaign. Additionally, the Brattleboro Retreat partners with schools and universities to offer training and internships to students pursuing clinical degrees. Continuation of Schedule H, Part V, Section B, Line 11: In October, 2017, the Windham County CHNA Steering Committee formed and began meeting to work on the 2018 Community Health Needs Assessment that will cover 2019-2021. The group met eight times. Data collection for Phase 1 (Windham County) took place between the months of November, 2017 and May, 2018. The 2018 Windham County CHNA Steering Committee planned and conducted qualitative research, which included a county-wide survey and outreach to organizations in the community on health care needs of minority and underserved populations. The resident surveys were available through the month of March 2018. The findings were presented at the Southeastern Vermont Accountable Communities for Health meeting in September 2018 to a number of human service organizations in Windham County who attended the meeting.In Phase II (statewide) of the 2018 CHNA, the Brattleboro Retreat gathered and assessed quantitative and qualitative data on mental health and addiction in the state of Vermont and consulted with the Vermont Department of Health. The Retreat conducted an online survey, which was distributed widely across the state to various stakeholder groups and to the general public. Following collection of the qualitative and quantitative data, planners identified emerging community health needs, and flagged major themes and key findings worthy of attention in the Implementation Plan. Based on these key findings, planners at the Brattleboro Retreat established the following priorities:-Mental/Psychiatric Health-Addiction Treatment-Access to Care.Planners carried out this process by focusing only on needs and priority areas that fall within the mission and scope of the Brattleboro Retreat (i.e., mental health and addiction treatment) and that exist within the Retreat's capacity to make an impact. In the first quarter of 2019, planners at the Brattleboro Retreat developed a three-year action plan to address our identified priority areas.As with most hospitals in Vermont and across the nation, 2020 presented the Brattleboro Retreat with some unexpected and often complex challenges related to the COVID-19 pandemic. Fortunately, efforts to prevent the spread of the coronavirus among patients and staff proved highly effective thanks to the vigilance of our employees and the expertise and tireless work of the Retreat's Infection Prevention department.By year's end, the roll out of our staff immunization program was well underway. We went on to provide vaccinations to nearly 400 of our employees by the end of January, 2021. The Retreat's ongoing partnership with Vermont's Agency of Human Services was highlighted in 2020 by the creation of a Sustainability Plan. Based in part on an independent report of the Retreat's business model and operational strengths and challenges, the Plan called for some difficult, but necessary changes aimed at securing the Retreat's long-term financial viability.Among these was a decision to re-calibrate our organizational focus and clinical skills on providing inpatient care for patients, particularly those with severe psychiatric challenges. To accomplish this institutional re-set, an announcement was made in October to close six programs that provided various outpatient and educational services that included a reduction in our workforce.A great deal of thought and effort went in to securing replacement services for clients and students impacted by these closures, and we were thrilled to be able to ensure that every person made a connection to alternative services.We were also pleased to be able to retain certain services that might otherwise have been lost (for example, addiction-based intensive outpatient programming and pain management) by absorbing them into other departments. And when operation of the Mulberry Bush Independent School was passed on to Brattleboro-based Horizon Early Learning in late December, we were thrilled to be able to retain an on-campus early learning and child care center for the community and our staff.Amidst such profound change and pandemic-related uncertainty, the Retreat continued to make progress on initiatives designed to improve patient care and strengthen hospital operations.Our project to reengineer the admissions and revenue cycle functions known as RPM (Redesign with Patient in Mind) made steady progress throughout 2020 and went live in early 2021.Construction of 12 new Level 1 beds on the first floor of our Linden Lodge building moved forward by leaps and bounds in 2020 despite COVID-related hurdles. This modern new unit, designed to accommodate some of the state's most vulnerable psychiatric patients, is now slated to open in September, 2021.The end