COPLEY HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COPLEY HOSPITAL INC (EIN 03-0179423)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-02-09
- IRS object ID
- 201830409349300113
- Schema version
- 2016v3.0
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-02-09T12:54:38-06:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030179423 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COPL | BusinessNameControlTxt |
| Phone | 8028888888 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Arthur Mathisen | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 8028888888 | PhoneNum |
| Signature | 2018-02-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2018-02-08 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.49.157.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-02-08 | IPDt |
| IP Tm | 14:22:09 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C9B17F91A2F9740444165E3537F2E031898F407F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 63471A045D9E60D22A51BA7109BDBA35E67E5406 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Arthur Mathisen | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $69,674,062 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.copleyvt.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1934 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 532 | TotalEmployeeCnt |
| Total Volunteers | 120 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200,601 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,983,083 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $64,200,803 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $66,547,154 | CYProgramServiceRevenueAmt |
| PY Investment Income | $55,225 | PYInvestmentIncomeAmt |
| CY Investment Income | -$93,708 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,494 | PYOtherRevenueAmt |
| CY Other Revenue | $19,946 | CYOtherRevenueAmt |
| PY Total Revenue | $64,490,123 | PYTotalRevenueAmt |
| CY Total Revenue | $69,456,475 | 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 | $34,698,928 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,041,404 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,613,479 | PYOtherExpensesAmt |
| CY Other Expenses | $30,738,959 | CYOtherExpensesAmt |
| PY Total Expenses | $64,312,407 | PYTotalExpensesAmt |
| CY Total Expenses | $66,780,363 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $177,716 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,676,112 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $51,647,574 | TotalAssetsBOYAmt |
| Total Assets EOY | $60,010,352 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,872,271 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,965,223 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,775,303 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $41,045,129 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To help people live healthier lives by providing exceptional care and superior service. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $61,251,057 | ExpenseAmt |
| Revenue | $66,547,154 | RevenueAmt |
| Desc | Copley Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement is critical to the hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Further, our mission is to serve the community with respect to providing healthcare services and healthcare education in keeping with the hospital's commitment to serve all members of its community. The Hospital offers free care and or subsidized care, care provided to persons covered by governmental programs at below cost, and health activities and programs to support the community and are considered where the need and/or individual's inability to pay coexists. These activities include a variety of services in the form of seminars, workshops, clinics, and screenings at minimal or no charge. | Desc |
| Total Program Service Expenses | $61,251,057 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 105 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 532 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 | 0 | 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 | Kevin Dorain | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8028888138 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Kathy Demars | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Harry Miller | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Carl Szlachetka | |||||||||
| Vice Chair | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Walter Frame | |||||||||
| Treasurer | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Sharon Green | |||||||||
| Secretary | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Elaine Nichols | |||||||||
| Chair | 3.80 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Nancy Putnam | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Richard Westman | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| David Yacovone | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Henry Binder MD | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Jan Roy | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Joseph Subasic MD | |||||||||
| Trustee/Med. Staff President | 41.80 | 0.20 | Yes (X) | $216,745 | $0 | $47,861 | |||
| David Silverman | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Jamey Ventura | |||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | |||
| Arthur Mathisen | |||||||||
| President and CEO | 38.00 | 2.00 | Yes (X) | $261,601 | $0 | $3,914 | Yes (X) | ||
| Rassoul Rangaviz | |||||||||
