2018-08-15T11:40:17-05:00 2017-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-10-01 036013761 Northeastern Vermont Regional Hosp Inc NORT 8027487520 Hospital Drive PO Box 905 St Johnsbury VT 058190905 Robert Hersey CFO 8027487520 2018-08-14 1 Joseph R Byrne CPA P01289281 2077752387 2018-08-14 2016 2022-09-23 18:48:47Z Paul Bengtson Hospital Drive PO Box 905 St Johnsbury VT 058190905 86321112 0 X www.nvrh.org X 1967 VT Critical Access Hospital 20 16 664 165 2050317 39742 18108 32026 75089462 80300719 396731 746741 94949 30843 75599250 81110329 157380 223766 0 0 44618239 48099812 0 0 0 29444024 30966144 74219643 79289722 1379607 1820607 63532373 63948643 24971317 24812656 38561056 39135987 X Northeastern Vermont Regional Hospital, Inc. is dedicated to improving the health of all people in the communities it serves. 0 0 69559430 223766 80300719 Northeastern Vermont Regional Hospital, Inc. is a full service, state of the art, Critical Access Hospital. The Hospital makes its services available to approximately 30,000 residents of the greater St. Johnsbury community. Inpatient services include medical and surgical, intensive care, pediatrics, and obstetrics. The emergency room at NVRH is fully staffed by full-time board certified/eligible physicians. A new Ambulatory Surgery Unit opened in October 2009. The new unit has space for 16 pre- and post-operative patients. Over 95% of our surgeries and procedures are conducted through day surgery. These services are supported by the laboratory, diagnostic imaging, MRI, CT scan, cardiac services, rehabilitation, respiratory, and other ancillary services. NVRH was chosen as the first Medical Home/Community Care Team in December of 2007 and created medical homes in 5 primary care practices and Community Care Teams. Surgical specialties include general surgery, neurosurgery, oral/maxillofacial, otolaryngology, obstetrics/gynecology, orthopedics, ophthalmology, and urology. NVRH is one of two Vermont hospitals to have been awarded the international baby-friendly designation by the World Health Organization.NVRH's charity care program is available to patients who are uninsured, underinsured, or have otherwise demonstrated they don't have the financial resources to fully pay for their hospital care. Patients with income levels below 200% of the federal poverty guideline for the applicable family size have their hospital bill discounted by 100%. Patients with income levels between 200% and 400% of the federal poverty guideline receive a discount on their hospital bill between 85% and 47%. Foregone charges, based on established rates, furnished under NVRH's free care program amounted to $2,665,968 during the year ended September 30, 2017. The emergency room at NVRH is fully staffed by full-time physicians and specialized nurses who are trained to deal with all aspects of medical care. Emergency room staff provide pre-hospital provider training and support, participation in local education programs, hospital continuing medical education and quality assurance programs. Care provided by the emergency room is coordinated with appropriate local physician practices. The NVRH pharmacy provides pharmaceutical services for patients, including a complete patient medication profile and computerized monitoring. Our pharmacy staff is a vital component of the healthcare team, consulting with physicians and other health professionals to ensure that patients receive the appropriate drug therapies. NVRH owns four Rural Health Clinics that are staffed with a combination of medical doctors, nurse practitioners, physician assistants and nurse midwives in order to meet the need of our patients. The four clinics include:1. Corner Medical - a family practice.2. Kingdom Internal Medicine3. St. Johnsbury Pediatrics4. Womans Wellness Center - providing a full OB/GYN care. 69559430 1 1 0 1 0 0 0 1 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 75 0 1 664 1 1 1 0 0 0 0 0 0 0 0 0 X 20 16 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 0 1 1 0 VT X Robert Hersey 8027487520 Hospital Drive PO Box 905 St Johnsbury VT 058190905 Steve McConnell Trustee 2.00 0.10 X 0 0 0 James Newell Past Trustee 2.00 0.10 X 0 0 0 Joe Kasprzak Trustee 2.00 0.10 X 0 0 0 Thomas Robinson Vice Chair 1 / Treasurer 8.00 0.10 X X 0 0 0 Thomas Paul Esq Past Trustee 2.00 0.10 X 0 0 0 Catherine Boykin Trustee 2.00 0.10 X 0 0 0 Michael Rousse MD Past Trustee 40.00 0.10 X 268013 0 34340 Steve Nichols Chair 8.00 0.10 X X 0 0 0 Mark Price MD Trustee 40.00 0.10 X 209057 0 38500 Deborah Hunt Trustee 2.00 0.10 X 0 0 0 Terry Larsen DO Trustee 