of 2020 saw a Brattleboro Retreat transformed in ways that few could have imagined at the turn of the New Year. While we experienced significant challenges, we also continued to move forward toward what we believe is the Retreat of tomorrow - a much leaner but more focused, more sustainable, and more patient-centered institution.The Retreat responded to the COVID-19 pandemic in 2020 by moving most outpatient services from in-person to telehealth/remote. The demand for mental health support from the community increased and we added clinical staff to meet the demand for remote therapy and partial hospitalization services. We closed an inpatient psychiatric unit and converted it to a negative pressure space in case we had COVID positive patients that had to be cared for at the Retreat. Demand for services declined during lockdown periods as patients avoided coming into an inpatient care setting, but we remained open and continued to serve Vermonters in psychiatric crisis. We had to close inpatient admissions for people coming from out of state per direction from public health authorities. Workforce challenges have impacted our operations throughout the pandemic as some staff did not want to provide bedside care during the pandemic before the vaccines were available. Part II, Community Building Activities: Retreat Trails-Nine mile recreational trail network open to the public for non-motorized recreational activities. Part III, Line 4: See Pages 9-10 of audited financial statements for footnote disclosure.In 2019, the Retreat adopted FASB Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606), which supersedes accounting standards that currently exist under Generally Accepted Accounting Principles and provides a single revenue model to address revenue recognition to be applied by all companies. Under the new standard, companies recognize revenue when a customer obtains control of promised goods or services in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods and services. ASU No. 2014-09 also requires companies to disclose additional information, including the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. The Retreat adopted this ASU for the year ended December 31, 2019 and elected the modified retrospective method; therefore, the financial statements and related notes have been presented accordingly.As a result of the adoption of the rules described above, the Retreat isrecording $0 of bad debt expense for 2020. Part III, Line 8: A cost to charge ratio was used to determine the amount reported on Line 6. Part III, Line 9b: Included in our debt collection policy there is a section that if a patient is known to qualify for Charity Care upon admission then the eligibility guideline is followed at the time of admission to capture that information. Part VI, Line 2: In 2020, the Brattleboro Retreat served 3,037 children, adolescents and adults in inpatient, residential, ambulatory, outpatient, and school programs.The impact of the Retreat's services upon its patients and their families and communities is often dramatic and life-saving; especially as fewer and fewer healthcare organizations choose to offer a full continuum of mental health and addiction care services. Meanwhile, the number of patients seeking treatment for mental health and substance abuse issues continues to rise throughout the region and the nation. The Retreat strives to meet this increasing demand for services by renovating and updating facilities and patient care areas and utilizing the latest in treatment modalities to improve health care outcomes for the populations served.In 2020, the Brattleboro Retreat served 1,973 individuals in our outpatient programs. Three hundred and ninety-two (392) children were served across all programs. Twenty-eight (28) children were served in our residential programs.The Retreat continued to meet the need for quality psychiatric and addiction care coupled with an ongoing trend of higher inpatient acuity by strengthened its clinical expertise in 2020. This included the continued roll out of evidence-based practices throughout the hospital's programs along with an expansion of required clinical skills trainings involving both psychiatric and co-morbid medical conditions (wound care, for example) offered through the Retreat's Clinical Education department.The Retreat also continued to make important strides forward in improving its financial systems with the goal of strengthening cash flows and establishing a more predictable operating margin.Summary of Process for Openness and Public Participation:The Brattleboro Retreat keeps the community informed with regular appearances and/or memberships with the Brattleboro Select Board, Building a Better Brattleboro, Brattleboro Development and Credit Corporation (BDCC), Brattleboro Chamber of Commerce, the Windham County Legislative Delegation, Southeastern