| CFO | 38.00 | 2.00 | $235,948 | $0 | $12,445 | Yes (X) | |||
| Lori Profota | |||||||||
| CNO | 38.00 | 2.00 | $176,365 | $0 | $28,981 | Yes (X) | |||
| Bryan Huber MD | |||||||||
| Physician | 40.00 | 0.00 | $664,249 | $0 | $61,462 | Yes (X) | |||
| Brian Aros MD | |||||||||
| Physician | 40.00 | 0.00 | $703,961 | $0 | $50,728 | Yes (X) | |||
| Saul Trevino MD | |||||||||
| Physician | 32.00 | 0.00 | $459,531 | $0 | $76,292 | Yes (X) | |||
| John Macy MD | |||||||||
| Physician | 40.00 | 0.00 | $632,062 | $0 | $57,245 | Yes (X) | |||
| Joseph McLaughlin MD | |||||||||
| Physician | 40.00 | 0.00 | $580,393 | $0 | $53,393 | Yes (X) | |||
| Melvyn Patashnick | |||||||||
| Former President and CEO | 0.00 | 0.00 | $235,126 | $0 | $40,820 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,165,981 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $433,141 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 51 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ReArch Company Inc | |||||
| 55 Community Drive Suite 402 | South Burlington | VT | 05403 | Construction | $3,363,493 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Physician Services | $572,911 |
| Apogee Medical Management | |||||
| 15059 N Scottsdale Rd Ste 600 | Scottsdale | AZ | 852542685 | Physician Services | $529,100 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 366850309 | Software Support | $512,771 |
| Siemens Medical Solutions | |||||
| PO Box 12001 | Dallas | TX | 753120733 | Equipment Service Support | $487,338 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 32 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,983,083 | RelatedOrganizationsAmt |
| Total Contributions | $2,983,083 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Gross Patient Revenue | 621400 | $109,770,218 | $109,770,218 | |
| Miscellaneous Revenue | 621400 | $1,224,124 | $1,224,124 | |
| Cafeteria Revenue | 900099 | $339,038 | $339,038 | |
| Provision for Bad Debt | 621400 | -$1,428,812 | -$1,428,812 | |
| Contractual/Char. Adj. | 621400 | -$43,357,414 | -$43,357,414 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $66,547,154 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,975 | TotalRevenueColumnAmt |
| Exclusion | $70,975 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,946 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,946 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,946 | TotalRevenueColumnAmt |
| Exclusion | $19,946 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $52,904 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $217,587 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$164,683 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$164,683 | TotalRevenueColumnAmt |
| Exclusion | -$164,683 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $69,456,475 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $64,983,992 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,489,400 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $983,860 | TotalAmt |
| Program Services | $264,607 | ProgramServicesAmt |
| Management And General | $719,253 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,260,412 | TotalAmt |
| Program Services | $27,391,603 | ProgramServicesAmt |
| Management And General | $1,868,809 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $730,955 | TotalAmt |
| Program Services | $677,206 | ProgramServicesAmt |
| Management And General | $53,749 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,170,135 | TotalAmt |
| Program Services | $2,932,374 | ProgramServicesAmt |
| Management And General | $237,761 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,896,042 | TotalAmt |
| Program Services | $1,736,144 | ProgramServicesAmt |
| Management And General | $159,898 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,110 | TotalAmt |
| Program Services | $420 | ProgramServicesAmt |
| Management And General | $25,690 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,831 | TotalAmt |
| Management And General | $46,831 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,045 | TotalAmt |
| Management And General | $44,045 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,926,438 | TotalAmt |
| Program Services | $7,027,179 | ProgramServicesAmt |
| Management And General | $899,259 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,751 | TotalAmt |
| Management And General | $189,751 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,178,269 | TotalAmt |
| Program Services | $844,528 | ProgramServicesAmt |
| Management And General | $333,741 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,626,280 | TotalAmt |
| Program Services | $1,308,511 | ProgramServicesAmt |
| Management And General | $317,769 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,750 | TotalAmt |
| Program Services | $67,460 | ProgramServicesAmt |
| Management And General | $24,290 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,868 | TotalAmt |
| Program Services | $26,868 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,384,021 | TotalAmt |
| Program Services | $2,048,379 | ProgramServicesAmt |
| Management And General | $335,642 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,148,237 | TotalAmt |
| Program Services | $1,088,926 | ProgramServicesAmt |
| Management And General | $59,311 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $11,824,755 | $11,795,566 | $29,189 |
| Service Provider Tax | $3,747,213 | $3,747,213 | |
| Dues & Subscriptions | $284,015 | $117,539 | $166,476 |
