2019-08-14T13:50:28-05:00 2018-09-30 020476956 TYLER SIMMS & ST SAUVEUR CPAS PC 19 MORGAN DRIVE LEBANON NH 03766 990 2017-10-01 030183721 WINDSOR HOSPITAL CORPORATION WIND 8026746711 289 COUNTY ROAD WINDSOR VT 05089 DAVID SANVILLE CFO 8026746711 2019-08-13 1 W JAY SIMMS P00435321 6036530044 2019-08-13 216.107.201.226 2019-08-13 13:19:21 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E125F4664CA59E986E126FDFBB4724C3AED932BF 2017 2019-02-21 02:37:17Z MT ASCUTNEY HOSPITAL & HEALTH CENTER DAVID SANVILLE 289 COUNTY ROAD WINDSOR VT 05089 55684344 0 X MTASCUTNEYHOSPITAL.ORG X 1933 VT TO IMPROVE THE LIVES OF THOSE WE SERVE. OUR ACTIVITIES INCLUDE PROVIDING HEALTHCARE. 17 10 540 185 -6151 -6151 906396 1057821 51135484 53629858 624393 883372 159577 77823 52825850 55648874 0 0 0 0 30149034 32199150 0 0 288074 20347045 21315219 50496079 53514369 2329771 2134505 50695886 54844981 25152463 26292087 25543423 28552894 X MT. ASCUTNEY HOSPITAL AND HEALTH CENTER'S MISSION IS TO IMPROVE THE LIVES OF THOSE WE SERVE. 0 0 43130184 53661706 MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) OPERATES A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHICH PROVIDES PRIMARY AND SECONDARY HEALTH CARE. MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, CLAREMONT, WOODSTOCK, HARTLAND, SPRINGFIELD, AND BROWNSVILLE. THE HOSPITAL PROVIDES ESSENTIAL HEALTHCARE SERVICES INCLUDING EMERGENCY DEPARTMENT, MED/SURG INPATIENT, AND ANCILLARY DIAGNOSTIC TESTS, IMAGING/RADIOLOGY PROCEDURES, AND WELLNESS/PREVENTION SERVICES. MAHHC STAFFS A TOTAL OF 25 ACUTE MED/SURG BEDS AND 10 ACUTE REHABILITATION BEDS. DURING THE YEAR, THERE WERE 1,075 DISCHARGES, 1,597 SURGERIES, 60,786 LAB TESTS, AND 11,746 IMAGING PROCEDURES. MAHHC IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING THE PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE AND PEDIATRICS IN WINDSOR AND WOODSTOCK. MAHHC PROVIDES FREE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. FOREGONE CHARGES FURNISHED UNDER MAHHC'S FREE CARE POLICY AMOUNTED TO $949,742 IN FY18. 43130184 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 61 0 1 540 1 1 1 0 0 0 0 0 0 0 0 0 X 17 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID SANVILLE 8026746711 289 COUNTY ROAD WINDSOR VT 05089 JOHN GILMAN TRUSTEE 1.00 X 0 0 0 MICHAEL NEWBOLD TRUSTEE 1.00 X 0 0 0 LYNN PETERSON MD TRUSTEE 1.00 X 0 0 0 HON DONNA SWEANEY VICE-CHAIR 1.00 X X 0 0 0 STEVEN SMITH MD TRUSTEE 1.00 40.00 X 0 183126 114455 ALAN KEILLER CHAIR (FROM 12/2017) 1.00 X X 0 0 0 MARIA PADIN MD DH REPRESENTATIVE 1.00 40.00 X 0 399509 275686 VINCENT FUSCA III TREASURER 1.00 X X 0 0 0 DEANNA S HOWARD DH REPRESENTATIVE 1.00 X 0 0 0 MATTHEW S HOUDE DH REPRESENTATIVE 1.00 40.00 X 0 194397 34795 STEPHEN D SURGENOR MD DH REPRESENTATIVE 1.00 40.00 X 0 490966 69725 JOHN TANSEY SECRETARY 1.00 X X 0 0 0 GAY LANDSTROM INTERIM CEO (THRU 1/2017) 40.00 1.00 X X 0 65456 4008 JOSEPH PERRAS PRESIDENT & CEO (FROM 1/17 40.00 1.00 X X 346184 0 0 PAMELA BROWN TRUSTEE 1.00 X 0 0 0 PATRICK JORDAN DH REPRESENTATIVE 1.00 40.00 X 0 46154 2396 WILLIAM PALMER MD TRUSTEE 1.00 40.00 X 0 203701 209145 DONNA VANFLEET CHAIR (EFFECTIVE THRU 12/2017) 1.00 X X 0 0 0 DAVID SANVILLE CFO 32.00 X 181809 0 20699 MARY JOYCE PHYSICIAN 40.00 X 249664 0 20699 CHRISTOPHER CONNOR PHYSICIAN 40.00 X 315647 0 10000 HEIDI CRUZ PHYSICIAN 40.00 X 238721 0 20689 DENNIS HEIBEIN PHYSICIAN 40.00 X 244242 0 10000 PETER RAUERT PHYSICIAN 40.00 X 407201 0 18140 1983468 1583309 810437 38 0 1 0 DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL DRIVE LEBANON NH 03756 LEADERSHIP, PHYSICIANS AND MEDICAL SERVI 3733587 EMERGENCY SERVICES OF NEW ENGLAND PO BOX 12 CHESTER VT 05143 MEDICAL STAFF PROVIDERS FOR EMERGENCY RO 1490109 AHSA STAFFING PO BOX 945 TRAVERSE CITY MI 49685 TEMPORARY NURSING/CLINICAL STAFFING 1038954 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 MNGMT & SUPPORT STAFF - ENVMMNTL SRVS 739934 CERNER PO BOX 959156 ST LOUIS MO 63195 SUPPORT FOR EMR 678169 32 740954 316867 1057821 PATIENT SERVICES 621110 97368607 97368607 PROGRAM & MISC OTHER 621110 2821217 2821217 ONE CARE VERMONT 621110 732703 732703 DSH/VAHHS REVENUE 621110 683877 683877 PROVISION FOR DOUBTFUL ACCOUNTS 621110 -1541879 -1541879 -46434667 -46434667 53629858 252096 -6151 258247 26322 0 26322 26322 26322 623898 21700 0 14322 623898 7378 631276 631276 40801 21148 19653 19653 EQUITY IN INCOME OF SUBSIDIARIES 621110 31848 31848 31848 55648874 53661706 -6151 935498 542826 35172 507654 24579332 20861262 3570842 147228 909748 771488 132877 5383 4453548 3739282 689930 24336 1713696 1426481 277276 9939 23641 23641 86288 86288 4183293 2235830 1915209 32254 123053 11811 82064 29178 63724 51450 11478 796 441317 139412 293093 8812 679706 656571 23103 32 67161 43119 23244 798 226535 226535 2076659 2076659 600378 408795 189909 1674 PURCHASED SERVICES 5505993 5166528 339465 SUPPLIES 3446707 3220412 205865 20430 DUES/FEES/TAXES 2263091 1875622 385024 2445 UTILITIES 671316 33495 637821 856357 376795 474793 4769 