40.00 0.10 X 293373 0 42423 Darcie McCann Trustee 2.00 0.10 X 0 0 0 Mary Parent Trustee 2.00 0.10 X 0 0 0 Terry Hoffer Trustee 2.00 0.10 X 0 0 0 Kristen Michaud Past Trustee 2.00 0.10 X 0 0 0 Martha Davis Trustee 2.00 0.10 X 0 0 0 Jane Arthur Trustee 2.00 0.10 X 0 0 0 Martha Ide Trustee 2.00 0.10 X 0 0 0 Laurel St James-Long Trustee 2.00 0.10 X 0 0 0 Ken Norris Trustee 2.00 0.10 X 0 0 0 Patrick Flood Past Trustee 2.00 0.10 X 0 0 0 John Goodrich Trustee 2.00 0.10 X 0 0 0 Barbara Hatch Trustee 2.00 0.10 X 0 0 0 Judythe Desrochers Trustee 2.00 0.10 X 0 0 0 Steve Feltus Trustee 2.00 0.10 X 0 0 0 Paul Bengtson CEO 40.00 1.00 X 344810 0 29208 Robert Hersey CFO 40.00 1.00 X 198755 0 28041 Richard N Gagnon Physician 40.00 0.00 X 450286 0 28428 Craig D Dreishbach Physician 40.00 0.00 X 336903 0 27094 Matthew Prohaska Physician 40.00 0.00 X 459520 0 36011 Ryan Sexton Physician 40.00 0.00 X 446853 0 36008 Eugene Dixon Physician 40.00 0.00 X 412775 0 20104 3420345 0 320157 51 0 1 1 Dan Wyand PT & Associates PLLC 2020 Trestle Road Danville VT 05828 Physical Therapy Services 2097345 Vermont Radiologists PO Box 217 St Johnsbury VT 05819 Diagnostic Imaging Services 1303036 University of Vermont Medical Center 111 Colchester Avenue Burlington VT 05401 Laboratory Services 1108604 Barton Associates PO Box 417844 Boston MA 02241 Medical Staffing 546973 Medical Doctor Associates PO Box 277185 Atlanta GA 30384 Medical Staffing 475898 11 32026 32026 32026 Patient Service Rev. 621400 157055099 155004782 2050317 Other Patient Service Revenue 621400 3262982 2756477 506505 Meaningful Use Revenue 621400 243220 243220 Provision for Bad Debts 621400 -3387319 -3387319 Contractual/Char. Adj. 621400 -76873263 -76873263 80300719 520748 520748 30843 0 30843 30843 30843 5436776 5210600 183 226176 -183 225993 225993 81110329 77743897 2050317 1284089 X 223766 223766 1486520 885705 600815 34709723 31014852 3694871 1438995 1285382 153613 8043932 7118766 925166 2420642 2135837 284805 111590 14074 97516 46647 46647 85770 85770 96974 96974 8377191 7511508 865683 100981 4393 96588 3662143 1670481 1991662 76009 17116 58893 2287134 1876601 410533 145980 132610 13370 50693 23992 26701 267890 267890 3069762 3056967 12795 1043008 1043008 Medical Supplies 7247097 7247097 Medicaid Provider Tax 4297275 4297275 79289722 69559430 9730292 0 X 6197 6661 7542655 8183089 9565211 9065414 1325738 1325186 473291 555079 59475302 38153958 21091013 21321344 15773737 17103843 7754531 6388027 63532373 63948643 6620748 7594034 1027694 416736 12122812 11413143 5200063 5388743 24971317 24812656 X 36665109 37151871 1454018 1541980 441929 442136 38561056 39135987 63532373 63948643 X 1820607 666766 -1912442 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 11931 11931 79277791 79289722 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 14003 17005 15460 11931 58399 250000 250000 250000 250000 1000000 1500000 X 0 37570 37570 28580193 16590109 11990084 1059084 1046986 12098 27387360 19575872 7811488 2411095 940991 1470104 21321344 Beneficial Interest in Net Assets of Parent 1424425 Due from Parent 4044960 Deferred Compensation 918642 6388027 Deferred Compensation 918642 Estimated Third-Party Payor Settlements 4470101 5388743 81767679 666766 87558 754324 81013355 96974 96974 81110329 79192748 0 79192748 96974 96974 79289722 Part III, Line 4: In 2008, the Organization received a donation of a piece of art work that it hangs in its hallways along with other paintings from local artists. These paintings are put on display to help provide an additional community benefit to the public. Part XI, Line 2d - Other Adjustments: Change in Beneficial Interest in Net Assets of Parent 87,558. 1 1 1 X 1 X 1 1 0 0 1187892 1187892 0.01500 19014431 10933050 8081381 0.10190 20202323 10933050 9269273 0.11690 22 92007 857174 398729 458445 0.00580 1 114837 114837 0.00140 15057164 10603175 4453989 0.05620 7 520 223766 223766 0.00280 30 92527 16252941 11001904 5251037 0.06620 30 92527 36455264 21934954 14520310 0.18310 1 51 1894 0 1894 0.00000 4 46 142023 0 142023 0.00180 5 97 143917 143917 0.00180 1 1509308 20732403 20732403 X 1 1 1 1 Northeastern Vermont Regional Hospital Inc 1315 Hospital Dr PO Box 905 St Johnsbury VT 058190905 www.nvrh.org 833 X X X X Northeastern Vermont Regional Hospital 1 0 0 1 X X X X X X X X 14 1 0 0 1 X www.nvrh.org/community-health-needs-assessment X 1 14 1 www.nvrh.org/community-health-needs-assessment 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X X 1 X http://nvrh.org/understanding-your-bill X http://nvrh.org/understanding-your-bill X http://nvrh.org/understanding-your-bill