| Education | $194,376 | $176,534 | $17,842 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,780,363 | TotalAmt |
| Program Services | $61,251,057 | ProgramServicesAmt |
| Management And General | $5,529,306 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,650 | BOYAmt |
| EOY | $2,650 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,876,115 | BOYAmt |
| EOY | $14,885,293 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,173,642 | BOYAmt |
| EOY | $5,151,040 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,112,888 | BOYAmt |
| EOY | $3,337,286 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,390,159 | BOYAmt |
| EOY | $1,578,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $55,674,167 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,528,429 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,125,503 | BOYAmt |
| EOY | $28,145,738 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,040,732 | BOYAmt |
| EOY | $4,634,446 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,925,885 | BOYAmt |
| EOY | $2,275,745 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,647,574 | BOYAmt |
| EOY | $60,010,352 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,564,622 | BOYAmt |
| EOY | $6,587,840 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,250 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,135,760 | BOYAmt |
| EOY | $8,922,371 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,171,889 | BOYAmt |
| EOY | $3,448,762 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,872,271 | BOYAmt |
| EOY | $18,965,223 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,734,571 | BOYAmt |
| EOY | $36,410,683 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,788,081 | BOYAmt |
| EOY | $272,261 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,252,651 | BOYAmt |
| EOY | $4,362,185 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,775,303 | BOYAmt |
| EOY | $41,045,129 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,647,574 | BOYAmt |
| EOY | $60,010,352 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,676,112 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,406,286 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $32,089 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $11,956 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $44,045 | 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 | The Organization pays dues to various organizations, a portion (11,956) of which is attributable to lobbying expenses. The Hospital also engaged a law firm for 32,089 for lobbying services. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $936,221 | OtherCostOrOtherBasisAmt |
| Book Value | $936,221 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,653,576 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,396,659 | DepreciationAmt |
| Book Value | $19,256,917 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $666,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $241,498 | DepreciationAmt |
| Book Value | $425,052 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,547,825 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,474,098 | DepreciationAmt |
| Book Value | $6,073,727 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,869,995 | OtherCostOrOtherBasisAmt |
| Depreciation | $416,174 | DepreciationAmt |
| Book Value | $1,453,821 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,145,738 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial Interest in Net Assets of Copley Health Systems, Inc. | Desc |
| Book Value | $4,634,446 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,634,446 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $2,248,762 |
| Estimated Third Party Payor Settlements | $1,200,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,448,762 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $67,050,189 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $67,050,189 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,406,286 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,406,286 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $69,456,475 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $66,780,363 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $66,780,363 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $66,780,363 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part XI, Line 4b - Other Adjustments: | FormAndLineReferenceDesc |
| Explanation | Change in Beneficial Interest in Net Assets of Copley Health Systems, Inc. 2,406,286. | ExplanationTxt |
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 | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $385,231 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $385,231 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,172,324 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,962,896 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,209,428 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10800 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,557,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,962,896 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,594,659 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $61,582 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $108,918 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $61,582 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $108,918 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,728,055 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,024,478 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,703,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11540 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $797,667 | BadDebtExpenseAmt |
