2019-11-12T15:02:55-06:00 2018-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-01-01 030107360 Brattleboro Retreat BRAT 8022577785 1 Anna Marsh Lane Brattleboro VT 05302 Louis Josephson PhD President & CEO 8022577785 2019-10-30 1 Joseph R Byrne CPA P01289281 2077752387 2019-10-30 69.49.157.66 2019-10-30 11:53:38 ED P FD764483AA263AFE8AB46477EA327BFBBE809DCF C97FEFACFBC752A47944C84B492960BB6E99453A 2018 2020-04-17 16:48:07Z Louis Josephson PhD 1 Anna Marsh Lane Brattleboro VT 05302 82524893 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 11 924 12 414165 -5120 665594 6240314 65878063 71771130 179345 184592 197753 39288 66920755 78235324 46641 40157 0 0 47875805 50229456 0 0 0 21485916 23527573 69408362 73797186 -2487607 4438138 44482489 48334026 24232288 23786014 20250201 24548012 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 0 60053952 40157 68331930 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 - 38,278, Partial - 9,042, Residential - 6,591, Outpatient - 20,546 216427 220459 Continuing education program providing up to 24 workshops and seminars throughout the year for physicians, nurses, social workers, psychologists, therapists, drug and alcohol counselors, and other healthcare professionals. 2237874 3183244 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 9,219. 62508253 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 93 0 1 924 1 1 1 0 0 0 0 1 1 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 0 1 1 0 VT X Arthur Nichols 8022584312 1 Anna Marsh Lane Brattleboro VT 05301 Elizabeth Catlin Board Chair 1.00 X X 0 0 0 Justin Johnson Asst. Board Chair 1.00 X X 0 0 0 Tammy Richards Secretary 1.00 X X 0 0 0 Kenneth Becker Trustee 1.00 X 0 0 0 Adam Grinold Trustee 1.00 X 0 0 0 Kate O'Connor Trustee 1.00 X 0 0 0 Drew Pate MD Trustee 1.00 X 0 0 0 Joseph Pyle Trustee 1.00 X 0 0 0 Christopher Turley Trustee 1.00 X 0 0 0 Thomas Huebner Trustee 1.00 X 0 0 0 Tonia Wheeler Trustee 1.00 X 0 0 0 Michael Sarsynki Jr CFP Past Trustee 1.00 X 0 0 0 Louis Josephson CEO 40.00 X X 393411 0 63839 Arthur Nichols CFO 40.00 X 216461 0 26880 Lisa Lambert Staff Psychiatrist 40.00 X 462495 0 8151 Mark McGee Chief Medical Officer 40.00 X 288096 0 39680 John Fanton Staff Psychiatrist 40.00 X 305757 0 22369 Karl Jeffries Unit Chief 40.00 X 260422 0 43527 Simha Ravven Interim Chief Medical Officer 40.00 X 254849 0 29995 2181491 0 234441 57 0 1 0 Sodexo 153 Second Avenue Waltham MA 02254 Cafe/Dietary/Housekeeping 3464229 Medical Solutions 1010 N 102nd St Suite 300 Omaha NE 68114 Contract Labor 1378462 Locumtenenscom PO Box 405547 Atlanta GA 30384 Contract Labor 1276379 Netsmart Technologies PO Box 823519 Philadelphia PA 19182 IT/Billing 839941 AHSA LLC PO Box 1928 Edmond OK 73083 Contract Labor 837409 16 70135 5724490 445689 10247 6240314 Patient Service Revenue 622200 170492438 170492438 Miscellaneous 900099 1888287 1061475 414165 412647 MSO Revenue 622200 1405438 1405438 Provision for Bad Debts 622200 -2901269 -2901269 Contractual/Char. Adj. 622200 -99113764 -99113764 71771130 237311 237311 225198 139157 86041 86041 86041 4065436 276 4113446 4985 -48010 -4709 -52719 -52719 20725 70135 31981 -11256 -11256 Joint Venture Earnings 900099 -35497 -35497 -35497 78235324 70908821 414165 672024 X 40157 40157 700591 700591 38681997 34340829 4341168 605501 538334 67167 7507506 6554054 953452 2733861 2389376 344485 266573 266573 76008 76008 20451 20451 10560801 9183411 1377390 88227 88227 171128 60221 110907 1319136 1319136 84407 49243 35164 480837 264774 216063 1865863 1037122 828741 689233 689233 Miscellaneous Expenses 2825258 912623 1912635 Provider Tax 2428670 2428670 Medical Supplies 1375866 1375866 Meals 1275115 1236977 38138 73797186 62508253 11288933 0 X 867152 840348 1171101 1198933 13428486 12494731 252272 228242 754797 622127 56199468 37971206 19414342 18228262 6541345 11818736 714726 682531 1338268 2220116 44482489 48334026 8213621 9541449 135513 0 11154950 11170671 1357000 1131708 3371204 1942186 24232288 23786014 X 19584654 18440367 388695 5808765 276852 298880 20250201 24548012 44482489 48334026 4438138 -140327 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 33686 33686 0 Part II-B, Line 1: Line 1b relates to a portion of MSO VP's salary in the amount of 22,360. Line 1i includes the portion of AHA and VAHHS dues related to lobbying. 