CARLOS G OTIS HEALTH CARE CENTER INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CARLOS G OTIS HEALTH CARE CENTER INC (EIN 03-0177161)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-12
- IRS object ID
- 201932249349301553
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-12T13:23:57-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 507 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030177161 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlos G Otis Health Care Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARL | BusinessNameControlTxt |
| Phone | 8023657920 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 216 | AddressLine1Txt |
| City | Townshend | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 053530216 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Stephen A Brown | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8023657920 | PhoneNum |
| Signature | 2019-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa M Dickson | PreparerPersonNm |
| PTIN | P00068196 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Preparation | 2019-08-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.105.168.164 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-12 | IPDt |
| IP Tm | 10:24:59 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 1858DCD9145052AFD59E6E126536EE0AD80069D4 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 1858DCD9145052AFD59E6E126536EE0AD80069D4 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Stephan Morse | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 216 | AddressLine1Txt |
| City | Townshend | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 053530216 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,351,472 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.gracecottage.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | Provision of health care services | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 241 | TotalEmployeeCnt |
| Total Volunteers | 65 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,170,215 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,362,167 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,624,730 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,989,229 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,060 | PYInvestmentIncomeAmt |
| CY Investment Income | -$11,688 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $23,796,005 | PYTotalRevenueAmt |
| CY Total Revenue | $24,339,708 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,127,240 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,664,670 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $271,698 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,914,931 | PYOtherExpensesAmt |
| CY Other Expenses | $8,173,275 | CYOtherExpensesAmt |
| PY Total Expenses | $24,042,171 | PYTotalExpensesAmt |
| CY Total Expenses | $23,837,945 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$246,166 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $501,763 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,080,267 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,316,029 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,983,317 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,528,786 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,096,950 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,787,243 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The Otis Health Care Center promotes excellence in healthcare and well being, putting people first. It aims to be the standard for patient care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,569,604 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $22,989,229 | RevenueAmt |
| Desc | Grace Cottage Hospital is a critical access hospital offering 24-hour emergency services, inpatient acute and skilled care, 24-hour diagnostic imaging services, a full-service laboratory, a pharmacy, a variety of outpatient medical care services, including physical therapy, occupational therapy, and speech therapy, and a rural health clinic providing primary care and psychiatric services. | Desc |
| Total Program Service Expenses | $21,569,604 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 241 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stephen A Brown | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8023653601 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Grafton Road | AddressLine1Txt |
| City | Townshend | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05353 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Alexandra Clark | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Clark | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Martha Dale | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Nopper | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Terry Pollio | ||||||||
| Trustee (eff. 1/2018) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Cheryl Sanctuary | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sheila Scheuerman | ||||||||
| Trustee (eff. 11/2017) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Timothy P Shafer MD | ||||||||
| Trustee/Family Physician | 44.50 | 0.00 | Yes (X) | $274,192 | $0 | $36,480 | ||
| Allan Shirks | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Stephan Morse | ||||||||
| President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Kevin Meyer | ||||||||
| Vice President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Barry Emerson | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Edward Druke | ||||||||