| 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 | Copley Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.copleyvt.org | WebsiteAddressTxt |
| State License | 827 | 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 | Copley Hospital Inc | 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 | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | www.copleyvt.org/about-us/community-health-needs-assessment/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.copleyvt.org/about-us/community-health-needs-assessment/ | StrategyWebsiteURLTxt |
| 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 | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| 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 | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | 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 Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Copley Hospital, Inc. | Part V, Section B, Line 5: In March 2015, Copley Hospital engaged Toby Knox and Associates LLC (TKA) to conduct market research pertaining to Copley's Community Healthcare Needs Assessment. This assessment was designed to fulfill the requirements of the Federal Patient Protection and Affordable Care Act (PPACA) and to help Copley Hospital to fulfill its mission, specifically to improve the health status of the people of the community by providing the highest quality of care regardless of ability to pay.The assessment process invited feedback from community members and stakeholders as well as reviewing relevant data and publications published by government and non-profit agencies from within the Copley community and statewide.Copley Hospital conducted this Community Health Needs Assessment in collaboration with the Morrisville District Office of the Vermont Department of Health (VDH), working specifically with Field Director Valerie Valcour and the Copley Hospital Service Area Blueprint for Health Community Health Team. The research effort utilized three data gathering techniques:SurveyingIn April 2015, an online survey tool was developed with Valcour and Knox to solicit input from throughout our community. The online survey tool was promoted in May via community newspapers, social media, Front Porch Forum and distributed by email to Copley Hospital board members, corporate members, employees, and community opinion leadersQualitative ResearchIn May and June 2015, three focus groups were conducted by Toby Knox, principal of Toby Knox & Associates, LLC, with seniors at Copley Terrace, participants in the Reach UP program and members of the extended Blueprint for Health Community Health Care Team. Secondary Data ReviewCopley Hospital also conducted an environmental scan of the healthcare landscape by reviewing relevant reports presented by public health and local non-profit agencies, including the Vermont Department of Health, Blueprint for Health and the County Health Rankings for Lamoille County. In addition, Copley utilized CommunityCommons.org, an online between Institute for People, Place and Possibility with the Center for Applied Research and Environmental Systems (CARES) at University of Missouri and Community Initiatives. It is supported by The Robert Wood Johnson Foundation, Kaiser Permanente, American Heart Association, and the Centers for Disease Control (CDC). CommunityCommons.org uses the "core outcome and action indicators framework" associated with The County Health Rankings/Roadmaps to Health, The Community Guide, Healthy People 2020, and other widely used sources of indicators and evidence-informed program activities. The framework is also derived from the shared national priorities identified in the National Prevention Strategy, The Community Transformation Grant Program and the Leading Health Indicators for Healthy People 2020.Data sources also included:U.S. Census Bureau, 2010 Demographic Profile DataU.S. Census Bureau 2009-2013 5- Year American Community Survey2012-2013 Behavioral Risk Factor Surveillance System (BRFSS)2014 Suicide Data for Lamoille County from the Vermont Vital Statistics System2015 Lamoille County Planning Commission Regional Transportation Plan (draft)2013 District Office Profile Partnership for Success Grant, Morrisville District Office2014 Lamoille County Health Rankings and Roadmaps2013 AHEC Vermont County Profiles for Medical and Health Sciences Students and Residents2013 Blueprint for Health HSA profile: Morrisville2012 Healthy Vermonters 2020 State Health Assessment Plan2015 Vermont Kids Count, Voices for Vermont Kids |
| Copley Hospital, Inc. | Part V, Section B, Line 7d: The CHNA was distributed to the Hospital's Board of Trustees along with the Copley Hospital Service Area Blueprint for Health Community Health Team as well as the Copley Hospital Service Area Unified Community Collaborative (UCC) and other social service organizations. The CHNA is available on the hospital's website, copleyvt.org/about-us/community-health-needs-assessment. |