7046470 47963 7094433 6856675 191951 2156 7046470 9664963 192287 3000575 6856675 10806727 58236 1200000 9664963 11244417 262310 700000 10806727 1.00000 0.00000 0.00000 0 0 120033 120033 43541525 28377508 15164017 9937146 7896954 2040192 2600764 1696744 904020 18228262 Outstanding Uncashed Checks 126837 Deferred Compensation Obligation 615349 Insurance Claim Payable 1200000 1942186 78266135 -140327 171138 30811 78235324 0 78235324 73968324 171138 171138 73797186 0 73797186 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 139,157. Fundraising Expenses 31,981. Part XII, Line 2d - Other Adjustments: Rental Expenses 139,157. Fundraising Expenses 31,981. Ride for Heros 39153 34613 4540 500 6235 Golf Tournament 51707 35522 16185 113 13620 5208 3882 2423 90860 70135 20725 113 14120 5208 3882 8658 31981 -11256 1 1 1 X 1 X 1 1 1 0 1 1 2516093 2516093 0.03410 2516093 2516093 0.03410 49067 49067 0.00070 212352 3000 209352 0.00280 11539725 10156963 1382762 0.01870 40157 40157 0.00050 11841301 10159963 1681338 0.02270 14357394 10159963 4197431 0.05680 7051 7051 0.00010 7051 7051 0.00010 1 1156598 11650330 17109071 -5458741 X 1 1 1 1 Brattleboro Retreat 1 Anna Marsh Lane Brattleboro VT 05301 www.brattlebororetreat.org 841 X Brattleboro Retreat 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X https://www.brattlebororetreat.org/sites/default/files/Final%202018%20CHNA% X 1 18 1 https://www.brattlebororetreat.org/sites/default/files/Final%202018%20CHNA% 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 1 X 0 0 Brattleboro Retreat Part V, Section B, Line 5: Because the Retreat has a diverse and extensive service area, the Retreat chose to define its service area at both the county and state levels, assessing the health needs of both areas. By assessing health status at both the county and state levels, planners gained a detailed understanding of the needs of the local populations as well as a broader assessment of Vermont. The 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 2015 CHNA, the Brattleboro Retreat identified three priority areas in which to focus its efforts for the upcoming 2016-2018 reporting period:1. Enhance care coordination activities between medical and mental health providers so that individuals and families receive more timely and effective mental health and addiction treatment and aftercare support.2. Make the Retreat's programs and services more accessible to populations that have historically been underserved by some mental health and addiction treatment providers, particularly racial/ethnic minorities, LGBTQ individuals and low-income families, by improving cultural competencies and addressing various barriers such as language and mobility.3. Increase educational initiatives, both for providers as well as for the general public, to increase understanding of and treatment for mental illness and addiction.In 2018, 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.Priority Actions#1: Enhance care coordination activities between medical and mental health providers so that individuals and families receive more timely and effective mental health and addiction treatment and aftercare support.-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 provide collaborative office rounds with area pediatric and family practices to facilitate problem solving on psychiatric and addiction cases.-Added a Referral Resource page to the Retreat's recently-redesigned website.#2: Make the Retreat's programs and services more accessible to populations that have historically been underserved by some mental health and addiction treatment providers, particularly racial/ethnic minorities, LGBTQ individuals and low-income families, by improving cultural competencies and addressing various barriers such as language and mobility.-Offered a continuing education workshop on 11/2/18 that focused on culturally diverse patient populations entitled Understanding the Impact of Racial Trauma on Black Families' Relational Bonds, with speaker Christiana Awosan, Ph.D.-Offered a continuing education workshop focused on gender diversity in patient population on 11/16/2018 with speaker Irwin Krieger, LCSW, entitled Transgender Teens and Adults: Evaluation and Transition.-Continued to provide on-site clinical services at Groundworks Collaborative, Brattleboro's temporary shelter for homeless men, women, and children. This is a service that began in 2015.-Further refined and expanded the scope of the hospital's cultural competency online training module and assigned it to all newly-hired staff during orientation and annually for all Retreat staff.-Continued to provide free, short-term childcare service at The Welcoming Place for clients who are receiving daily medication assisted treatment for opioid addiction through the Retreat's HUB clinic.#3: Increase educational initiatives, both for providers as well as for the general public, to increase understanding of and treatment for mental illness and addiction.-Continued to support our Stand Up to Stigma community awareness campaign through community events, advertising, website, promotional items, etc.-Offered 12 all-day and one half-day continuing education workshops in the fall of 2018. Combined with 12 all-day continuing education workshops in the spring of 2018 for a total of 24.5 for the year season.-Offered three free community workshops in 2018. On January 3, 2018, Paul Rodrigue, LMFT led a workshop titled "Realizing Self-Compassion." On September 17, 2018 Jenny Karstad, MA, LADC, LCMHC led a workshop titled "Coping Strategies for Anxiety." The last community health workshop for 2018 was held on November 13, 2018 led by Paul Rodrigue, MA, LMFT titled "The Path Toward Self-Compassion."