| Secretary (eff. 11/2017) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| J Walter Corcoran deceased | ||||||||
| Secretary (end 10/2017) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Douglas DiVello | ||||||||
| CEO (eff. 2/2018) | 40.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Roger Allbee | ||||||||
| CEO (end 2/2018) | 24.00 | 1.00 | $124,800 | $0 | $0 | Yes (X) | ||
| Stephen A Brown | ||||||||
| CFO | 45.30 | 0.00 | $202,601 | $0 | $24,965 | Yes (X) | ||
| Maurice Geurts MD | ||||||||
| Physician | 58.60 | 0.00 | $362,171 | $0 | $38,181 | Yes (X) | ||
| Moss J Linder MD | ||||||||
| Physician | 42.10 | 0.00 | $262,252 | $0 | $34,893 | Yes (X) | ||
| Ewa Arnold MD | ||||||||
| Physician | 38.90 | 0.00 | $242,807 | $0 | $36,117 | Yes (X) | ||
| Jesper Brickley DO | ||||||||
| Physician | 41.00 | 0.00 | $254,883 | $0 | $26,987 | Yes (X) | ||
| Kimona Alin MD | ||||||||
| Physician | 39.40 | 0.00 | $251,598 | $0 | $34,078 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,975,304 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $231,701 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 28 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Cerner Corporation | |||||
| PO Box 412702 | Kansas City | MO | 64141 | Hardware/Software Support | $448,416 |
| Tafts Heating & Cooling | |||||
| 17 Eric Street | Springfield | VT | 05156 | HVAC Installation/Servic | $337,921 |
| Cross Country Staffing | |||||
| PO Box 404674 | Atlanta | GA | 303844674 | Travel Nursing Services-RNs | $130,208 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,208,206 | RelatedOrganizationsAmt |
| Government Grants | $144,961 | GovernmentGrantsAmt |
| All Other Contributions | $9,000 | AllOtherContributionsAmt |
| Total Contributions | $1,362,167 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621400 | $18,730,838 | $18,730,838 |
| Pharmacy Revenue | 446110 | $3,849,017 | $3,849,017 |
| GCF Administration/Other | 621400 | $288,969 | $288,969 |
| Cafeteria Revenue | 722514 | $67,543 | $67,543 |
| Meaningful Use | 621400 | $42,500 | $42,500 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,362 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,362 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,989,229 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76 | TotalRevenueColumnAmt |
| Exclusion | $76 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $11,764 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$11,764 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$11,764 | TotalRevenueColumnAmt |
| Exclusion | -$11,764 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,339,708 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,989,229 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$11,688 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $797,965 | TotalAmt |
| Program Services | $304,592 | ProgramServicesAmt |
| Management And General | $493,373 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,463,783 | TotalAmt |
| Program Services | $10,539,219 | ProgramServicesAmt |
| Management And General | $731,854 | ManagementAndGeneralAmt |
| Fundraising | $192,710 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,832 | TotalAmt |
| Program Services | $216,044 | ProgramServicesAmt |
| Management And General | $17,808 | ManagementAndGeneralAmt |
| Fundraising | $3,980 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,340,967 | TotalAmt |
| Program Services | $2,101,576 | ProgramServicesAmt |
| Management And General | $201,584 | ManagementAndGeneralAmt |
| Fundraising | $37,807 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $824,123 | TotalAmt |
| Program Services | $730,879 | ProgramServicesAmt |
| Management And General | $80,222 | ManagementAndGeneralAmt |
| Fundraising | $13,022 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,652 | TotalAmt |
| Management And General | $11,652 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,955 | TotalAmt |
| Management And General | $73,955 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,677 | TotalAmt |
| Program Services | $730,853 | ProgramServicesAmt |
| Management And General | $33,824 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,169 | TotalAmt |
| Program Services | $211 | ProgramServicesAmt |
| Management And General | $69,958 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,225 | TotalAmt |
| Program Services | $425,611 | ProgramServicesAmt |
| Management And General | $98,863 | ManagementAndGeneralAmt |
| Fundraising | $13,751 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $716,331 | TotalAmt |
| Program Services | $624,689 | ProgramServicesAmt |
| Management And General | $88,644 | ManagementAndGeneralAmt |
| Fundraising | $2,998 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,355 | TotalAmt |
| Program Services | $187,149 | ProgramServicesAmt |
| Management And General | $5,206 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,201 | TotalAmt |
| Program Services | $126,340 | ProgramServicesAmt |
| Management And General | $13,862 | ManagementAndGeneralAmt |
| Fundraising | $6,999 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,528 | TotalAmt |
| Program Services | $5,528 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,586 | TotalAmt |
| Program Services | $103,291 | ProgramServicesAmt |
| Management And General | $32,295 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $612,930 | TotalAmt |
| Program Services | $612,930 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,114 | TotalAmt |