| Copley Hospital, Inc. | Part V, Section B, Line 11: The Board of Trustees reviewed and adopted the CHNA Implementation Plan in February 2016. The plan reflects the recommendations of the Steering Committee. The Steering Committee identified the following three needs for the Hospital's implementation plan: reducing the cost of healthcare by reducing preventable hospital visits; chronic health conditions, with a focus on obesity, diabetes related issues; and preventive care with a focus on alcohol, tobacco, and depression screening. The Hospital connects patients presenting in the emergency department that do not have a primary care physician (PCP) to a community health team member for assistance in securing a PCP. All "well woman and maternal care patients are screened for tobacco, alcohol and depression. Patient and family services team members refer patients to appropriate resources to address chronic health issues beyond the Hospital's scope in addition to other social determinants of health. The Hospital continues to strengthen transitions in care, collaborating with primary care providers, home health, long term skilled nursing facilities and mental health services, to support preventive care and chronic health conditions. As one of the largest employers in the area, Copley's employee health program is focusing on reducing obesity within our employee population. The Hospital created and is hosting a collaborative community blog, LiveWellLamoille.com, that is designed to address all the social determinants of health with a goal of providing tips, resources and encouragement to help residents make healthy choices. Healthy choices lead to a healthier lifestyle. The need for better more reliable transportation; the lack of facilities or options for people to exercise and choose healthy eating habits; and poverty and the lack of affordable housing were among other issues also identified. The Hospital may monitor, but will not generally address additional issues unless specified in the implementation plan. This is because the Hospital does not have the expertise needed; or the necessary actions fall more appropriately to the responsibility of others; or suitable efforts are individuals modifying personal behavior rather than the efforts of a healthcare organization; and/or the Hospital's limited resources prevent additional response to other issues. |
| Copley Hospital, Inc. | Part V, Section B, Line 24: Services that are not medically necessary are excluded from coverage under the FAP, but an uninsured discount is granted for these services. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Copley Hospital Inc | ||||
| 88 High Street | Hardwick | VT | 05843 | Outpatient Rehab Services |
| 2 - Stoweflake Resort | ||||
| 1746 Mountain Road | Stowe | VT | 05672 | Outpatient Rehab Services |
| 3 - Mansfield Orthopaedics | ||||
| 555 Washington Highway | Morrisville | VT | 05661 | Outpatient Orthopaedic, Rehab and Radiology Services |
| 4 - Mansfield Orthopaedics | ||||
| 6 North Main Street | Waterbury | VT | 05676 | Outpatient Orthopaedic, Radiology Services |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. |
| Part III, Line 4: | Patient accounts receivable are stated at the amount management expects to collect from outstanding balances, and thus are reduced by an allowance for doubtful accounts. In evaluating collectibility of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provisions for bad debts. Management regularly reviews data about these major payor sources of revenue 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, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). 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 on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The allowance for doubtful accounts decreased from $2,200,000 in 2016 to $1,900,000 in 2017 based on evaluation of recent payment trends.The Organization utilized a cost to charge ratio as the costing methodology used to determine the amount of bad debt expense at cost. |
| Part III, Line 9b: | Financial Assistance is available to guarantors who meet the eligibility requirements. Income level, household size, residency status, etc, determine eligibility. Federal Poverty Level guidelines are utilized to determine the amount of assistance a household may be eligible for. For the patient's convenience, all statements have an abbreviated version of the Financial Assistance Application on the back. |
| Part VI, Line 2: | Copley gathers and analyzes information about the greater Lamoille Valley community and its healthcare needs through various means, including: analyzing and responding to health trends in our patients; through aggregate data from our Quality and Wellness initiatives, the OneCare Vermont Accountable Care Organization, and the Copley Service Area Blueprint for Health Program. We also review relevant data published by the Vermont Dept. of Health, Green Mountain Care Board, Vermont Department of Health and Federal Centers for Disease Control.The Hospital is governed by a volunteer board of trustees made up of local citizens representing a cross section of the community served. We maintain involvement in a number of community groups within our service area. Copley continues to work collaborative with other organizations to identify and address community health needs. Our collaborations include but are not limited to the Extended Community Health Team of the Copley Area Blueprint for Health (including primary care practices), Lamoille Valley Unified Community Collaborative with Vermont OneCare/ACO, Lamoille Home Health and Hospice, The Manor (long term residential care), Lamoille County Mental Health, CHSLV Behavioral Health and Wellness, Healthy Lamoille Valley, People in Partnership, the Morrisville District office of the Vermont Department of Health, United Way and Leadership Lamoille through the Lamoille Chamber of Commerce. |