53514369 43130184 10096111 288074 6094896 7170204 172467 174261 603278 692307 5888667 6004348 478194 459566 581355 472047 44631560 26546318 17135210 18085242 15281709 17206629 1856051 1888026 2604059 2692351 50695886 54844981 4820536 6599443 953292 753948 567610 19577979 18171742 25152463 26292087 X 18320180 21306927 1345233 1354615 5878010 5891352 25543423 28552894 50695886 54844981 X 2134505 192916 682050 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 12969 12969 0 PART II-B, LINE 1: THE HOSPITAL PAID $10,620 IN THE FORM OF DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (VAHHS). VAHHS IS A MEMBER-OWNED ORGANIZATION DEVOTED TO IMPROVING THE HEALTH STATUS OF COMMUNITIES THROUGHOUT VERMONT THROUGH ACTIVITIES WHICH INCLUDE ADVOCACY, POLICY DEVELOPMENT, EDUCATION AND RESEARCH. THE HOSPITAL ALSO PAID $2,349 IN THE FORM OF DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA). 0 4958242 289494 187437 5060299 4667571 475456 184785 4958242 4431980 420076 184485 4667571 4759330 -30485 296865 4431980 4645093 312380 198143 4759330 0.83360 0.16640 0 0 410000 410000 17111835 9015222 8096613 13949902 10245489 3704413 13159823 7285607 5874216 18085242 DARTMOUTH-HITCHCOCK CLINIC (RELATED) ACCOUNTS PAYABLE 566875 EST. SETTLEMENTS W/ 3RD PARTY PAYORS 1396395 MARY HITCHCOCK MEMORIAL HOSPITAL & NEAH (RELATED) ACCOUNTS PAYABLE 71618 MARY HITCHCOCK MEMORIAL HOSPITAL (RELATED) NOTE PAYABLE 10842747 OTHER LIABILITIES 720823 POST RETIREMENT BENEFIT OBLIGATION 4573284 18171742 X 56458700 192916 682050 874966 55583734 86288 -21148 65140 55648874 53449229 21148 21148 53428081 86288 86288 53514369 PART V, LINE 4: IN GENERAL, THE AMOUNT OF THE ORIGINAL GIFT AND ANY REQUIRED ACCUMULATIONS BY THE DONOR ARE NOT EXPENDABLE. HOWEVER, THE MARKET VALUE OF THE FUND MAY FALL BELOW THAT AMOUNT DEPENDING ON CURRENT FINANCIAL CONDITIONS IN THE UNDERLYING INVESTMENTS. UNDER THE POLICY OF THE HOSPITAL, THE ENDOWMENT ASSETS ARE INVESTED MODERATELY WITH THE INTENT OF PROVIDING A PREDICTABLE STREAM OF FUNDING TO THE HOSPITAL. THE HOSPITAL INVESTS IN EQUITY FUNDS, BOND FUNDS AND MONEY MARKET INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN LIMITED RISK CONSTRAINTS. ACTUAL RETURNS IN ANY YEAR MAY VARY FROM BUDGETED AMOUNTS DUE TO MARKET FLUCTUATIONS. PART X, LINE 2: ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ADDRESSES THE ACCOUNTING UNCERTAINTY OF INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF "MORE-LIKELY-THAN-NOT" FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON MEASUREMENT CLASSIFICATION, INTEREST AND PENALTIES AND DISCLOSURE. THE ORGANIZATION HAS DETERMINED THAT THE PROVISIONS OF SUBTOPIC 740-10 DO NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATIONS FOR FISCAL YEARS PRIOR TO 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER COMPONENTS OF NET PERIODIC BENEFIT COST 185,694. CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST-RETIREMENT PLANS 496,356. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -21,148. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 21,148. GOLF TOURNAMENT 40801 40801 5118 2448 7363 1209 5010 40801 40801 5118 2448 7363 1209 5010 21148 19653 1 1 1 X 225.000000000000 1 X 1 1 1 0 1 1 400697 400697 0.00750 6587826 2573564 4014262 0.07500 6988523 2573564 4414959 0.08250 1583963 910713 673250 0.01260 93359 93359 0.00170 4386065 3444743 941322 0.01760 2069 2069 0.00000 6065456 4355456 1710000 0.03190 13053979 6929020 6124959 0.11440 0 949742 23692477 17044147 6648330 X 1 1 1 1 WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 X X X X DISTINCT PART REHAB UNIT WINDSOR HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE SCHEDULE O X X 1 15 1 SEE SCHEDULE O 0 1 X 225.000000000000 300.000000000000 X X X X X X X 1 1 X X X X 1 X SEE SCHEDULE O X SEE SCHEDULE O X SEE SCHEDULE O X X X X X 1 X 0 X X X X 1 X 0 0 WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 5: METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH ELECTRONIC MAIL, PHYSICAL PRINTED SURVEYS DISTRIBUTED THROUGH THE COMMUNITIES AT APPROXIMATELY 72 SITES AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE MT. ASCUTNEY HOSPITAL SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. AT THE BEGINNING OF THE SURVEY, RESPONDENTS WERE ASKED TO INDICATE THE REGION THEY PRIMARILY SERVE OR ARE MOST FAMILIAR WITH. A TOTAL OF 137 KEY STAKEHOLDER RESPONDENTS INDICATED THAT THEIR RESPONSES WERE REFLECTIVE OF THE GREATER WINDSOR SERVICE AREA. RESPONDENTS REPRESENTED THE FOLLOWING SECTORS:HUMAN SERVICE/SOCIAL SERVICE MENTAL /BEHAVIORAL HEALTH HOME HEALTH CARE PRIMARY HEALTH CAREMEDICAL SUBSPECIALTYPUBLIC SAFETY/FIRE EMERGENCY MEDICAL SERVICES EDUCATION/YOUTH SERVICES MUNICIPAL/COUNTY GOVERNMENT COMMUNITY MEMBER/VOLUNTEER WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 6A: OTHER FACILITIES WERE MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH), ALICE PECK DAY MEMORIAL HOSPITAL, NEW LONDON HOSPITAL AND VALLEY REGIONAL HOSPITAL. DURING JANUARY THROUGH JULY 2018, MAHHC COMPLETED