| Program Services | $246,140 | ProgramServicesAmt |
| Management And General | $43,543 | ManagementAndGeneralAmt |
| Fundraising | $431 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies and La | $2,927,549 | $2,927,549 |
| Medicaid Tax | $620,394 | $620,394 |
| Provision for Bad Debt | $556,089 | $556,089 |
| Equipment Repair | $298,574 | $298,574 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211,946 | TotalAmt |
| Program Services | $211,946 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,837,945 | TotalAmt |
| Program Services | $21,569,604 | ProgramServicesAmt |
| Management And General | $1,996,643 | ManagementAndGeneralAmt |
| Fundraising | $271,698 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,719 | BOYAmt |
| EOY | $2,107 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,779 | BOYAmt |
| EOY | $21,279 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,017,796 | BOYAmt |
| EOY | $2,083,725 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,465,293 | BOYAmt |
| EOY | $1,715,794 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,215 | BOYAmt |
| EOY | $209,789 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,923,673 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,559,246 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,395,151 | BOYAmt |
| EOY | $3,364,427 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,925,314 | BOYAmt |
| EOY | $7,918,908 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,080,267 | BOYAmt |
| EOY | $15,316,029 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,966,260 | BOYAmt |
| EOY | $2,764,099 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $800,000 | BOYAmt |
| EOY | $660,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,217,057 | BOYAmt |
| EOY | $1,783,540 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $321,147 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,983,317 | BOYAmt |
| EOY | $5,528,786 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,777,158 | BOYAmt |
| EOY | $6,558,441 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,476 | BOYAmt |
| EOY | $477,324 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,719,316 | BOYAmt |
| EOY | $2,751,478 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,096,950 | BOYAmt |
| EOY | $9,787,243 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,080,267 | BOYAmt |
| EOY | $15,316,029 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $501,763 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $188,530 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $4,082 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $4,082 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Carlos G. Otis Health Care Center is a member of the Vermont Association of Hospitals and Health Systems and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Carlos G. Otis Health Care Center in furtherance of its exempt purpose. Carlos G. Otis Health Care Center does not directly perform any lobbying activities. AHA, portion of dues available for lobbying: $549 VAHHS, portion of dues available for lobbying: $3,533 | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,319,792 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$90,990 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,228,802 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,040,711 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $279,081 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,319,792 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,927,438 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $113,273 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,040,711 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,073,919 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$146,481 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,927,438 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,642,046 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $451,855 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $19,982 | OtherExpendituresAmt |
| End Year Balance | $3,073,919 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.13730 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.85220 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.01050 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,549 | OtherCostOrOtherBasisAmt |
| Book Value | $30,549 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,833,907 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,706,532 | DepreciationAmt |
| Book Value | $2,127,375 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,923,668 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,786,122 | DepreciationAmt |
| Book Value | $1,137,546 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $135,549 | OtherCostOrOtherBasisAmt |
| Depreciation | $66,592 | DepreciationAmt |
| Book Value | $68,957 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,364,427 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Beneficial interest in net assets of GCF | $7,821,439 |
| Deposits with Trustee | $63,437 |
| Meaningful use receivable | $34,000 |
| Other Receivables | $32 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,918,908 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third Party Settlemeents | Desc |
| Amt | $321,147 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $321,147 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $24,528,238 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $188,530 | OtherRevenueAmt |
| Revenue Not Reported | $188,530 | RevenueNotReportedAmt |