| Part VI, Line 3: | Information about Copley's Charitable Care policy, which includes helping patients apply for assistance under federal, state or local government programs, is posted by each registration desk (Main Lobby and Emergency Department). It is also available, along with the application form, online on the Hospital's website in addition to the "Hospital Report Card" website of the Green Mountain Care Board. Details are also included in the Patient Guide for inpatients, families and visitors.Copley's Charitable Care program is also promoted in our philanthropy efforts as many donors give to the program. All care providers may refer patients to the Hospital's Patient Financial Services counselors or to Patient and Family Services to connect them to assistance. |
| Part VI, Line 4: | Copley Health Systems, Inc. is an essential health care resource in the rural greater Lamoille County area of Vermont. We are located in the heart of one of the state's popular 4-season recreational resort areas and serve Johnson State College. Our services include Copley Hospital, a 25-bed Critical Access community hospital, low-income elderly housing, and an independent living facility.Our Hospital Service Area, as defined by the 2010 U.S. Census, has a population of just over 30,000 people, across more than 459 square miles. Our service area includes all of the towns and villages of Lamoille County, and parts of Caledonia and Orlean Counties. Towns with the most population include Morristown, Stowe, Johnson, and Cambridge; all others have less than 3,000 residents.The major industry in the area is Accommodations and Food Service, representing 25% of the jobs, followed by Health and Social Assistance (15%), Retail Trade (13%), and Education (11%), according to the Vermont Department of Labor. Copley Hospital is one of the largest year-round employers in the area.In the 2015 County Health Rankings by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, Lamoille County is ranked #8 out of the 14 counties for health factors. This ranking is based on a combination of health behavior measures (tobacco use, diet/exercise, alcohol use, sexual activity), clinical care measures (access, quality), socio-economic factors (education, employment, income, family/social support, community safety) and environmental measures (air quality and the built environment). County Health Rankings also have Lamoille County ranked #4 out of the 14 counties for Health Outcomes. This ranking is based on a combination of morbidity measures (poor or fair health, poor physical health days, poor mental health days, low birthweight) and mortality (premature death).Lamoille County is one of the few counties in Vermont whose population of people younger than 18 years of age is growing. We have a higher rate of poverty compared to the state. Nearly a third of our area residents are below 200% of poverty level. Fourteen percent of our population is 65 years old or older. |
| Part VI, Line 5: | Copley Hospital serves all patients, regardless of ability to pay. Services include 24 hour/7days a week emergency services, women's and children's services, general surgery, laboratory services, and diagnostic imaging, and orthopaedics. We provide services for community residents whose next nearest hospital may be an hour away in good weather. Copley Hospital regularly promotes healthy lifestyle choices and preventive information via social media outlets, including a collaborative community blog LiveWellLamoille.com, community newsletters, and information distributed on the hospital campus. We promote and support healthy, family-friendly activities and events to encourage healthy choices for a healthy lifestyle. Grant funding to Healthy Lamoille Valley was given to support the organization's sustainability planning in order to continue anti substance abuse initiatives and increase awareness on long term effects of adverse childhood events.The Hospital also contributed to the Town of Morristown's free bicycle and pedestrian program in support of creating and maintaining public space that facilitates and encourages exercise. Funds were also donated to the Lamoille Valley Council of Hunger Free Vermont in support of their programs to address food insecurity. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | Yes (1) | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Joseph Subasic MD | ||||||||||||||
| Trustee/Med. Staff President | $195,039 | $0 | $0 | $0 | $21,706 | $0 | $8,600 | $0 | $39,261 | $0 | $264,606 | $0 | $0 | $0 |
| Arthur Mathisen | ||||||||||||||
| President and CEO | $245,654 | $0 | $0 | $0 | $15,947 | $0 | $0 | $0 | $3,914 | $0 | $265,515 | $0 | $0 | $0 |
| Rassoul Rangaviz | ||||||||||||||
| CFO | $211,000 | $0 | $0 | $0 | $24,948 | $0 | $9,414 | $0 | $3,031 | $0 | $248,393 | $0 | $0 | $0 |
| Lori Profota | ||||||||||||||
| CNO | $176,045 | $0 | $0 | $0 | $320 | $0 | $0 | $0 | $28,981 | $0 | $205,346 | $0 | $0 | $0 |
| Bryan Huber MD | ||||||||||||||
| Physician | $605,318 | $0 | $13,681 | $0 | $45,250 | $0 | $10,600 | $0 | $50,862 | $0 | $725,711 | $0 | $0 | $0 |
| Brian Aros MD | ||||||||||||||
| Physician | $590,441 | $0 | $50,000 | $0 | $63,520 | $0 | $10,600 | $0 | $40,128 | $0 | $754,689 | $0 | $0 | $0 |
| Saul Trevino MD | ||||||||||||||
| Physician | $397,940 | $0 | $0 | $0 | $61,591 | $0 | $10,600 | $0 | $65,692 | $0 | $535,823 | $0 | $0 | $0 |
| John Macy MD | ||||||||||||||