X X X X X 1 X 0 X X X X 1 X 0 0 Northeastern Vermont Regional Hospital Part V, Section B, Line 5: NVRH conducted a thorough CHNA in 2015. A review of secondary source data identified seniors and low-income families as the most vulnerable populations in our region. Consequently, NVRH staff conducted focus groups with seniors and low-income families. Additional primary source data was obtained from partner organizations including: the Vermont Department of Health key informant interviews of people living in Essex county; the community visit process conducted in St. Johnsbury (the largest town in our service area) by the Vermont Council on Rural Development (over 200 people attended); surveys from Meals on Wheels recipients provided by the Northeast Kingdom Council on Aging.These community engagement opportunities confirmed our three top community health priorities of poverty, mental health and substance abuse, and obesity.The entire CHNA and methodology is available at http://www.nvrh.org/community-health-needs-assessment Northeastern Vermont Regional Hospital Part V, Section B, Line 11: An update and current evaluation to the CHNA Implementation Plan is available at http://www.nvrh.org/community-health-needs-assessmentIn recognition of the importance of the social determinants of health in overall health and well-being, NVRH has taken the lead in creating the Caledonia and So. Essex Accountable Health Community (CAHC). The CAHC uses the framework of Accountable Health Communities, the elements of Collective Impact, and the principles of Results Based Accountability. Key organizations joining NVRH to address the root cause of poor health are the regional mental health organization, housing organization, community action organizations, FQHC organizations, council on aging, and the Vermont Foodbank. Many other state agencies and community based non-profits make up the body of the CAHC. The CAHC has identified five outcomes for our community: well-nourished, well-housed, physically healthy, mentally healthy, and financially secure. Workgroups have formed from the CAHC to provide strategic direction and results-based focus in each outcome area. 9 1 - NVRH - Corner Medical 195 Industrial Parkway Lyndonville VT 05849 Outpatient Physician Clinic 2 - NVRH - St Johnsbury Pediatrics 97 Sherman Drive St Johnsbury VT 05819 General Pediatric Services 3 - Occupational Medicine at NVRH 1280 Hospital Drive St Johnsbury VT 05819 Work-Related Med Needs Clinic 4 - Women's Wellness Center 1315 Hospital Dr PO Box 905 St Johnsbury VT 058190905 OB/GYN Care Facility 5 - NVRH- Orthopedics- Medical Arts Building 1280 Hospital Drive St Johnsbury VT 05819 Orthopedic & Rehab Center 6 - NVRH - Orthopedics - Fracture Clinic 4 Sherman Drive St Johnsbury VT 05819 Fracture Clinic 7 - NVRH - Physical Therapy - Lyndonville 195 Industrial Parkway Lyndonville VT 05849 Physical Therapy Center 8 - NVRH - Physical Therapy - St Johnsbury 97 Sherman Drive St Johnsbury VT 05819 Physical Therapy Center 9 - NVRH - Kingdom Internal Medicine 714 Breezy Hill Road St Johnsbury VT 05819 Outpatient Physician Clinic Part I, Line 7: The Organization used three different methods to allocate costs reported in the table: four physician clinics are rural health clinics: NVRH - Corner Medical, NVRH - St Johnsbury Pediatrics, NVRH - Kingdom Internal Medicine, and NVRH - Women's Wellness. Costs for these clinics were taken directly from the Medicare cost report. Costs for other reported programs were direct costs for the program plus an allocation of indirect costs based on a ratio of direct to indirect costs taken from the Medicare cost report. A cost to charge ratio was used to determine the cost of bad debts and free care for all programs reported on the table. Part I, Line 7g: The Organization included as subsidized health services costs attributable to four physician clinics. 1. NVRH - Corner Medical, a primary care physician clinic. Total costs related to this physician clinic were $3,975,847.2. NVRH - St Johnsbury Pediatrics, a pediatric physician clinic. Total costs related to this physician clinic were $2,644,499. 