| Revenue Subtotal | $24,339,708 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $24,339,708 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $23,837,945 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $23,837,945 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,837,945 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | OHCC uses its endowment funds to assist in the provision of health care. |
| Part X, Line 2: | OHCC and the Foundation are tax-exempt corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(a) and had been classified as an organization that is not a private foundation under Section 509(a)(3). Management evaluated the Organization's tax positions and concluded the Organization has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. |
| Part XI, Line 2d - Other Adjustments: | Change in Beneficial Interest in Net Assets of GCF 188,530. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 140.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $107,860 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $107,860 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,313,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,365,871 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,947,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,421,615 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,365,871 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,055,744 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08620 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $504,900 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $294,291 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $210,609 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,346 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $512,246 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $294,291 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $217,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,933,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,660,162 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,273,699 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09530 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $406,492 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $79,684 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,523,181 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,536,789 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$13,608 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Grafton Road | AddressLine1Txt |
| City | Townshend | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05353 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.gracecottage.org | WebsiteAddressTxt |
| State License | 878 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Section C | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 140.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Section C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Grace Cottage Hospital | Part V, Section B, Line 5: As required by Vermont statute and Treasury Regulation 501(r), Grace Cottage Hospital conducts a Community Health Needs Assessment (CHNA) every three years. Our most recent CHNA was done collaboratively in 2018 (tax year 2017) with Brattleboro Memorial Hospital (BMH) and the Brattleboro Retreat. These three healthcare organizations focused on involving as many stakeholders and community members as possible in the data collection process, which took place from October 2017 to May 2018. Secondary data was collected from multiple sources including: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, Vermont Department of Health, Vermont Department of Labor, Vermont Department of Transportation, Vermont Foodbank, and Vermont Town and County Data Pages. The secondary data was benchmarked against state and national trends, where possible. Primary data was obtained through a consumer survey and a secondary survey of representatives of medically underserved populations. The consumer survey was distributed in both paper copy as well as online. In total, 1,257 surveys were collected for Windham County. The secondary survey was held to collect qualitative data on at-risk populations. The following medically underserved populations were represented in the focus group: - Elderly/Senior Population - HIV+ Individuals - Homeless Population - LGBTQ (Lesbian, Gay, Bisexual, Transgender and/or Questioning) Individuals - Racial and Ethnic Minority PopulationsThe three hospitals set up a steering committee made up of individuals from the State of Vermont Department of Health, Brattleboro Memorial Hospital, Grace Cottage Hospital, and The Brattleboro Retreat. Additionally, the participating organizations engaged a wide range of stakeholders through the surveys, including health care providers, human service organizations, and other nonprofit organizations. Grace Cottage identified the following as High Priority Significant Health Needs in our service area: Diabetes/Obesity/Weight Management, Mental Health Issues (Stress, Anxiety, Depression), Substance Abuse.The 2018 Community Health Needs Assessment was adopted by the Grace Cottage Board of Trustees on September 21, 2018 and the Implementation Plan was approved by the Board on January 18, 2019. An updated Implementation Plan for FY18 is available for public viewing at https://gracecottage.org/about-us/our-hospital/community-health-needs-assessment/. |
| Grace Cottage Hospital | Part V, Section B, Line 6a: The 2018 Community Health Needs Assessment was conducted with Brattleboro Memorial Hospital and The Brattleboro Retreat. |