Vermont Economic Development Strategies (SeVEDS), the Rotary Club of Brattleboro, and ongoing collaborations with other community organizations including Brattleboro Memorial Hospital, Grace Cottage Hospital, Health Care and Rehabilitation Services (HCRS), Rescue Inc., the Brattleboro Police Dept., and area schools.In addition to its regular treatment and professional education services, the Brattleboro Retreat offers numerous programs to the community free of charge, including various lectures, forums, and special educational events. The feedback of patients, their families, and community members is of great importance to the Brattleboro Retreat.Strategic Plan & Financial Information:In 2020 the Brattleboro Retreat spent approximately $5M on capital improvements. The depreciation schedule was $1.7M. As a private not-for- profit organization, copies of the strategic plan are not publicly available. Part VI, Line 3: At the time of admission, patients receive counseling about their eligibility for assistance under various governmental programs as well as the organization's charity care policy. Part VI, Line 4: The Brattleboro Retreat is located in Brattleboro, Vermont, which is in the southeastern corner of Vermont-on the border with both New Hampshire and Massachusetts. Brattleboro is a small, rural town with an estimated population of 11,332. The estimated population for Windham County is 42,222. The state of Vermont has an estimated population of 623,989. (U.S. Census estimate, July 1, 2019).The Retreat plays a vital role as a large provider of mental health and substance abuse services in New England. It provides treatment to individuals of all ages from throughout the Northeast, accepts high numbers of Medicare and Medicaid funded patients and provides services offered by few other hospitals. In addition, the Retreat provides an array of ambulatory services to people in the local area. These services include outpatient counseling as well as partial hospital and intensive outpatient mental health and substance use disorder treatment.The Brattleboro Retreat is the only mental health and addiction specialty hospital in Vermont and one of the few in New England. In Vermont, there are four medical hospitals with psychiatric units. The Retreat is the largest provider of inpatient psychiatric services in the state and operates roughly the same number of psychiatric beds as the other four hospitals combined. The Retreat is also the only mental health hospital in Vermont for children and adolescents. The surrounding states have similar arrays of services: a few free-standing psychiatric hospitals, such as Providence Behavioral Healthcare Hospital in Holyoke, MA, and some medical hospitals operating psychiatric units. Many area medical hospitals have downsized or eliminated their psychiatric beds in recent years, particularly those in New Hampshire. Most psychiatric units also exclusively serve adults with few inpatient programs available for children and adolescents. The Retreat is dedicated to serving this population. As a regional specialty hospital, the Retreat draws patients from a large and diverse catchment area: across Vermont and throughout the greater New England area and beyond. The relatively low population of Vermont and the greater population to the south necessitate drawing from a broad and diverse area. The Retreat's geographic location also facilitates this regional draw. While the majority of inpatient admissions to the Retreat come from the state of Vermont, patients also come from all other New England States and beyond. Massachusetts, with an estimated population in 2019 of 6,892,503 is the second largest sending state. The Retreat is located just 8 miles from the Massachusetts border with interstate access to the western part of the state, including the cities of Northampton, Holyoke, and Springfield. The demographics of income, race, poverty etc., vary greatly across the catchment area and are therefore difficult to characterize. According to the data collected in the American Community Survey (ACS) and the Puerto Rico Community Survey (PRCS) conducted annually by the U.S. Census Bureau, the estimated median household income of Vermont residents is $60,076. Eleven percent of Vermonters live in poverty and 4.9 percent of Vermonters are without health insurance. In 2019, 74 percent of the Retreat's funding came from public sources-22 percent from Medicare and 51 percent from Medicaid/State programs. Part VI, Line 5: AL-ANON-weekly use of Central Conference RoomAA-weekly use of CafeteriaMidwinter Lunch Series-a series of 4 hour-long educational programs. Held annually in February, the series is free and open to staff, community providers, and the public. Topics are related to mental health and substance abuse in children, adolescents, and adults.Community Wellness Workshops-presented