OUR COMMUNITY NEEDS ASSESSMENT IN PARTNERSHIP WITH AFOREMENTIONED NEIGHBORING HOSPITALS INCLUDING THE VISITING NURSES AND HOSPICE OF VT AND NH, AS WELL AS MHMH, USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 6B: THROUGH JANUARY JULY 2018, MAHHC WORKED WITH MARY HITCHCOCK MEMORIAL HOSPITAL AND COMMUNITY PARTNERS (72 ORGANIZATIONS) TO DISSEMINATE SURVEYS, SERVE AT KEY INFORMANTS (137) AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 7D: A BENEFIT REORT WAS PREPARED AND MADE AVAILABLE AND DISTRIBUTED THROUGH 5 COMMUNITY PRESENTATIONS, (INCLUDING 2 REGIONAL SUMMITS WITH OVER 100 PARTICIPANTS) CONDUCTED BY THE COMMUNITY BENEFIT STAFF, AS WELL AS A THOROUGH PRESENTATION MADE TO HOSPITAL'S BOARD OF TRUSTEES. THE MT. ASCUTNEY COMMUNITY HEALTH COMMITTEE, AS WELL AS THE WINDSOR AREA COMMUNITY PARTNERSHIP, AND WOODSTOCK HEALTH AND WELLNESS NETWORK, PARTICIPATED IN THE DISTRIBUTION OF THE REPORT. THE CHNA AND ALL INFORMATION IN THE NEEDS ASSESSMENT IS AVAILABLE FOR STAKEHOLDERS. THE CHNA IS ALSO AVAILABLE VIA PAPER COPY FOR PUBLIC INSPECTION UPON REQUEST, AT THE HOSPITAL'S MAIN INFORMATION DESK. IT IS ALSO AVAILABLE PROMINENTLY ON THE FOLLOWING WEBSITE, HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/FY2018%20MTA%20COMMUNITY%20HEALTH%20NEEDS%20ASSESSMENT%2010.3.18.PDF WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 11: THE MISSION OF MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) IS TO IMPROVE THE LIVES OF THOSE WE SERVE. TO ACCOMPLISH THIS, WE AND OUR COMMUNITY PARTNERS REGULARLY REACH OUT TO ENGAGE IN DIALOGUE WITH PEOPLE ACROSS OUR AREA ABOUT PRESSING HEALTH NEEDS. THE RESULT OF THIS WORK IS A COMPREHENSIVE LOCAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).*THIS ASSESSMENT IS DESIGNED TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES AND OPPORTUNITIES TO IMPROVE COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS.THE GEOGRAPHIC AREA COVERED BY THE ASSESSMENT IS 13 MUNICIPALITIES IN VERMONT AND NEW HAMPSHIRE THAT COMPRISE THE MT. ASCUTNEY HOSPITAL AND HEALTH CENTER SERVICE AREA.THE CHNA LEADS TO A LOCAL COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WITH STRATEGIES AND METRICS TO IMPROVE HEALTH AND REDUCE RISKS LEADING TO CHRONIC DISEASENOT ONLY FOR INDIVIDUALS, BUT FOR THE ENTIRE COMMUNITY.THIS CHNA-CHIP PROCESS, WHICH INCORPORATES INPUT FROM PEOPLE WHO REPRESENT THE COMMUNITY'S BROAD INTERESTS, IS AN ESSENTIAL PART OF CREATING AN ACCOUNTABLE COMMUNITY FOR HEALTH. IT'S THE LAW FOR TAX-EXEMPT HOSPITALS, AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. BUT IT'S ALSO SOUND MEDICINE. THE ASSESSMENT PROCESS FOSTERS ENGAGEMENT, AND THE RESULTS HELP US UNDERSTAND THE SPECIFIC ISSUES FACING OUR COMMUNITIES SO THAT WE CAN DEVELOP EFFECTIVE, COLLECTIVE SOLUTIONS.1. AL ALCOHOL AND DRUG MISUSE, INCLUDING HEROIN & PAIN MEDICATIONS THE INTERDISCIPLINARY CHRONIC PAIN CONSULT TEAM MET ON A MONTHLY BASIS TO PROVIDE SUPPORT FOR MANAGING CHALLENGING CHRONIC PAIN PATIENTS THE BLUEPRINT SELF MANAGEMENT PROGRAM ALSO CONVENED TWO CHRONIC PAIN SELF MANAGEMENT CLASSES THIS REPORTING PERIOD. MAHHC IMPLEMENTED MEDICATION ASSISTED THERAPY "SPOKE" PROGRAMS IN 4 SITES, MAHHC, OTTAUQUECHEE HEALTH CENTER, CONNECTICUT VALLEY RECOVERY SERVICES AND BRADFORD PSYCHIATRIC ASSOCIATION SERVING OVER 200 PATIENTS EACH QUARTER PURCHASED MICHIGAN MODEL (SUBSTANCE MISUSE PREVENTION CURRICULA) FOR WINDSOR, HARTLAND, AND WEATHERSFIELD SCHOOLS FOR 2018/2019 SCHOOL YEAR IMPLEMENTATION MAHHC AND THE WINDSOR AREA DRUG TASK FORCE CONVENED "BEYOND NALOXONE: PREVENTION OF OPIATE DEATHS SUMMIT". THE FIRST WAS HELD IN JUNE AND THE SECOND IN SEPTEMBER 2018 MAHHC AND THE WINDSOR AREA DRUG TASK FORCE CONVENED A SUMMIT TO REVIEW DATA, SHARE CONCERNS, AND CREATE SOLUTIONS FOR YOUTH SUBSTANCE MISUSE AND CREATED 2 RESOURCE GUIDES RELATING TO YOUTH PREVENTION INTERVENTION AND TREATMENT SERVICES. EXPANDED REGIONAL APPROACH BY CONTRACTING WITH GIFFORD HEALTH CARE AND LITTLE RIVERS HEALTHCARE TO PARTICIPATE IN PREVENTION EFFORTS. DESIGNED AND IMPLEMENTED MARIJUANA LAW COMMUNITY SURVEY TO GAUGE UNDERSTANDING AND IDENTIFY MARIJUANA EDUCATION NEEDS. 602 RESPONSES COLLECTED ACROSS WINDSOR COUNTY. WORKGROUP CONVENED TO CREATE TWO RESOURCE GUIDES: PREVENTION ACTIVITIES & YOUTH SUBSTANCE MISUSE TREATMENT PROGRAMS2. ACCESS TO MENTAL HEALTH SERVICES WELLNESS RECOVERY ACTION PLAN (WRAP) WORKSHOPS DELIVERED FOR SKILL BUILDING AND SELF-MANAGEMENT SUPPORT FOR ANXIETY, DEPRESSION AND GENERAL MENTAL HEALTH EXPANSION OF AN HCRS EMBEDDED LADC TO 4 DAYS A WEEK IN PATIENT-CENTERED MEDICAL HOME (PCMH), SUPPORTED BY SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) GRANT PSYCHIATRIST EMBEDDED IN PATIENT CENTERED MEDICAL HOME MENTAL HEALTH COUNSELING SESSIONS AT WINDSOR CONNECTION RESOURCE CENTER INCREASED FROM 336 IN 2017 TO 776 IN 20183. ACCESS TO DENTAL CARE WORKING WITH NORTHEAST DELTA DENTAL AND ALICE PECK DAY COMMUNITY HEALTH, MAHHC ORGANIZED A DENTAL CLINIC IN THE WINDSOR ELEMENTARY SCHOOL CALLED WINDSOR SMILES