| Grace Cottage Hospital | Part V, Section B, Line 11: The Hospital had not completed its updated Implementation Plan from the 2018 CHNA by the end of the filing period, although it was completed, approved by the Board of Trustees, and available to the public in January 2019, well within the required six-month timeframe from the completion of the CHNA. Pursuant to IRS instructions, we have reported 2014 as the year the hospital last adopted an implementation plan, as that information is accurate as of the close of the filing period (September 30, 2018).Please see attached 2018 CHNA Implementation Plan for information on how the Hospital is addressing the significant needs identified in its most recently conducted CHNA. An update on progress made annually on the goals of the 2015 Plan are available on page 64 of the 2018 CHNA Report. While a significant health need in our service area, Grace Cottage Hospital is not addressing dental issues as we do not provide dental services. The additional Level 2 Priorities identified in the 2018 CHNA -- Healthy Aging, Smoking/Tobacco Use, and Heart Disease -- are addressed with all patients on an on-going and personal basis. |
| Grace Cottage Hospital | Part V, Section B, Line 13b: Generally, Grace Cottage Hospital uses the Federal Poverty Guidelines to determine eligibility for financial assistance. However, applications may be reviewed on a case by case basis and at times financial assistance granted even if a patient is above the prescribed FPG level or qualifies only for a lesser reduction in fees if there is a prevailing circumstance that justifies additional financial support. |
| Grace Cottage Hospital | Part V, Section B, Line 20e: Grace Cottage Hospital (GCH) located in rural, mountainous Townshend, VT provides services to patients, whether a community member, second homeowner, or vacationer, through our Critical Access Hospital, Rural Health Clinic, and Outpatient Rehabilitation. Taking pride in the community we serve, we make every attempt possible to notify patients of The Reduced Fee Program and Formal Payment Plan options at GCH that will allow patients to receive care without undue hardship. The following are some of the steps currently in place, to notify patients of the available options: - All registration areas of the Critical Access Hospital, Rural Health Clinic, and Outpatient Rehabilitation Services have visible signs on display notifying patients of our Reduced Fee Program. - All registration staff upon verification of no insurance, limited insurance coverage with high patient responsibility portions, or communication from patient indicating difficulty with paying bill, will offer a Reduced Fee Application, Policy, and business card for our Resource Advocate, identifying the many services she provides to patients free of charge and her contact information. Staff will also offer to schedule an appointment for the patient with Resource Advocate for assistance in completing the Reduced Fee Application, troubleshooting issues with insurance, and/or applying for insurance coverage whether it is primary or secondary. - Patients receive at least 5 billing statements over the course of 120 day time frame (patients in a formal payment plan or whom have a billing issue arise may increase the number of statements to be received or increase the number of days to complete the 5 billing statement cycle). Every statement has a message that notifies them of the Reduced Fee Program and steps to take to get started. - Once a patient balance is past due (>30 days from date of first patient billing) Patient Accounts Specialists contact patients via phone in an attempt to alert patient to past due balance, offer a formal payment plan if balance unable to be paid in full. If/when patient indicates difficulty in paying their bill, Patient Accounts Specialists will notify patient of the Reduced Fee Program and offer to mail the application and policy to them. Patient Accounts Specialists note patients account with a briefing of the phone call. If a patient balance is aged >120 days from the date of the first billing statement and a potential to be sent to a third party collections agency the account is reviewed, if there is a note from patient accounts indicating a Reduced Fee application and policy have been mailed to the patient within the last 45 days a hold will be placed on transferring the balance to the third party collections agency. After 45-60 days if no Reduced Fee application or communication from the patient the balance will be transferred to the third party collections agency at that time. - All Reduced Fee applications are processed with required documentation to determine eligibility in accordance with our Sliding Fee Scale based on Federal Poverty Guidelines. If missing required documents, a written request is sent to the patient and application held while awaiting documents. All processed applications are filed, written notice of eligibility is mailed to the patient, eligibility is noted on patient's account and adjustments are made manually after insurance processing and prior to a billing statement being mailed to the patient, and all applications are documented on a yearly spreadsheet showing household members, date of application (eligibility begin date), expiration date, whether they are eligible, percentage they are eligible for, and comments for case by case applications that identifies parameters for this approval/denial i.e. only one date of service. |