by the Brattleboro Retreat; these include wellness programs, ongoing classes, and support groups, many of which are free, for all members of the community. Brattleboro Last Night, Strolling of the Heifers, and Harris Hill Ski Jump Event-all make use of the Retreat facility for these annual events (campus grounds, parking, tents, Facilities & Security Staff, etc.)Cafeteria & Conference Room-both facilities are used for meetings by groups including: Brattleboro Area Development Committee, Brattleboro Area Chamber of Commerce, Early Education Services, Brattleboro Area Human Resources Network, Windham Regional Commission, Local Emergency Planning Committee (LEPC), Brattleboro Area Hospice, Brattleboro Early Educators Cooperative, Brattleboro Area Human Resources Network, Windham County Consortium on Substance Use (COSU), Safe Driving Program, Windham Southeast Supervisory Union, Windham Central Supervisory Union, NFI Vermont, Center for Health & Learning, Green Mountain Care Board, Blue Cross Blue Shield of Vermont, Al Anon, Alcoholics Anonymous, and United Way of Windham County.Relay for Life-the hospital's "Retreat Feat" team participates in this local event to raise funds and awareness in the fight against cancer. Part VI, Line 6: Vermont Assoc. for Mental Health-provides advocacy for the mental health community in Vermont: Vermont Program for Quality in Healthcare-provides advocacy for access to health-care services in Vermont. X 0 0 0 0 0 0 0 0 0 Lisa Lambert Staff Psychiatrist 474504 0 0 0 0 0 6078 0 22 0 480604 0 0 0 Louis Josephson CEO 419860 0 0 0 14400 0 8550 0 34126 0 476936 0 0 0 Guarav Chawla Chief Medical Officer 356977 0 0 0 0 0 0 0 23179 0 380156 0 0 0 Karl Jeffries Sr Medical Director 301230 0 0 0 0 0 8550 0 38301 0 348081 0 0 0 Tracey Kasnow Unit Chief 268052 0 0 0 0 0 8250 0 32395 0 308697 0 0 0 Alfred Goldyne Staff Psychiatrist 251562 0 0 0 21096 0 2544 0 11550 0 286752 0 0 0 A Vermont Educational and Health Buildings Financing Agency 237154467 2015-07-15 11245000 Refund Series 2011A Bonds 0 0 0 A 824803 11245000 97745 11147255 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 1 Date Rebate Computation Performed Issuer Name: Vermont Educational and Health Buildings Financing Agency Date the Rebate Computation was Performed: 12/21/2020 X 25000 FMV X 1 10057 FMV X Laptops 20 20000 FMV X Hand Sanitizer and Masks 1 12500 FMV 0 0 1 0 Form 990, Part III, line 3 In 2020, the Retreat discontinued its Uniformed Service, Mulberry Bush Daycare, and Bridges/Meadows School programs in an effort to reduce the breadth of the Retreat's operations and improve profitability. The Retreat responded to the COVID-19 pandemic in 2020 by moving most outpatient services from in-person to telehealth/remote. The demand for mental health support from the community increased and we added clinical staff to meet the demand for remote therapy and partial hospitalization services. We closed an inpatient psychiatric unit and converted it to a negative pressure space in case we had COVID positive patients that had to be cared for at the Retreat. Demand for services declined during lockdown periods as patients avoided coming into an inpatient care setting, but we remained open and continued to serve Vermonters in psychiatric crisis. We had to close inpatient admissions for people coming from out of state per direction from public health authorities. Workforce challenges have impacted our operations throughout the pandemic as some staff did not want to provide bedside care during the pandemic before the vaccines were available. Form 990, Part VI, Section B, line 11b The Governing Body will receive the prepared 990 electronically for their review prior to filing the return, followed by a presentation at their next full board meeting. Form 990, Part VI, Section B, line 12c A. The Brattleboro Retreat accepts the responsibility for the provision of optimum care and services to its patient population, and therefore must protect the integrity of clinical decision making and the provision of treatment and care to all patients. B. The Brattleboro Retreat will disclose any existing or potential conflicts of interest for those who provide care, treatment and services as well as management and governance activities. C. The Brattleboro Retreat will routinely review its existing relationship and its staff's relationships, with other care providers, educational institutions and payers to ensure that all relationships are within law and regulation and to identify and determine if conflicts of interest exist. D. Regardless of any fiduciary relationship with any healthcare provider (licensed clinical practitioner, vendor, educational institution, payer, outside resource agency, etc.), the hospital and its representative staff (including medical staff), will strive to provide optimum care to patients following appropriate utilization