PROGRAM IN 2018, THE WINDSOR COMMUNITY HEALTH CLINIC SUPPLIED 12 DENTAL VOUCHERS WHICH TOTALED $6,701.25 WORTH OF SERVICES4. ACCESS TO AFFORDABLE HEALTH INSURANCE AND PRESCRIPTION MEDICATION M THE WINDSOR COMMUNITY HEALTH CLINIC ASSISTS CLIENTS WITH VT HEALTH CONNECT, MEDICARE, AND MEDICAID APPLICATIONS.ALSO HELPS PATIENTS COMPLETE APPLICATIONS FOR REDUCED PRICE MEDICATIONS FROM PHARMACEUTICAL COMPANIES. IN 2018, 5 MEDICAL DOCTORS, 5 REGISTERED NURSES, 2 MENTAL HEALTH PROFESSIONALS, 8 MID-LEVEL NURSING PROVIDERS, AND 1 LICENSED CLINICAL SOCIAL WORKER DONATED THEIR TIME TO SUPPORT THE CLINIC. A TOTAL OF $852,318 OF IN-KIND SUPPORT WAS OFFERED, WITH PAID PROGRAM EXPENSES BEING $78,464. A TOTAL OF $8,396 WAS SPENT ON MEDICATION VOUCHERS IN 2018E5. HEALTH CARE FOR SENIORS ESTABLISHED A REGIONAL, COMMUNITY-BASED FALLS PREVENTION BEST PRACTICE PROGRAM INVOLVING EMS IN WOODSTOCK AND WINDSOR, HISTORIC HOMES OF RUNNEMEDE, OLD WINDSOR VILLAGE, RETIRED SENIORS VOLUNTEER PROGRAM (RSVP), PATIENT- CENTERED MEDICAL HOME, MAHHC PHYSICAL THERAPY; ADOPTION OF FALLS FREE STATEWIDE PROGRAM (STEDI SYSTEM); DEVELOPED EMS PROTOCOL; PROVIDED TRAINING; PROMOTED REFERRALS TO PT AND COMMUNITY-BASED SKILLS TRAINING; AND PROVIDED BALANCE AND STRENGTH TRAINING FOR SENIORS. INTERAGENCY CARE MANAGEMENT AND CARE COORDINATION THROUGH THE COMMUNITY HEALTH TEAM FOR HIGH-RISK CHRONIC CARE ELDERS. LEADERSHIP AND BOARD PARTICIPATION FOR THE CREATION OF SCOTLAND HOUSE ADULT DAY HEALTH AND WELLNESS PROGRAM. SUPPORT AND SERVICES AT HOME (SASH) WELLNESS NURSE SERVED OVER 100 PATIENTS WITH ASSESSMENTS, EDUCATION, MONITORING AND CARE COORDINATION. INVOLVED IN 2 QUALITY INITIATIVES WITH MAHHC PATIENT-CENTERED MEDICAL HOME INCLUDING HYPERTENSION AND DIABETES QUALITY INITIATIVES. HOUSING AND SUPPORTIVE SERVICES (HASS) COORDINATOR WORKED TO DECREASE SOCIAL ISOLATION BY PROVIDING ONE- ON-ONE VISITING FOR 31 RESIDENTS, WITH CLASSES AND EVENTS INCLUDING GARDENING, BOOK CLUBS, CRAFTS, ART AND MUSIC. LEADERSHIP AND BOARD PARTICIPATION FOR THE CREATION OF SCOTLAND HOUSE ADULT DAY HEALTH AND WELLNESS PROGRAM. SUPPORT AND SERVICES AT HOME (SASH) WELLNESS NURSE SERVED OVER 100 PATIENTS WITH ASSESSMENTS, EDUCATION, MONITORING AND CARE COORDINATION. INVOLVED IN 2 QUALITY INITIATIVES WITH MAHHC PATIENT-CENTERED MEDICAL HOME INCLUDING HYPERTENSION AND DIABETES QUALITY INITIATIVES. HOUSING AND SUPPORTIVE SERVICES (HASS) COORDINATOR WORKED TO DECREASE SOCIAL ISOLATION BY PROVIDING ONE- ON-ONE VISITING FOR 31 RESIDENTS, WITH CLASSES AND EVENTS INCLUDING GARDENING, BOOK CLUBS, CRAFTS, ART AND MUSIC.6. NUTRITION / ACCESS TO AFFORDABLE, HEALTHY FOOD HOSTED VT FOOD BANK'S "VEGGIEVANGO" EVERY MONTH (DELIVERY OF FREE VEGETABLES TO THE COMMUNITY). SERVES 90 TO 215 FAMILIES EACH MONTH. MAHHC MEDICAL PROVIDERS GIVE "PRESCRIPTIONS" FOR VEGETABLES AND "VEGGIEVANGO PREVENT TYPE 2 DIABETES SUPPORT GROUP WORKSHOPS WERE HELD ON A MONTHLY BASIS FROM JANUARY THROUGH SEPTEMBER. NEW TOPICS WERE REVIEWED UNDER THE GUIDANCE OF EXPERTS IN DIABETES AND RELATED FIELDS ORGANIZED SUMMER PICNIC SERIES. SERVED DAILY, FREE LUNCH TO CHILDREN ACROSS THE SCHOOL DISTRICT. THREE LOCATIONS SERVED OVER AN 8-WEEK PERIOD TO ABOUT 70 CHILDREN PER DAY, FOR A TOTAL OF ABOUT 2,800 LUNCHES SERVED. PEDIATRIC CLINIC SCREENED FOR FOOD INSUFFICIENCY AND PROVIDED REFERALS TO THE COMMUNITY HEALTH TEAM FOR THOSE AT RISK. MAHHC REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR PROVIDED NUTRITIONAL COUNSELING ON AN ONGOING BASIS ORGANIZED A LEARNING KITCHEN CLASS FOR RESIDENTS LIVING IN LOCAL SUBSIDIZED HOUSING UNITS.7. PHYSICAL ACTIVITY AND OBESITY IN JULY 2018, MAHHC JOINED THE FIRST COHORT OF 6 HOSPITALS EXPANDING THE RISEVT PROGRAM STATEWIDE. THE PROGRAM INCREASES OUR CAPACITY FOR MORE OPPORTUNITIES RELATED TO PHYSICAL ACTIVITY AND ADDRESSES FOOD INSECURITY/NUTRITION IN WSESU TOWNS. ORGANIZED A 20-MEMBER, CROSS-SECTOR STEERING COMMITTEE TO HELP SHAPE PLAN FOR 2019 MT. ASCUTNEY PREVENTION PARTNERSHIP (MAPP) CONDUCTED READINESS ASSESSMENTS FOR TOWN HEALTH & WELLNESS COMMITTEES IN WINDSOR, WOODSTOCK, AND WEATHERSFIELD. COMMUNITY OUTREACH RELATED TO INCREASING PHYSICAL ACTIVITY THROUGH THE VERMONT 3-4-50 CAMPAIGN RESULTED IN OVER 2,000 CONTACTS. MAHHC IS AT THE 3-4-50 WORKSITE WELLNESS "GOLD" LEVEL FOR HOSTING A MYRIAD OF WELLNESS INCENTIVES AND EXERCISE OFFERINGS.8. INCOME POVERTY AND FAMILY STRESS FAMILY WELLNESS PROGRAM IS EMBEDDED IN THE PEDIATRIC CLINIC AND EMPLOYS THE VERMONT FAMILY-BASED APPROACH METHODOLOGY. PARENT TRAINING IN COLLABORATIVE PROBLEM-SOLVING (CPS). WINDSOR BECAME A PROMISE COMMUNITY TO PROMOTE KINDERGARTEN READINESS AND EMOTIONAL-SOCIAL COMPETENCE OF CHILDREN AND FAMILIES. MAHHC PROVIDED BACKBONE SUPPORT TO A CROSS-SECTOR STEERING COMMITTEE. PROJECT ACTIVITIES INCLUDED TRAINING FOR EARLY CHILDHOOD EDUCATORS, ESTABLISHING FREE TAKE-A-BOOK BOXES IN 4 TOWNS, AND CREATING A FAMILY-FRIENDLY ACTIVITY SPACE AT THE WINDSOR CONNECTION RESOURCE CENTER. PATCH SERVICES AT THE WINDSOR CONNECTION RESOURCE CENTER INCLUDE ECONOMIC SERVICES, MENTAL HEALTH COUNSELING AND VISITS FOR EMPLOYMENT COUNSELING.