3. NVRH - Women's Wellness Center, an obstetrician/gynecological physician clinic. Total costs related to this physician clinic were $3,145,508.4. NVRH - Kingdom Internal Medicine, a primary care physician clinic. Total costs related to this physician clinic were $2,331,919. Part II, Community Building Activities: Physical Improvements/HousingNVRH Community Garden:NVRH has provided garden space on our campus for community use for 30 years. There are currently 23 garden spots. The garden spots are provided free of charge on a first come, first served basis. The community benefit value is based on the staff time to coordinate the assignment of spots and other correspondence with the gardeners.Workforce development:NVRH is located in a rural area with limited access to public transportation. Poverty is also our primary health disparity. We have listened to our community and they tell us they need access to services that are close to home. NVRH takes the lead in recruiting both primary care and specialty physicians and mid level providers to fill the need for access to services close to home. The value listed in this section is related to the costs associated with recruiting primary care and specialty providers; as well as loan repayment for four specialists and two nurse practitioners. Also included are expenses related to an Associate Degree Nursing Program. 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 that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Part III, Line 8: All Medicare allowable costs were taken directly from the Medicare cost report. Part III, Line 9b: NVRH provides care to all patients regardless of their ability to pay for services. Patients who indicate they have no insurance receive information about NVRH's Patient Assistance program, including the income level eligibility guidelines, with their first bill and with all subsequent bills. Patient Assistance is provided to those patients who, through a written documentation process, are identified as financially needy. Patients that have qualified for 100% Patient Assistance are not billed for subsequent services for one year. After one year, those patients go through the qualification process again. Financial assistance applications are made readily available to patients. There are signs posted throughout the hospital and clinics as well as links on our website. Part VI, Line 2: Assessment of community needs is an ongoing process at Northeastern Vermont Regional Hospital. Northeastern Vermont Regional Hospital achieves openness, inclusiveness, and public participation in our strategic planning and decision making in a variety of ongoing and deliberate ways.NVRH governance structure includes the Northeastern Vermont Regional Corp. (NVRC) Corporators. The over 250 Corporators, representing all the towns in our service area, are an invaluable source of wisdom and perspective for hospital leadership. They are key links in the essential communication system between members of our community and the Hospital.Because the Corporators represent the community, they act as our eyes and ears on the street. The quarterly Corporators meetings are an opportunity for two-way sharing of information. The Corporators share their needs and concerns, as well as the needs and concerns of their families, friends, and neighbors. In return, the Corporators are updated on hospital services, as well as state and national healthcare issues.The Hospital participates in formal community assessments that are conducted every few years by various community organizations including the Fit, Regional Prevention Partnership - Substance Abuse Prevention Coalition, the Housing Coalition, and the Vermont Departments of Health. Hospital staff are active members and partners with these coalitions and organizations.Formal community assessments begin with identifying a problem or purpose. The purpose could be broad, such as "what are the top priorities in our community or it could be more specific based on the missions of the Organization. The local prevention coalitions have all recently conducted community assessments based on their missions to prevent substance abuse, prevent and end tobacco use, and prevent obesity related chronic conditions.The next step is developing a community profile using primary source data. Primary source data is primarily obtained from the Vermont Department of Health biannual Health Status of Vermonters report. This report compiles data from a variety of sources including the Behavioral Risk Factor Surveillance System (BRFSS), U.S. Census, the Department of Environmental Conservation data, the Vermont Health Care Cost and Utilization Project, and several other state and national data sources.Secondary data is gathered by identifying and getting input from key stakeholders including community leaders, relevant organizations, and community members. Input is gathered by using one on one interviews, surveys (including using online tools like Survey Monkey), and focus forums for all key stakeholder groups.Inventories of