| Schedule H, Part V, Section B, Line 7a and 10a: | The Hospital's 2018 CHNA, 2018 CHNA Implementation Plan, and 2015 CHNA Implementation Plans are available on its website at: https://gracecottage.org/about-us/our-hospital/community-health-needs-assessment/ |
| Schedule H, Part V, Section B, Line 16a-16c: | The Hospital's Financial Assistance Policy is available on its website at: https://gracecottage.org/wp-content/uploads/2019/04/16.0050-REDUCED-FEE-FREE-CARE-POLICY.pdf The Hospital's Financial Assistance Application is available on its website at:https://gracecottage.org/wp-content/uploads/2015/11/Free-or-Reduced-Fee-Care-Application.pdfThe Hospital's Plain Language Summary is available on its website at:http://gracecottage.org/patients-visitors/billing-and-insurance/free-or-reduced-fee-care/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Messenger Valley Pharmacy | ||||
| 170 Grafton Road | Townshend | VT | 05353 | Pharmacy |
| 2 - Grace Cottage Family Health | ||||
| 185 Grafton Road | Townshend | VT | 05353 | Rural health clinic |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | N/A |
| Part I, Line 6a: | N/A |
| Part I, Line 7: | The amounts reported for Charity Care and Means-Tested Government Programs were calculated using a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. |
| Part I, Line 7g: | N/A |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 556,089. |
| Part II, Community Building Activities: | See previous and subsequent narrative responses. |
| Part III, Line 2: | The cost of the bad debt expense reported on line 2 was calculated by applying the ratio of patient care cost-to-charges (calculated on Worksheet 2) to the total bad debt expense. The amount of bad debt expense for accounts written off as bad debt is the account balance after all charity care discounts, contractual allowances, and insurance/patient payments have been applied. Any cash collected on accounts previously written off is included as an offset to bad debt expense. |
| Part III, Line 3: | The amount of bad debt expense (at cost) attributable to patients eligible under our charity care policy reported on line 3 was estimated based on a review of Reduced Fee/Free Care Applications. The number of approved completed applications versus the number of incomplete applications was compared and a ratio applied to the Charity Care balance to estimate this number. It is felt that this estimate should actually be much higher because, though we work hard to educate our patients regarding the charity care policy, including having a Resource Advocate to help patients complete them if they require assistance, many of the applications we distribute to patients are not returned. Knowing our patient population as we do, we believe it is primarily attributable to patients not wanting to share the income information. |
| Part III, Line 4: | Please see Footnote 1 on Page 8 of the attached financial statements for the footnote that addresses bad debt. |
| Part III, Line 8: | Medicare allowable costs reported in the Medicare Cost Report are reported in accordance with CMS Guidelines using the cost-to-charge ratio methodology. |
| Part III, Line 9b: | Grace Cottage Hospital does not pursue collections actions against patients for amounts qualified for financial assistance. If a patient is unable to pay a balance in full after reduced fees and financial assistance have been applied, the patient is required to setup an acceptable payment plan per the collections policy. Any patient making acceptable monthly payments on their balance will not be at risk for further collections actions and/or forfeiture of their reduced fee care or financial assistance. However, any balance remaining after that discount that goes unpaid as agreed upon will follow the collections actions outlined in the Hospital's collection policy. Failure to resolve the balance in full or any missed payments will result in forfeiture of reduced fees and/or financial assistance, and the patient's account will be placed with a collections agency for further action. Additionally, the patient will not be eligible for reduced fees or financial assistance until a substantial effort is put forth to rectify the outstanding balance. |
| Part VI, Line 2: | Grace Cottage Hospital is such a small hospital in a rural, relatively sparsely populated area that our community leaders, patients, and members of the public are quick to inform our administrators and our medical staff about how Grace Cottage serves the healthcare needs of the public. Grace Cottage's small size ensures that we can be responsive to community requests made via our website, e-mails to members of our staff, or informal face-to-face meetings with people in the communities we serve. |
| Part VI, Line 3: | Although we are Vermont's smallest Critical Access Hospital, Grace Cottage Hospital believes that quality health care should be available to all; and that we all have a responsibility to help others in need regardless of their ability to pay. Posters and brochures detailing the availability of help with billing, public programs, and charity care are displayed in high traffic areas throughout the Hospital, rural health clinic and pharmacy, as well as listed on the Hospital's website. The staff reaches out to patients in a variety of ways to ensure that they are aware that help is available. During fiscal year 2018, the Hospital continued to employ a Patient Resource Advocate to help uninsured and underinsured patients locate and procure services for which they may qualify. The Patient Resource Advocate's services were free of charge for community members between the ages of 18-64 years (those 65 and older were encouraged to contact Senior Solutions, formerly Southeastern Vermont Council on Aging). The Hospital's Patient Resource Advocate helped many people with a wide variety of resource issues, helping to fill out necessary forms and making connections for patients with other federal, state and local resources. This employee was an expert in filling out reduced fee applications, finding sources for reduced-cost or free prescription medications, and locating other avenues of support. |