(SEE CONTINUED EXPLANATION ON SCHEDULE O) WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 13B: PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF FPL MAY BE ELIGIBLE TO RECEIVE A DISCOUNT BASED ON THE SELF-PAY BALANCE. DISCOUNTS WILL BE GRANTED SUCH THAT THE TOTAL SELF-PAY BILL DOES NOT EXCEED 10% OF 2 YEARS GROSS INCOME, PLUS 10% OF ASSETS IN EXCESS OF THE SHELTERED ASSET CALCULATION DESCRIBED EARLIER IN THE POLICY. ANY DISCOUNTS OTHER THAN THOSE DESCRIBED ABOVE MUST BE APPROVED BY THE FINANCIAL ASSISTANCE APPEALS COMMITTEE BASED ON A WRITTEN APPEAL FROM THE PATIENT OR RESPONSIBLE PARTY. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 13H: MAHHC APPLIES A DISCOUNT TO THE FAP ELIGIBLE PATIENT'S GROSS CHARGES TO ALL BALANCES WHERE THERE IS NO INSURANCE, OR TO MEDICALLY NECESSARY SERVICES PROCESSED BY INSURANCE CARRIERS RESULTING IN A BALANCE, WHICH THE PATIENT IS EXPECTED TO PAY. THE DISCOUNT IS CALCULATED ANNUALLY. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN GENERALLY BILLED TO PATIENTS WITH INSURANCE. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 16J: THE MAHHC FINANCIAL ASSISTANCE POLICY IS POSTED ON MAHHC WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY VERSION. MAHHC PROVIDES THE PATIENT FRIENDLY BROCHURE VERSION OF THE POLICY TO ALL UNINSURED PATIENTS. MAHHC ALSO NOTIFIES PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABILITY. ADDITIONALLY, MAHHC POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITY INCLUDING ADMISSION OFFICES. MAHHC SCREENS UNINSURED PATIENTS AND A REPRESENTATIVE FROM THE WINDSOR COMMUNITY HEALTH DEPARTMENT (1 FULLTIME EMPLOYEE) CONNECTS WITH THE PATIENT TO ASSIST IN GETTING THEM SIGNED UP ON HEALTH PLANS OR APPLY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. A COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENTS SEGMENTS. A COST-TO-CHARGE RATIO WAS USED. PART I, LINE 7G: PHYSICIAN CLINIC COSTS INCLUDED WITHIN SUBSIDIZED HEALTH SERVICES ARE $6,245,064 OF THE TOTAL COMMUNITY BENEFIT EXPENSES AND $9,844,453 OF THE DIRECT OFFSETTING REVENUE. PART III, LINE 2: BAD DEBT EXPENSE IS DERIVED FROM THE WRITE OFF OF PATIENT ACCOUNTS AFTER THEY HAVE BEEN SENT 4 STATEMENTS OVER A COURSE OF 120 DAYS. ALSO, BAD DEBT EXPENSE CONTAINS ESTIMATES FOR FUTURE WRITE-OFFS BASED ON MANAGEMENT'S JUDGEMENTS AND FINANCIAL MODELS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. BALANCES STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE PROVISION FOR DOUBTFUL ACCOUNTS AND A CREDIT TO ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR DOUBTFUL ACCOUNTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR DOUBTFUL ACCOUNTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR DOUBTFUL ACCOUNTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACTUAL WRITE-OFFS ARE CHARGED AGAINST THE PROVISION FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE SHORTFALL REPRESENTS THE PPS REIMBURSEMENT DIFFERENCE ON THE REHAB UNITS. SINCE THE REIMBURSEMENT DOES NOT COVER THE COSTS OF THESE UNITS, A SUBSIDY IS CREATED. BECAUSE THE HOSPITAL DETERMINED THAT THESE SERVICES ARE IMPORTANT TO OUR SERVICE AREA, THE HOSPITAL COVERS THE SUBSIDY. THE COSTING METHODOLOGY USED ABOVE WAS THE COST TO CHARGE RATIO. PART III, LINE 9B: MAHHC'S COLLECTION POLICY AND CHARITABLE CARE POLICIES ARE CONSISTENTLY APPLIED TO ALL PATIENTS. OUR COLLECTION POLICY APPLIES TO ANY BALANCE OWED BY THE PATIENT WHETHER IT IS A BALANCE AFTER INSURANCE, A BALANCE WITH NO INSURANCE, OR A BALANCE AFTER AN ADJUSTMENT FOR PARTIAL CHARITABLE CARE. STATEMENTS, AND WRITE-OFF CRITERIA ARE THE SAME FOR ALL LIKE BALANCES, REGARDLESS OF THE REASON FOR THE BALANCE AND REGARDLESS OF WHETHER IT IS A BALANCE AFTER CHARITABLE CARE OR NOT. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE THE APPROPRIATE ADJUSTMENT ON THEIR BILL. IF A BALANCE REMAINS AFTER THAT ADJUSTMENT, THEY ARE BILLED ACCORDING TO THE COLLECTION POLICY, FOR THE REMAINDER. PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE NEEDS OF THE COMMUNITY ARE ASSESSED THROUGH ONGOING REVIEW OF HEALTH INDICATORS SUCH AS THE YOUTH RISK BEHAVIOR SURVEY, BRFSS, QUALITY INDICATORS FROM BOTH THE HOSPITAL AND EXTERNAL EVALUATIONS SUCH AS ONE CARE VERMONT AND THE THAT PRACTICE PROFILES. COMMUNITY HEALTH NEEDS ARE ALSO ASSESSED THROUGH PATIENT SATISFACTION SURVEYS AND THE PATIENT COMPLAINT PROCESS. THE HOSPITAL ALSO HAS A COMMUNITY HEALTH TEAM EMBEDDED IN OUR PATIENT CENTERED MEDICAL HOME WHO RESPOND TO THE NEEDS OF PATIENTS WITH COMPLEX CHRONIC CARE NEEDS. PART VI, LINE 3: WINDSOR COMMUNITY HEALTH CLINIC (A DEPARTMENT WITHIN THE HOSPITAL) PROVIDES INFORMATION AND ONE-ON-ONE ASSISTANCE WITH ANY INDIVIDUAL THAT IS IDENTIFIED WITHOUT INSURANCE. THIS BEGINS AT THE TIME THAT A PATIENT PRESENTS FOR THEIR HEALTH CARE APPOINTMENT; THE REGISTRATION STAFF MAKE THE INTRODUCTION AND PROVIDE INFORMATION TO THE PATIENT ON THE SERVICES. ALSO, A REFERRAL