-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.-Partnered with Brattleboro Museum and Arts Center (BMAC), Turning Point, Groundworks Collaborative, and other organizations in the community, to honor the courage of those in recovery through Michael Poster's "If she has a pulse, she has a chance" documentary photography exhibit (at BMAC, Oct. 5, 2018-Jan. 7, 2019).-Brattleboro Retreat enters partnership with America Works in June 2018 with the goal to provide clients in recovery from opioid addiction with critical workforce development services.-Brattleboro Retreat marched in the annual Strolling of the Heifers parade with NAMI Vermont in June 2018 with staff and community volunteers sharing the Stand Up to Stigma campaign message.-Produced three new "Keep Talking" video Broadcasts on Brattleboro Community Television in 2018: -"Understanding and Treating Compulsive Hoarding Disorder" -"Your Teenager- The Importance of Staying Engaged" -"Sleep and Good News for Those Who Can't"-Published five Op-Eds and/or educational pieces in local and regional newspapers: -"Scapegoating Mental Illness is Wrong Approach to Ending Mass Shootings," by Louis Josephson, Ph.D., The Commons, March 7, 2018; Brattleboro Reformer, March 8, 2018 -"We can prevent further loss in the wake of high-profile suicides," by Kirk Woodring, LICSW, previous Chief Clinical Officer with the Brattleboro Retreat, Bennington Banner, June 10, 2018; Milton Independent June 13, 2018; and on the VTDigger website -"Safe, Quality Patient Care at the Brattleboro Retreat is a Shared Goal," by Meghan Baston, MSN, RN, Op-Ed was published in the Brattleboro Reformer, the Commons, and the Vermont Business Magazine on July 3, 2018. It was published in the VTDigger on July 4, 2018 -"Connection as a Protective Factor Against Suicide," by Kirk Woodring, LICSW, The Couch podcast aired on July 8, 2018 -"Media spotlight on mental health provides opportunity," by Louis Josephson, Ph.D., opinion piece was published in the Brattleboro Reformer on 12/7/2018; Vermont Biz 12/7/2018The 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. Part V, Section B, Line 11 Continued 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 will develop a three-year action plan to address our identified priority areas. 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: Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to earnings and a credit to a valuation allowance based on its assessment of the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to accounts receivable.In evaluating the collectibility of accounts receivable, the Retreat analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Data for each major payor source is regularly reviewed to evaluate the appropriateness of the allowance for doubtful accounts. For receivables relating to self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Retreat records a provision for bad debts based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.During 2018, the Retreat increased its estimate for allowance for doubtful accounts from $3,914,474 to $7,220,649. During 2017, the Retreat increased its estimate from $3,499,910 to $3,914,474. Management has been evaluating and restructuring the Retreat's revenue cycle during 2018 and 2017 and, as a result, this process has caused delays in the processing of claims and identified additional uncollectible accounts. 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 2018, the Brattleboro Retreat served 4,788 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 2018, the Brattleboro Retreat served 2,777 individuals in our outpatient programs. 656 children were served across all programs. Sixty-seven children were served in our residential programs and 180 children in our school programs. In response to a healthcare environment that continued to shift in 2018, and as demand for psychiatric and addiction services became more pronounced, the Retreat continued to meet the need for high quality care by strengthening its clinical expertise. This included the continued ongoing roll-out of evidence-based practices in clinical areas throughout the hospital. This has required a significant investment in staff education and training. 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.2018 marked the second year of the Retreat's 2017-2019 strategic plan entitled Setting a New Standard. This three-year plan outlines a host of strategic initiatives that are organized under four main categories: Focus on Clinical Excellence; Achieve Financial Stability; Increase Accountability; and Reimagine our Historic Campus.Summary of Strategic Plan Progress in 2018:1. "Focus on Clinical Excellence" 2018 Summary of Achievements: Assembled a visionary nursing leadership team, which has been instrumental in strengthening bedside nursing; re-engineered the Clinical Education department to bolster onboarding and continuing clinical education of direct care staff; developed a new Nurse Residency program with planned 2019 roll out; established a relationship with an international nursing agency to help address the nursing shortage; invested in enhanced wages for direct care staff. 