| Physician | $574,868 | $0 | $23,737 | $0 | $33,457 | $0 | $10,600 | $0 | $46,645 | $0 | $689,307 | $0 | $0 | $0 |
| Joseph McLaughlin MD | ||||||||||||||
| Physician | $534,604 | $0 | $0 | $0 | $45,789 | $0 | $10,600 | $0 | $42,793 | $0 | $633,786 | $0 | $0 | $0 |
| Melvyn Patashnick | ||||||||||||||
| Former President and CEO | $192,745 | $0 | $0 | $0 | $42,381 | $0 | $8,241 | $0 | $32,579 | $0 | $275,946 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 5 | FormAndLineReferenceDesc |
| Explanation | Bryan Huber, Brian Aros, and John Macy, highest compensated employees, received bonuses of $13,681, $50,000, & $23,737, respectively. The bonuses were based upon the gross revenue produced individually for the Hospital. The bonus is triggered when the individual produces a certain level of revenue. The bonus is 20% of the excess revenue produced over that level. There is a cap on the amount of bonus the individual can receive. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| David Vinick | |||
| Family Member of Sharon Greene, Board Secretary | $76,264 | Employment | 0 |
| Diane Szlachetka | |||
| Family Member of Carl Szlachetka, Vice Chair | $28,918 | Independent Contractor Arrangement | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Copley Hospital, Inc. is a member organization whose sole corporate member is Copley Health Systems, Inc. Copley Health Systems, Inc. and the Hospital share the same board of trustees. |
| Form 990, Part VI, Section A, line 7a | Copley Hospital, Inc. shares the same board as Copley Health Systems, Inc. Each year, the members of Copley Health Systems, Inc. will hold an annual meeting. The purposes of the annual meeting shall include the election of members to the Corporation, the election of Trustees to the Corporation's Board of Trustees, the election of the community member at large of the governance and bylaws committee, and the transaction of such other business as may properly come before the membership. The Board shall consist of up to twenty-one elected members, the Chief Executive Officer of the Corporation and the President of the Medical Staff of Copley Hospital, Inc., all as voting members. All Trustees must be members of the Corporation. |
| Form 990, Part VI, Section B, line 11b | The finance committee reviews the Form 990 prior to submission. A complete copy of the form is made available to all members of the governing body through the finance office. |
| Form 990, Part VI, Section B, line 12c | The Governance Committee reviews the statements and surveys completed by interested persons and maintains a list of individuals who may be considered disqualified persons under IRS regulations. The Governance Committee reports the results of its reviews annually to the Board. The internal Compliance Committee of the Corporation reviews any potential conflict of interest which involves an interested person who is not a trustee or officer of the Corporation. The internal Compliance Committee reports the results of its reviews annually to the Board. |
| Form 990, Part VI, Section B, line 15 | The CEO's pay is determined through the use of an outside compensation firm. Senior leadership and other highly compensated individuals have their pay ranges determined through market data from Astron Solutions. The compensation for the CEO is approved by the Board. |
| Form 990, Part VI, Section C, line 19 | The governing documents are made available upon request. The conflict of interest policy and Matrix are available upon request. The financial statements are summarized in an annual report that is available to the public. The Hospital also submits both their budget and actual financial information to the State of Vermont's Green Mountain Care Board. |
| Form 990, Part IX, line 11g | Other Fees: Program service expenses 1,770,803. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,770,803. Contract Labor: Program service expenses 2,128,630. Management and general expenses 160. Fundraising expenses 0. Total expenses 2,128,790. Purchased Services: Program service expenses 3,127,746. Management and general expenses 899,099. Fundraising expenses 0. Total expenses 4,026,845. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Copley Hospital, Inc. 528 Washington Highway Morrisville, VT 05661 EIN: 03-0179423 Copley 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 Copley Health Systems, Inc. -2,406,286. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Lamoille Area Housing Corporation Copley Terrace Project | |||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030270255 | Subsidized Elderly Housing | VT | 501(c)(3) | Line 10 | Copley Health Systems Inc | 0 | |
| Copley Health Systems Inc | |||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030301457 | Support of Copley Hospital | VT | 501(c)(3) | Line 12b, II | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Health Center Building Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030220357 | EIN |
| Primary Activities | Office Building Rental | PrimaryActivitiesTxt |
| Legal Domicile State | VT | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Health Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | 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 | 0 | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | 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 (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Health Center Building | ||
| K | $197,729 | FMV |
| Copley Health Systems Inc | ||
| C | $2,983,083 | FMV |