FROM THE PHYSICIAN/PROVIDER MAY DIRECT A PATIENT TO THIS DEPARTMENT. THE STAFF OF THIS DEPARTMENT ASSIST PATIENTS IN APPLYING FOR HEALTH INSURANCE, WHETHER ON THE COMMERCIAL "EXCHANGE", OR IN GOVERNMENTAL INSURERS. THEY ALSO PROVIDE INFORMATION ON AND THE APPLICATION FOR FINANCIAL ASSISTANCE; OFTEN TIME, ASSISTING PATIENTS WITH COMPLETING THE APPLICATION. THIS IS A DEDICATED STAFF THAT IS ON SITE DURING THE NORMAL BUSINESS HOURS WHEN THE MAJORITY OF PATIENTS WOULD BE SEEKING CARE. PART VI, LINE 4: MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, HARTLAND, WOODSTOCK, SPRINGFIELD, WEATHERSFIELD, BROWNSVILLE, VT AND CORNISH, AND CLAREMONT, NH. MAHHC IS THE LARGEST EMPLOYER IN THE TOWN OF WINDSOR, WITH MANY OF ITS RESIDENTS HAVING LOWER THAN AVERAGE PAYING JOBS AND STRUGGLE WITH FINANCIAL STABILITY; INCLUDING TRANSPORTATION DIFFICULTIES. PART VI, LINE 5: THE HOSPITAL HAS ESTABLISHED A DIRECTOR OF COMMUNITY HEALTH, A PREVENTION EDUCATION AND HEALTH PROMOTION DEPARTMENT AND A COMMUNITY HEALTH COMMITTEE WHICH IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES. OUR STAFF ORGANIZE, LEAD AND IMPLEMENT HEALTH PROMOTION AND PREVENTION PROGRAMS FOR HIGH RISK BEHAVIORS SUCH AS ALCOHOL, TOBACCO AND DRUG MISUSE. WE PROMOTE EXERCISE AND NUTRITION PROGRAMS IN A WELL-ESTABLISHED CAMPAIGN WORKING WITH THE VERMONT DEPARTMENT OF HEALTH IN THE 3-4-50 CAMPAIGN. THIS CAMPAIGN INVOLVES OUTREACH AND ENGAGEMENT TO AND WITH THE COMMUNITY TO DECREASE THE THREE BEHAVIORS OF TOBACCO USE, LACK OF EXERCISE AND POOR NUTRITION THAT ARE RELATED TO THE FOUR CONDITIONS OF HEART DISEASE AND STROKE, DIABETES, CANCER AND RESPIRATORY DISEASES THAT ACCOUNT FOR OVER 50% OF THE DEATHS IN VERMONT. THIS YEAR OUR OUTREACH IMPACTED OVER 1000 PEOPLE. WE SERVE AS AN INTEGRATOR AND LEADER OF COMMUNITY HEALTH BY CHAIRING AND LEADING THE FOLLOWING COMMUNITY PARTNERSHIPS; WINDSOR AREA COMMUNITY PARTNERSHIP, WINDSOR PA TCH TEAM, BLUEPRINT FOR HEALTH EXTENDED TEAM, WINDSOR HSA COMMUNITY COLLABORATIVE AND WINDSOR DRUG TASK FORCE. MISSION STATEMENTS AND MINUTES ARE AVAILABLE PER REQUEST. PART VI, LINE 6: THE HOSPITAL COMMUNITY BENEFIT STAFF IS AN ACTIVE PARTICIPANT IN REGIONAL COMMUNITY HEALTH COMMITTEE, WHICH IS LEAD AND ORGANIZED BY DARTMOUTH-HITCHCOCK. THE HOSPITAL IS AFFILIATED, FORMALLY, WITH DARTMOUTH-HITCHCOCK. AS ARE OTHER LOCAL HOSPITALS, ALICE PECK DAY MEMORIAL HOSPITAL AND NEW LONDON HOSPITAL. VALLEY REGIONAL HOSPITAL IS ALSO PART OF THE REGIONAL COMMUNITY HEALTH COMMITTEE. THE PARTICIPANTS COLLABORATE, COMPARE SOLUTIONS AND OFFER SUPPORT TO EACH OTHER AS ALL ARE SERVING OVERLAPPING SERVICE AREAS. PART VI, LINE 2 DURING THE PERIOD JANUARY THROUGH JULY 2018, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED BY MT. ASCUTNEY HOSPITAL AND HEALTH CENTER IN PARTNERSHIP WITH DARTMOUTH-HITCHCOCK, ALICE PECK DAY MEMORIAL HOSPITAL, VALLEY REGIONAL HEALTHCARE, NEW LONDON HOSPITAL AND VISITING NURSE AND HOSPICE FOR VT AND NH, AND THE NEW HAMPSHIRE COMMUNITY HEALTH INSTITUTE. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. FOR THE PURPOSE OF THE ASSESSMENT, THE GEOGRAPHIC AREA OF INTEREST WAS 13 MUNICIPALITIES IN VERMONT AND NEW HAMPSHIRE COMPRISING THE MT. ASCUTNEY HOSPITAL AND HEALTH CENTER SERVICE AREA WITH A TOTAL RESIDENT POPULATION OF 44,035 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED SURVEYS OF COMMUNITY RESIDENTS MADE AVAILABLE ON-LINE AND PAPER SURVEYS PLACED IN NUMEROUS LOCATIONS THROUGHOUT THE REGION; A DIRECT EMAIL SURVEY OF KEY STAKEHOLDERS AND COMMUNITY LEADERS REPRESENTING MULTIPLE COMMUNITY SECTORS; A SET OF COMMUNITY DISCUSSION GROUPS; COMPILATION OF RESULTS FROM ASSESSMENT ACTIVITIES FOCUSED SPECIFICALLY ON BEHAVIORAL HEALTH NEEDS AND GAPS; AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. ALL INFORMATION COLLECTION ACTIVITIES AND ANALYSES SOUGHT TO FOCUS ASSESSMENT ACTIVITIES ON VULNERABLE AND DISPROPORTIONATELY SERVED POPULATIONS IN THE REGION INCLUDING POPULATIONS THAT COULD EXPERIENCE LIMITED ACCESS TO HEALTH-RELATED SERVICES OR RESOURCES DUE TOINCOME, AGE, DISABILITY, AND SOCIAL OR PHYSICAL ISOLATION. HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/COMMUNITY-SERVICES/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS PART VI, LINE 3 UNINSURED PATIENTS, ARE PRO-ACTIVELY SCREENED TO IDENTIFY FOR POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE OR OTHER LOCAL PROGRAMS. A FULL-TIME EMPLOYEE, WHO IS DEDICATED TO SERVING THIS POPULATION GETS IN CONTACT WITH THE PATIENT TO HELP THEM COMPLETE THE APPLICATIONS, INCLUDING MAHHC FINANCIAL ASSISTANCE PROGRAM. THIS WORK IS THE SINGLE FOCUS OF HER JOB, AND SHE MAKES HERSELF AVAILABLE TO THE PATIENT IN PERSON, BY PHONE OR EMAIL. X 0 1 0 0 0 0 0 1 0 STEVEN SMITH MD TRUSTEE 0 182352 0 0 0 774 0 95090 0 19365 0 297581 0 0 MARIA PADIN MD DH REPRESENTATIVE 0 386729 0 0 0 12780 0 253282 0 22404 0 675195 0 0 MATTHEW S HOUDE DH REPRESENTATIVE 0 194397 0 0 0 0 0 13795 0 21000 0 229192 0 0 STEPHEN D SURGENOR MD DH REPRESENTATIVE 0 450673 0 0 0 40293 0 