existing services, and gap and/or asset mapping are also typically part of the community assessment process.As primary and secondary data is gathered the analyzing phase kicks in. Sometimes the focus of an assessment may shift if data reveals a new or more urgent health priority.Reporting the results of the assessment is an important piece of the process. Every effort is made to get summaries and reports back to interested community members and organizations. More and more often, the Hospital and partner organizations are using Collective Impact principles when designing community interventions or deciding on which health services to add or enhance. Collective Impact starts with community engagement and buy in, but goes beyond to ensure that knowledge, power, credit, and results are shared fairly between "experts and community members. Part VI, Line 3: A summary of NVRH's Patient Assistance Program and the income eligibility guidelines are included in the first and all subsequent bills sent to patients identified as self pay. The phone number of a financial counselor is also provided. The counselor is available to discuss eligibility guidelines and the qualification process. The counselor also discusses with patients the availability of Medicaid and other State assistance programs. Information about the NVRH Patient Assistance Program is also available on the NVRH website. Patients can also learn about NVRH's Patient Assistance program via a link to the State's Green Mountain Care Board.The Patient Assistance Program is available to hospital patients as well as patients of all NVRH-owned physician practices. Part VI, Line 4: Northeastern Vermont Regional Hospital (NVRH) serves about 30,000 people in Caledonia and southern Essex counties in the northeast corner of Vermont. The Hospital is located about 50 miles from the Canadian border to the north, and about 15 miles from the New Hampshire border to the east. Only 3 towns in our service area have a population of more than 2,000 people.Our area is divided equally between males and females. Approximately 49% of our residents are over 45 years of age. The area is predominately white (96%) and English is the predominant language. The median income is below the state average at $44,453 per household ($53,442 Vermont). Just over half of our residents have a high school diploma or less, under 25% have completed a four year college degree.Manufacturing is the largest employment sector (15.3%), followed by retail (13.9%), and health care and social services (13.8%). There are 4 public school districts, and numerous private or independent schools. There are 3 colleges, including Community College of Vermont, located in our service area. Part VI, Line 5: The Hospital also promoted health and safety throughout the community through the following programs:1. Baby Sitting Course2. Bike Safety Fair3. Blood Drawings at NVRH4. Car Seat Safety Program5. Community Connections6. Community Gardens 7. Community Wellness Calendar8. Healthier Living Workshop/ Chronic Pain / DPP9. Healthwire Consumer Education Series10. Lactation Services11. Little Sprouts12. No Sugar Added Obesity Preventions and Reduction13. Regional Prevention and Tobacco14. Radio Education Program15. Support Group Diabetes16. Taxi Vouchers17. Tobacco Prevention and Outreach18. Veggie Van Go 1 Northern Counties Health Care Inc 165 Sherman Drive St Johnsbury VT 05819 510199559 501(c)(3) 130380 Community Benefit Grant University of Vermont AHEC Program 1 South Prospect Street Burlington VT 05401 030179440 501(c)(3) 27000 To support AHEC Program Dr Bob's Home 855 Ardmore Avenue Akron OH 44302 341461210 501(c)(3) 7972 To Support Dr. Bob's Home 3 0 Part I, Line 2: The Hospital only awards grants to qualifying public charities exempt under 501(c)(3). Organizations receiving a grant must sign a grant agreement that details how the funds may be used. Additional monitoring is not deemed necessary. X X X X 0 0 0 0 0 0 0 1 0 Michael Rousse MD Past Trustee 268013 0 0 0 0 0 11586 0 22754 0 302353 0 0 0 Mark Price MD Trustee 209057 0 0 0 0 0 0 0 38500 0 247557 0 0 0 Terry Larsen DO Trustee 269099 0 0 0 24274 0 11850 0 30573 0 335796 0 0 0 Paul Bengtson CEO 320810 0 0 0 24000 0 11925 0 17283 0 374018 0 0 0 Robert Hersey CFO 192755 0 0 0 6000 0 8988 0 19053 0 226796 0 0 0 Richard N Gagnon Physician 450286 0 0 0 0 0 11925 0 16503 0 478714 0 0 0 Craig D Dreishbach Physician 336903 0 0 0 0 0 11925 0 15169 0 363997 0 0 0 Matthew Prohaska Physician 407805 0 17360 0 34355 0 11925 0 24086 0 495531 0 0 0 Ryan Sexton Physician 393285 0 18450 0 35118 0 