of resources standards. Care provided to patients will not be dependent upon financial relationships or fiduciary responsibilities. a. Tests, studies, treatments or procedures deemed usual and routine in the diagnosis, management or treatment of disease processes; as standard in the healthcare community, will not be withheld from any patient (unless the patient exercises his/her patient right to refuse treatment). b. Any healthcare provider who feels there is a conflict of interest in patient management and their relationship with the facility, must contact administration and notify the Chief Executive Officer immediately. E. Discussion at the administrative level will be initiated, whereby problem resolution will be the primary goal. In the interim, the Chief of the service/department with jurisdiction over the healthcare provider will arrange for coverage of the patient; until resolution has been reached. F. If resolution cannot be reached at the administrative level, the matter will be forwarded to an Executive Committee of the Governing Body, who will meet as soon as practicable, however no later than one week after notification of issue. The Governing Body's primary purpose is to assure that optimum patient care and treatment is provided, regardless of fiduciary relationships, while maintaining a fair and just review of all circumstances surrounding the issue. The determination of the Governing Body will be final. G. No contract or transaction entered into by the corporation known as the Brattleboro Retreat, shall be affected by the fact that a director, member or officer of the corporation was personally interested in the contract or transaction or was personally interested in or a director or officer of a corporation that was personally interested in the contract or transaction. H. A member of the Governing Body or a member of a committee, when called upon to cast a vote for or against a matter which personally involves such individual, shall disclose himself/herself ineligible to vote on the grounds of conflict of interest. In cases where conflict of interest is not clearly apparent, or when such conflict is not declared by a person who in the opinion of other members has potential conflict, the conflict of interest issue may be brought before the body who will vote on such issue to determine whether or not a conflict of interest exists. I. Should there become known, at any time, a conflict of interest between any member of the Governing Body, medical staff, hospital personnel or other healthcare providers and the hospital or any of its agents, the individual(s) may excuse himself/herself from discussions and/or determinations with the identified healthcare provider(s). J. All members of the Governing Body, medical staff and hospital personnel have the responsibility and obligation, if there is such a time as it is discovered; that due to a fiduciary relationship, care of any patient may be compromised or may not be delivered within the known standard of care; to notify the Chief Executive Officer of the Brattleboro Retreat immediately upon identification of this issue Form 990, Part VI, Section B, line 15 The Board Compensation Committee reviews comparative data for the CEO. The CEO does review benchmarking/comparative data for VPs and other key employees. Form 990, Part VI, Section C, line 19 All governing documents, conflict of interest policy, and audited financial statements are available upon request Form 990, Part IX, line 11g Clinical Services: Program service expenses 274,052. Management and general expenses 0. Fundraising expenses 0. Total expenses 274,052. Contract Services: Program service expenses 9,692,878. Management and general expenses 709,080. Fundraising expenses 0. Total expenses 10,401,958. Purchased Services: Program service expenses 67,438. Management and general expenses 0. Fundraising expenses 0. Total expenses 67,438. Consulting Fees: Program service expenses 0. Management and general expenses 1,730,287. Fundraising expenses 0. Total expenses 1,730,287. Collection Fees: Program service expenses 17,643. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,643. Form 990, Part X, Line 10; Land, Building, and Equipment Section 1.263(a)-3(n) Election: Brattleboro Retreat 1 Anna Marsh Lane Brattleboro, VT 05302 EIN 03-0107360 Brattleboro Retreat is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part VI, Line 16: Brattleboro Retreat invested in the Vermont Collaborative Care, LLC with Catamount Insurance Services, Inc. which is a wholly-owned subsidiary of Blue Cross and Blue Shield of Vermont, a non-for-profit organization. Vermont Collaborative Care LLC PO Box 186 Montpelier VT 056010186 462187169 Care Management Services VT Brattleboro Retreat Related -8472 291191 0 1 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Vermont Collaborative Care LLC S 600000 FMV