49762 0 19963 0 560691 0 0 JOSEPH PERRAS PRESIDENT & CEO (FROM 1/17 346184 0 0 0 0 0 0 0 0 0 346184 0 0 0 WILLIAM PALMER MD TRUSTEE 0 202513 0 0 0 1188 0 196234 0 12911 0 412846 0 0 DAVID SANVILLE CFO 181809 0 0 0 0 0 0 0 20699 0 202508 0 0 0 MARY JOYCE PHYSICIAN 249664 0 0 0 0 0 0 0 20699 0 270363 0 0 0 CHRISTOPHER CONNOR PHYSICIAN 315647 0 0 0 0 0 0 0 10000 0 325647 0 0 0 HEIDI CRUZ PHYSICIAN 238721 0 0 0 0 0 0 0 20689 0 259410 0 0 0 DENNIS HEIBEIN PHYSICIAN 244242 0 0 0 0 0 0 0 10000 0 254242 0 0 0 PETER RAUERT PHYSICIAN 407201 0 0 0 0 0 0 0 18140 0 425341 0 0 0 PART I, LINE 3 THE INTERIM CEO WAS PAID BY MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, PAID MARIA PADIN $10,686 AND STEPHEN D SURGENOR $37,218. MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION PAID GAY LANDSTROM $29,011. PART I, LINE 7 CONNOR RECEIVED A BONUS. THE BONUS WAS AWARDED EITHER DUE TO MEETING RVU GOALS OR BASED ON QUALITY AND CITIZENSHIP. FORM 990, PART VI, SECTION A, LINE 2 MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER IS A PART OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM, WHICH OWNS FOR-PROFIT SUBSIDIARIES THAT PROVIDE SERVICES AND SUPPORT THE MISSION OF THE ORGANIZATION. AS A RESULT, SOME OFFICERS OF THE MAHHC ALSO MAY BE OFFICERS OF FOR-PROFIT ENTITIES WITHIN THE HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A DARTMOUTH-HITCHCOCK HEALTH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF MAHHC'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHT TO RATIFY MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD; APPROVE THE DISSOLUTION OR LIQUIDATION OF MAHHC; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS. FORM 990, PART VI, SECTION B, LINE 11B BOARD OF TRUSTEES REVIEWED PRIOR TO FILING, PROVIDED MULTIPLE DAYS TO PROVIDE FEEDBACK AND/OR QUESTIONS AND HOSPITAL THEN FILED AFTER THERE WAS SATISFACTION. FORM 990, PART VI, SECTION B, LINE 12C THE FINANCE AND AUDIT COMMITTEE MONITOR AND REPORT TO THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD MEETS ANNUALLY TO REVIEW COMPENSATION FOR THE CEO, USING INDEPENDENT SURVEYS OF AREA COMPENSATION FOR EXECUTIVES OF VARIOUS SIZED HOSPITALS. OTHER OFFICERS AND KEY EMPLOYEES SALARIES ARE DETERMINED, BY THE HR DEPARTMENT USING COMPARABLE MARKET DATA. FORM 990, PART VI, SECTION C, LINE 19 ALL INTERNAL POLICIES, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST RETIREMENT PLANS 496,356. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST 185,694. FORM 990, PART XII, LINE 3B: THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER. SCHEDULE H, PART V, LINE 4: THE HOSPITAL CONDUCTED A CHNA SUBSEQUENT TO THE CURRENT TAX YEAR BEING REPORTED, IN TAX YEAR 2018. SCHEDULE H, PART V, LINE 7A: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ COMMUNITYHEALTHANNUALREPORT_2018.PDF SCHEDULE H, PART V, LINE 9: THE HOSPITAL ADOPTED AN IMPLEMENTATION STRATEGY SUBSEQUENT TO THE CURRENT TAX YEAR BEING REPORTED, IN TAX YEAR 2018. SCHEDULE H, PART V, LINE 10A: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/ DOCUMENTS/CHNA%20IMPLEMENTATION%20PLAN%202015-2.PDF SCHEDULE H, PART V, LINE 11 CONTINUED: 8. INCOME POVERTY AND FAMILY STRESS THE RESOURCE CENTER'S ECONOMIC SERVICES SERVED 202 PEOPLE, AN INCREASE FROM 188 IN 2017; MENTAL HEALTH COUNSELING INCREASED FROM 336 TO 776; EMPLOYMENT COUNSELING INCREASED FROM ZERO TO 6. 9. ACCESS TO TRANSPORTATION IMPLEMENTED RIDES TO WELLNESS PILOT PROGRAM WITH VERMONT PUBLIC TRANSPORTATION ASSOCIATION. VOLUNTEERS PROVIDED MEDICAL TRANSPORTATION WHEN NEEDED. VOUCHERS AND GAS CARDS WERE PROVIDED THROUGH OUR FREE CLINIC. PUBLISHED AN ARTICLE WITH NATIONAL EXPOSURE THROUGH THE AMERICAN HOSPITAL ASSOCIATION, ENTITLED, "HUDDLE FOR CARE" ABOUT REDUCING BARRIERS TO TRANSPORTATION IN A RURAL ENVIRONMENT. APRIL 2018, WHICH HIGHLIGHTED OUR TRANSPORTATION ALGORITHMS AND EFFORTS PRESENTED A NATIONAL WEBEX THROUGH THE FEDERAL OFFICE OF RURAL HEALTH ENTITLED "TRANSPORTATION - A SOCIAL DETERMINANT OF HEALTH PROMOTING SOLUTIONS SINCE APRIL, THE RIDES TO WELLNESS PROGRAM HAS ASSISTED 30 PATIENTS AND HAS GIVEN A TOTAL OF 78 RIDES THROUGH VOLUNTEERS IN ACTION, PREPAID GAS CARDS AND TAXI VOUCHERS 10. ACCESS TO PRIMARY HEALTH CARE ACHIEVEMENT OF NCQA REDESIGNATION AS LEVEL III PATIENT- CENTERED MEDICAL HOME. RECRUITMENT OF PRIMARY CARE PROVIDERS. COMMUNITY HEALTH TEAM WORKING WITH COMMUNITY PARTNERS TO DECREASE COSTS AND INCREASE QUALITY FOR HIGH RISK AND VERY HIGH RISK, COMPLEX, CHRONIC CARE PATIENTS. CARE COORDINATION OUTREACH WITH SASH, SENIOR SOLUTIONS, VNH, BAYADA, AND HCRS. PROVIDED LEADERSHIP FOR REGIONAL IMPLEMENTATION OF ONECARE VERMONT AND BLUEPRINT FOR HEALTH PROGRAMS AND INITIATIVES 11. SMOKING/TOBACCO USE/VAPING TOWN PRESENTATIONS TO SELECTBOARDS ON POLICIES/ORDINANCES RELATED TO "ADULT-ONLY" PRODUCTS INCLUDING TOBACCO, FLAVORED TOBACCO PRODUCTS, CANNABIS PRODUCTS, AND ALCOHOL. MET WITH AREA TOWN SELECT BOARD MEMBERS TO DISCUSS "ADULT ONLY" RETAIL ESTABLISHMENT AND HOW RETAIL OUTLET DENSITY, LOCATION, AND