| Part VI, Line 4: | Grace Cottage Hospital plays a vital role in healthcare for this rural, mountainous community. Its federal designation as a critical access hospital recognizes its importance in providing health care to an otherwise medically underserved community. The Hospital's emergency department is especially vital to members of the community, who would otherwise have to travel many miles on winding, mountainous highways to reach emergency medical care at another hospital. Grace Cottage Hospital is located in Windham County, in southeastern Vermont. According to the U.S. Census Bureau, Windham County has an estimated total of 43,714 residents. Grace Cottage Hospital's patient base is approximately 26,000 residents, mostly from 21 surrounding towns. The median household income of Windham County, Vermont, is $50,917 (U.S. Census Bureau "Quick Facts," updated 2016). Income statistics for the total population served by Grace Cottage Hospital are not available because Grace Cottage only requires income information from patients requesting reduced fees or free care. |
| Part VI, Line 5: | Grace Cottage Hospital is a Critical Access Hospital located in rural, mountainous Townshend, Vermont. The Hospital is served by a Board of Trustees consisting of local citizens active in community businesses and organizations. Only one of the twelve trustees, a physician, is a hospital employee. All trustees reside or work in the Hospital's service area and bring a wealth of community input to the Hospital's strategic planning process. The Hospital extends medical staff privileges to all qualified physicians in the community.Grace Cottage Hospital applies any surplus funds towards improving its ability to provide quality patient care and being an integral part of assuring the health and well-being of the communities we serve. For example, in view of the fact that Mental Health was identified as a High Priority Significant Need in our Community Health Needs Assessment, Grace Cottage doubled the size of our behavioral health team during fiscal year 2015 and, in 2015 we hired a full-time psychiatric nurse practitioner who is embedded in the family health practice, where he is a key player in the healthcare team. Despite its small size, Grace Cottage Hospital is committed to giving back to the community to the greatest extent possible. Thanks to the Vermont Blueprint for Health, Grace Cottage's Community Health Team has been able to provide free consultations, open to everyone in the community served by Grace Cottage. Members of the Community Health Team, including a care coordinator and an outreach coordinator (both registered nurses), a health coach, a diabetes educator (also a registered nurse), and a behavioral health specialist work with patients one-on-one, conduct support groups, and also attend area senior lunches and provide screenings at area organizations (such as Neighborhood Connections).In addition, the Community Health Team interacts with another Vermont Blueprint for Health program, SASH (Support and Services at Home), and provides, in collaboration with SASH, ongoing support groups and workshops. Grace Cottage Hospital is a very active partner in numerous community collaborations and programs, including (but not limited to): - West River Valley Thrives: supporting and promoting healthy lifestyle choices, with an emphasis on the prevention of alcohol, tobacco, and other drug use by young people. - Townshend Community Hope and Action: promoting a healthy, connected community through area events. - West River Valley Food Group/Vermont Food Bank: organizing the procurement and distribution of food to those in need. A Veggie Van Go truck from the Vermont Food Bank comes to Grace Cottage once a month for free food distribution of fresh produce and other healthy food items. No proof of eligibility is required. On average, 50-60 individuals take the free food home to their families. - West River Valley Dental Coalition: comprised of Grace Cottage, Neighborhood Connections, Stratton Foundation, Norwich University, and area school nurses, to promote dental health awareness and dental services in the area for all in need of dental care. - Windham County Consortium on Opiate and Substance Use (COSU): a county wide collaborative that is working on treatment, education, workforce readiness, and prevention of misuse of opiates. - Accountable Communities for Health (ACH): a collaboration of area agencies and hospitals to address improvements in overall health and wellbeing for all residents of our health service area. This is a Blueprint/One Care initiative. - Community Wellness: In 2018, there were a total of 3,584 wellness program visits. Wellness activities included strong bones exercise classes, Tai Chi for fall prevention, weight control programs, living alone support group, Alzheimer's Caregiver support group, mental illness family support group, men's support groups, and yoga. |