2. "Achieve Financial Stability" 2018 Summary of Achievements: Successfully reorganized and improved revenue cycle functions; strengthened/expanded our partnership with the State (negotiated Medicaid rate increase; collaborated on plan to add 12 new Level-I inpatient beds; explored options for dealing with possible loss of IMD waiver)concluded business analysis of service line; utilized tele-psychiatry to extend physician coverage; revised payer contracts and successfully controlled operating expenses in numerous areas.3. "Increase Accountability" 2018 Summary of Achievements: revised hospital Organizational chart to streamline hospital management; developed a sustainable model for regulatory readiness (Joint Commission, CMS, etc.); reconfigured IT Steering Committee and reorganized IT department with emphasis on customer service; initiated a reorganization of the Human Resources department.4. "Reimagine our Historic Campus" 2017 Summary of Achievements: rolled out clean energy alternatives and the use of renewable resources; commenced construction of a new state-funded, 12-bed inpatient unit for Level I adults.Summary of Process for Openness and Public ParticipationThe 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 and Financial InformationIn 2018 the Brattleboro Retreat spent approximately $685,000 on capital improvements. The depreciation schedule was $1.9 million. As a private not-for- profit organization, copies of the strategic plan are not publicly available. Questions regarding any strategic planning issues or opportunities for public input may be addressed to Konstantin von Krusenstiern, Vice President of Development and Communications. For more information, please contact: Konstantin von Krusenstiern, Vice President of Development & CommunicationsBrattleboro Retreat1 Anna Marsh Lane, P.O. Box 803Brattleboro, VT 05301(802) 258-4366 Part VI, Line 3: At the time of admission, patients are counseled as to 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 11,471. The estimated population for Windham County is 42,756. The state of Vermont has an estimated population of 626,299. (U.S. Census estimate, July 1, 2018). 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 abuse 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 2018 of 6,902,149 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 $57,513. 11.3 percent of Vermonters live in poverty and 5.5 percent of Vermonters are without health insurance. In 2018, 64 percent of the Retreat's funding came from public sources-11 percent from Medicare and 53 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. The Retreat offers 6-8 free community workshops per year as part of the program.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, 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. 1 United Way of Windham County PO Box 617 Brattleboro VT 053020617 036003074 501(c)(3) 19140 Organizational Support 1 0 Part I, Line 2: Grants and other assistance payments are made only to 501(c)(3) organizations or governmental entities. Therefore, additional monitoring is not deemed necessary. X 0 0 0 0 0 0 0 0 0 Louis Josephson CEO 336276 0 0 0 57135 0 8250 0 55589 0 457250 0 0 0 Arthur Nichols CFO 216461 0 0 0 0 0 2197 0 24683 0 243341 0 0 0 Lisa Lambert Staff Psychiatrist 462495 0 0 0 0 0 8151 0 0 0 470646 0 0 0 Mark McGee Chief Medical Officer 287648 0 0 0 448 0 6816 0 32864 0 327776 0 0 0 John Fanton Staff Psychiatrist 305363 0 0 0 394 0 3869 0 18500 0 328126 0 0 0 Karl Jeffries Unit Chief 260022 0 0 0 400 0 8111 0 35416 0 303949 0 0 0 Simha Ravven Interim Chief Medical Officer 254583 0 0 0 266 0 5585 0 24410 0 284844 0 0 0 A Vermont Educational and Health Buildings Financing Agency 237154467 2015-07-15 11245000 Refund Series 2011A Bonds 0 0 0 A 11245000 97745 11147255 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 1 0 0 0 0 0 0 A 0 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 317,565. Management and general expenses 0. Fundraising expenses 0. Total expenses 317,565. Contract Services: Program service expenses 8,817,875. Management and general expenses 1,079,361. Fundraising expenses 0. Total expenses 9,897,236. Purchased Services: Program service expenses 47,971. Management and general expenses 0. Fundraising expenses 0. Total expenses 47,971. Consulting Fees: Program service expenses 0. Management and general expenses 298,029. Fundraising expenses 0. Total expenses 298,029. 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.