11925 0 24083 0 482861 0 0 0 Eugene Dixon Physician 412775 0 0 0 0 0 11925 0 8179 0 432879 0 0 0 Part I, Line 7 Dr. Prohaska's contract includes extra compensation for RVUs produced in excess of target RVUs. Dr. Sextons incentive was based on several factors including, recruitment of physicians, patient satisfaction, and reduction of patient wait times. Form 990, Part VII, Section A, Line 5 Mark Price, MD, a trustee of the Organization, is paid by Dartmouth Hitchcock Medical Center, an unrelated organization, for services rendered to Northeastern Vermont Regional Hospital, a related organization. He is also paid by Northeastern Vermont Regional Hospital. A breakdown of his calendar year 2016 compensation is as follows: Unrelated organization Salary: $194,057 Benefits: $38,500 (an estimate) Related organization Other Compensation: $15,000 A Vermont Educational And Health Buildings Financing Agency 237154467 2016-04-01 12605000 Refinancing of 2004 & 2009 Series A Bonds 0 0 0 A 1018061 12605000 162039 12442961 2016 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 Elaine L Robinson Family member of Thomas Robinson, 1st Vice Chair & Treasurer 40138 Employment 0 Jane Price Family Member of Mark Price MD, Trustee 46192 Employment 0 William Long MD Family Member of Laurel St.James-Long, Trustee 137305 Employment 0 X Medical Supplies and Equipment 1 32026 FMV 0 0 0 Form 990, Part VI, Section A, line 6 The sole member of the Organization is Northeastern Vermont Regional Corp. Form 990, Part VI, Section A, line 7a All trustees shall be elected by the member of the Organization. Form 990, Part VI, Section B, line 11b The process for reviewing the Organization's 990 evolves from oversight for utilized numbers from the TB which have been audited. Schedules to support various aspects of the tax return are prepared by several finance department staff, and Bob Hersey, as CFO, reviews the information which is submitted to the auditors. In addition, prior to the document's filing, the draft Form 990 is reviewed by the Organization's CEO, CFO, and Treasurer. A copy of Form 990 is provided to the Organization's board on the closest meeting date after the filing of the return. Form 990, Part VI, Section B, line 12c The organization monitors and enforces compliance with the conflict of interest policy by requiring directors and trustees to complete an annual questionnaire. Board members disclose any potential conflict prior to voting. Significant conflicts of interest would be discussed with legal counsel prior to board action. Form 990, Part VI, Section B, line 15 A compensation committee sets the compensation level for the Organization's CEO. The CEO is charged with determining the compensation level for the Organization's CFO. The basis for arriving at the CFO and CEO's compensation is determined by using comparable compensation data of the CEOs and CFOs from other similar sized Vermont hospitals. The Organization obtains this data by examining other Vermont hospital Form 990s. Compensation for all other key employees is based on the Vermont and New Hampshire annual wage survey. The CEO has the final determination for the appropriate level of compensation for all other employees. Form 990, Part VI, Section C, line 19 The Organization makes its financial statements available to the public upon request as well as through the publishing of its annual report on its website. The Organization makes its governing documents and conflict of interest policy available to the public upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,290,563. Management and general expenses 865,683. Fundraising expenses 0. Total expenses 4,156,246. Physician Fees: Program service expenses 3,613,029. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,613,029. Lab Fees: Program service expenses 607,916. Management and general expenses 0. Fundraising expenses 0. Total expenses 607,916. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northeastern Vermont Regional Hospital, Inc. 1315 Hospital Drive St. Johnsbury, VT 05819-0905 EIN: 03-6013761 Northeastern Vermont Regional Hospital, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Beneficial Interest in Net Assets of Parent 87,558. Equity Transfer to Parent -2,000,000. Northeastern Vermont Regional Corp 1315 Hospital Drive St Johnsbury VT 058190905 222583253 Health Care Services VT 501(c)3 11, Type II N/A 0 Northeastern Health Enterprises Inc 1315 Hospital Drive St Johnsbury VT 05819 030294757 Management Services VT Northeastern VT Regional Corp C 1.00000 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0