PRODUCT ADVERTISING CAN IMPACT TOWN CULTURE. HOSTED "WORLD NO TOBACCO DAY" AT MT. ASCUTNEY HOSPITAL DISSEMINATED INFORMATION ON FLAVORED TOBACCO PRODUCTS, CESSATION OPPORTUNITIES, AND SECONDHAND SMOKE. SPONSORED A PSA CONTEST FOR AREA SCHOOL YOUTH TO CREATE PREVENTION MESSAGING AROUND TOBACCO, VAPING, AND ALCOHOL USE. CONTINUED WORK WITH WINDSOR'S AUTUMN MOON FESTIVAL PLANNING COMMITTEE ON MAKING THE FESTIVAL A SMOKE-FREE EVENT. WORKED TO CREATED FESTIVAL MARKETING MATERIALS ADVERTISING THIS STATUS. SCHEDULE H, PART V, LINE 16A: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ MAH%20FINANCIAL%20ASSISTANCE%20POLICY_0.PDF SCHEDULE H, PART V, LINE 16B: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/FINANCIAL%20ASSIST ANCE.PDF SCHEDULE H, PART V, LINE 16C: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ MAH17_FINANCIALASSISTANCEPOLICYBROCHURE_WEB.PDF HISTORIC HOMES OF RUNNEMEDE 289 COUNTY ROAD WINDSOR VT 05089 237396147 PROVIDING SVCS FOR THE AGING VT 501(C)(3) LINE 11 WINDSOR HOSPITAL CORPORATION 1 MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION INC 289 COUNTY ROAD WINDSOR VT 05089 030300481 HEALTH EDUCATION & PROMOTION VT 501(C)(3) LINE 3 WINDSOR HOSPITAL CORPORATION 1 DARTMOUTH-HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTING ORG NH 501(C)(3) LINE 12B, II N/A 0 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(C)(3) LINE 3 DARTMOUTH-HITCHCOCK HEALTH 0 DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYS SVCS NH 501(C)(3) LINE 11 DARTMOUTH-HITCHCOCK HEALTH 0 HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 HLTHCRE RSRCH NH 501(C)(3) LINE 7 DARTMOUTH-HITCHCOCK CLINIC 0 HAMDEN RISK RETENTION GROUP INC 30 MAIN STREET SUITE 330 BURLINGTON VT 05401 208530788 SELF INS VT 501(C)(3) LINE 12B, II DARTMOUTH-HITCHCOCK CLINIC 0 THE NEW LONDON HOSPITAL ASSOC INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(C)(3) LINE 3 DARTMOUTH-HITCHCOCK HEALTH 0 VISITING NURSE ASSOCIATION AND HOSPICE OF VT AND NH INC 205 BILLINGS FARM RD NO 5 WILDER VT 05088 036006494 HOSPICE VT 501(C)(3) LINE 11 DARTMOUTH-HITCHCOCK HEALTH 0 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 501(C)(3) LINE 3 DARTMOUTH-HITCHCOCK HEALTH 0 ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DR LEBANON NH 03766 020222791 HOSPITAL NH 501(C)(3) LINE 3 DARTMOUTH-HITCHCOCK HEALTH 0 SURGERY CENTER OF GREATER NASHUA 10 PROSPECT ST NO 101 NASHUA NH 03060 461084049 SURGERY CENTER NH 501(C)(3) LINE 3 N/A 0 CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE NH 03431 020202220 SUPPORTING ORG NH 501(C)(3) LINE 12B, II CHESHIRE MEDICAL CENTER 0 CHESIRE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 473379283 HEALTHCARE NH 501(C)(3) LINE 3 CHESHIRE MEDICAL CENTER 0 DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORG NH 501(C)(3) LINE 7 N/A 0 ALICE PECK DAY LIFECARE CENTER 30 ALICE PECK DAY DRIVE LEBANON NH 03766 020479094 SENIOR LIVING NH 501(C)(3) LINE 10 ALICE PECK DAY MEMORIAL HOSPITAL 0 DH MASTER INVESTMENT PARTNERSHIP ONE MED CTR DR LEBANON NH 03756 020505863 POOLED INVESTMENT NH MARY HITCHCOCK MEMORIAL HOSPITAL EXCLUDED 1085918 16858213 0 -6151 0 0.02460 NEW ENGLAND PHARMACY COLLAB ONE MED CTR DR LEBANON NH 03756 263819035 GROUP PURCHASING NH N/A -71 0 0 0.04740 IMAGINECARE INC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 813105071 SOFTWARE TECHNOLOGY DE N/A C 0 HITCHCOCK HEALTH CONNECT INC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 800908979 TELEHEALTH DE N/A C 0 POMPANOOSUC INVESTMENT CORPORATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020352330 REAL ESTATE HLDG NH N/A C 0 HAMDEN ASSURANCE COMPANY LIMITED 44 CHURCH ST HAMILTON BD HM 12 980121409 LIABILITY INSURANCE BD N/A C 0 KEARSARGE COMMUNITY SERVICES INC 273 COUNTY RD NEW LONDON NH 03257 020460136 REAL ESTATE HLDG NH N/A C 0 NEW LONDON PHYSICIAN GROUP INC 273 COUNTY RD NEW LONDON NH 03257 020494420 PHYSICIAN GROUP NH N/A C 0 NEW LONDON MEDICAL CENTER EAST INC 273 COUNTY RD NEW LONDON NH 03257 020480857 REAL ESTATE HLDG NH N/A C 0 KEENE HEALTH SERVICES 580 COURT STREET KEENE NH 03431 020374997 REAL ESTATE HLDG NH N/A C 0 KEENE HEALTH REALTY 580 COURT STREET KEENE NH 03431 020374998 REAL ESTATE HLDG NH N/A C 0 KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE NH 03431 020374999 REAL ESTATE HLDG NH N/A C 0 88 PROSPECT ST CONDO OWNERS ASSOC 88 PROSPECT STREET WHITE RIVER JUNCTION VT 06002 020480857 REAL ESTATE HLDG VT N/A C 0 CHARITABLE REMAINDER UNITRUSTS (10) 289 COUNTY RD WINDSOR VT 05089 CHARITABLE TRUST VT N/A T 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 MARY HITCHCOCK MEMORIAL HOSPITALDARTMOUTH-HITCHCOCK HEALTH E 11002812 ACTUAL HISTORIC HOMES OF RUNNEMEDE Q 186822 ACTUAL NEW ENGLAND ALLIANCE FOR HEALTH LLC (MHMH) P 438826 ACTUAL DARTMOUTH-HITCHCOCK CLINIC E 566875 ACTUAL DARTMOUTH-HITCHCOCK CLINIC O 3164525 ACTUAL MARY HITCHCOCK MEMORIAL HOSPITAL P 348101 ACTUAL MARY HITCHCOCK MEMORIAL HOSPITALDARTMOUTH-HITCHCOCK HEALTH R 197978 ACTUAL MARY HITCHCOCK MEMORIAL HOSPITAL E 47110 ACTUAL