| Part VI, Line 6: | N/A |
| Part VI, Line 7, Reports Filed With States | VT |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Timothy P Shafer MD | ||||||||||||||
| Trustee/Family Physician | $271,307 | $0 | $29 | $0 | $2,856 | $0 | $7,296 | $0 | $29,184 | $0 | $310,672 | $0 | $0 | $0 |
| Stephen A Brown | ||||||||||||||
| CFO | $184,579 | $0 | $0 | $0 | $18,022 | $0 | $6,166 | $0 | $18,799 | $0 | $227,566 | $0 | $0 | $0 |
| Maurice Geurts MD | ||||||||||||||
| Physician | $353,111 | $0 | $6,964 | $0 | $2,096 | $0 | $8,100 | $0 | $30,081 | $0 | $400,352 | $0 | $0 | $0 |
| Moss J Linder MD | ||||||||||||||
| Physician | $254,930 | $0 | $4,961 | $0 | $2,361 | $0 | $4,812 | $0 | $30,081 | $0 | $297,145 | $0 | $0 | $0 |
| Ewa Arnold MD | ||||||||||||||
| Physician | $230,011 | $0 | $0 | $0 | $12,796 | $0 | $6,036 | $0 | $30,081 | $0 | $278,924 | $0 | $0 | $0 |
| Jesper Brickley DO | ||||||||||||||
| Physician | $253,386 | $0 | $0 | $0 | $1,497 | $0 | $4,083 | $0 | $22,904 | $0 | $281,870 | $0 | $0 | $0 |
| Kimona Alin MD | ||||||||||||||
| Physician | $249,802 | $0 | $0 | $0 | $1,796 | $0 | $6,001 | $0 | $28,077 | $0 | $285,676 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7 | Physician contracts provide the opportunity to receive additional payments for productivity above minimum thresholds. For the period reported, five physicians listed in Part VII were under such a contract: Dr. Ewa Arnold, Dr. Jesper Brickley, Dr. Maurice Geurts, Dr. Moss Linder, and Dr. Timothy Shafer. Of these, three received an incentive compensation payment: Dr. Maurice Geurts $6,964; Dr. Moss Linder $4,961; and Dr. Timothy Shafer $29. |
| Schedule J, Part II: | Roger Allbee, the CEO of Otis Health Care Center, is a part-time employee. He receives no benefits or deferred compensation and his total reportable compensation was below the Schedule J reporting threshold during the filing period. In February 2018, Mr. Allbee left the organization. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | A draft of the Form 990 is initially reviewed in detail by Carlos G. Otis Health Care Center's key finance employees. Thereafter, the final draft is provided to the full Board for review prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | A copy of the conflict of interest policy is distributed annually to the Board of Trustees and each Trustee signs to confirm that they have thoroughly read, understand, and agree to comply with the conflict of interest policy. |
| Form 990, Part VI, Section B, line 15 | CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted and voted on by the full Board annually. The Board used external market compensation data to determine the CEO's initial compensation when hired and annually uses such data to compare OHCC's CEO compensation with that of other hospital executives in the Northeast region. The CEO is excused from Board discussion and voting on issues surrounding CEO compensation and benefits. Compensation of other hospital employees: The CEO reviews the salaries of employees annually and determines compensation based on performance and salary ranges, using regional salary range data for comparison. |
| Form 990, Part VI, Section C, line 19 | Upon request, Carlos G. Otis Health Care Center, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public. |
| Form 990, Part VII, Section A: | The compensation reported for Dr. Timothy Shafer was for his services as a full-time physician. He was not compensated for his services as members of OHCC's Board of Trustees. Mr. Allbee was a part-time employee serving as CEO of Otis Health Care Center until February 2018. He received no benefits or deferred compensation and his total reportable compensation was below the Schedule J reporting threshold during the filing period. In February 2018, Mr. Allbee left his position as CEO of the organization and was replaced by Douglas DiVello, a full-time employee. Accordingly, both Mr. Allbee and Mr. DiVello are listed in Form 990, Part VII, Section A. IRS instructions stipulate that compensation information is to be reported on Part VII and Schedule J, Part II on a calendar year basis. As the current fiscal year (September 30, 2018) being covered by this Form 990 filing is for tax year 2017, no compensation information is reported for Mr. DiVello as he did not begin his tenure with the organization until 2018. Salary and benefit information for Mr. DiVello on the organization's next Form 990, which will be for fiscal year ending September 30, 2019. |
| Form 990, Part XI, line 9: | Increase in Beneficial Interest in Net Assets of GCF 188,530. |
| Form 990, Part XI, Line 2c: | The Finance and Audit Committee oversees the audit process for the Carlos G. Otis Health Care Center, Inc. and Grace Cottage Foundation, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for both fiscal years. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1 | AddressLine1Txt |
| City | Townshend | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05353 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030343282 | EIN |
| Primary Activities | Solicit contributions for the funding of health care services by OHCC | PrimaryActivitiesTxt |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlos G Otis Health Care Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Grace Cottage Foundation Inc | ||
| Q | $288,969 | Actual per books |
| Grace Cottage Foundation Inc | ||
| C | $1,208,206 | Actual per books |
| Grace Cottage Foundation Inc | ||
| E | $5,628,688 | Actual per books |