WINDSOR HOSPITAL CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- WINDSOR HOSPITAL CORPORATION (EIN 03-0183721)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-02-14
- IRS object ID
- 201730459349301348
- Schema version
- 2015v3.0
- 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 G
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-14T13:40:05-06:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 020476956 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TYLER SIMMS & ST SAUVEUR CPA PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19 MORGAN DRIVE | AddressLine1Txt |
| City | LEBANON | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030183721 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINDSOR HOSPITAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WIND | BusinessNameControlTxt |
| Phone | 8026746711 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 289 COUNTY ROAD | AddressLine1Txt |
| City | WINDSOR | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05089 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID SANVILLE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8026746711 | PhoneNum |
| Signature | 2017-02-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | W JAY SIMMS | PreparerPersonNm |
| PTIN | P00435321 | PTIN |
| Phone | 6036530044 | PhoneNum |
| Preparation | 2017-02-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MTASCUTNEY HOSPITAL & HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID SANVILLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 289 COUNTY ROAD | AddressLine1Txt |
| City | WINDSOR | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05089 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $52,020,997 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | MTASCUTNEYHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1933 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE LIVES OF THOSE WE SERVE. OUR ACTIVITIES INCLUDE PROVIDING HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 553 | TotalEmployeeCnt |
| Total Volunteers | 58 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,069,750 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,048,528 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,311,078 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $48,955,981 | CYProgramServiceRevenueAmt |
| PY Investment Income | $411,240 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,763,248 | CYInvestmentIncomeAmt |
| PY Other Revenue | $137,949 | PYOtherRevenueAmt |
| CY Other Revenue | $221,132 | CYOtherRevenueAmt |
| PY Total Revenue | $49,930,017 | PYTotalRevenueAmt |
| CY Total Revenue | $51,988,889 | 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 | $28,788,615 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,253,933 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $215,708 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,334,771 | PYOtherExpensesAmt |
| CY Other Expenses | $20,352,611 | CYOtherExpensesAmt |
| PY Total Expenses | $49,123,386 | PYTotalExpensesAmt |
| CY Total Expenses | $49,606,544 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $806,631 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,382,345 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $45,798,892 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,763,552 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,255,744 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,988,956 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,543,148 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,774,596 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER'S MISSION IS TO IMPROVE THE LIVES OF THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $39,410,710 | ExpenseAmt |
| Revenue | $49,129,506 | RevenueAmt |
| Desc | MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) OPERATES A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHICH PROVIDES PRIMARY AND SECONDARY HEALTH CARE. MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, CLAREMONT, WOODSTOCK, HARTLAND, SPRINGFIELD, AND BROWNSVILLE. THE HOSPITAL PROVIDES ESSENTIAL HEALTHCARE SERVICES INCLUDING EMERGENCY DEPARTMENT, MED/SURG INPATIENT, AND ANCILLARY DIAGNOSTIC TESTS, IMAGING/RADIOLOGY PROCEDURES, AND WELLNESS/PREVENTION SERVICES. MAHHC STAFFS A TOTAL OF 25 ACUTE MED/SURG BEDS AND 10 ACUTE REHABILITATION BEDS. DURING THE YEAR, THERE WERE 977 INPATIENT DISCHARGES, 1,765 OUTPATIENT SURGERIES, 60,503 OUTPATIENT LAB TESTS, AND 12,664 OUTPATIENT IMAGING PROCEDURES. MAHHC IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING THE PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE AND PEDIATRICS IN WINDSOR AND WOODSTOCK. MAHHC PROVIDES FREE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. FOREGONE CHARGES FURNISHED UNDER MAHHC'S FREE CARE POLICY AMOUNTED TO $615,260 IN FY16. | Desc |
| Total Program Service Expenses | $39,410,710 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 553 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID SANVILLE | PersonNm |
| Phone | 8026746711 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 289 COUNTY ROAD | AddressLine1Txt |
| City | WINDSOR | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05089 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN GILMAN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL NEWBOLD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LYNN PETERSON MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| HON DONNA SWEANEY | ||||||||
| VICE-CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| STEVEN SMITH MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $4,950 | $166,329 | $83,275 | 40.00 | ||
| DONNA VANFLEET | ||||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARIA PADIN MD | ||||||||
| DH REPRESENTATIVE | 1.00 | Yes (X) | $0 | $372,362 | $36,609 | 40.00 | ||
| WILLIAM PALMER MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $190,825 | $138,860 | 40.00 | ||
| VINCENT FUSCA III | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $329,987 | $40,558 | 40.00 | ||
| PATTY O'NEILL | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DEANNA S HOWARD | ||||||||
| DH REPRESENTATIVE | 1.00 | Yes (X) | $0 | $243,489 | $65,131 | 40.00 | ||
| MATTHEW S HOUDE | ||||||||
| DH REPRESENTATIVE | 1.00 | Yes (X) | $0 | $128,834 | $27,300 | 40.00 | ||
| STEVEN D SURGENOR MD | ||||||||
| TRUSETEE | 1.00 | Yes (X) | $0 | $453,904 | $58,338 | 40.00 | ||
| ALAN KEILLER | ||||||||
| DH REPRESENTATIVE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN TANSEY | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GAY LANDSTROM | ||||||||
| INTERIM CEO (EFFECTIVE 6/16/16) | 40.00 | Yes (X) | $0 | $597,242 | $44,071 | Yes (X) | 1.00 | |
| KEVIN DONOVAN | ||||||||
| CEO (THROUGH 6/15/16) | 40.00 | Yes (X) | $6,600 | $308,276 | $59,784 | Yes (X) | 1.00 | |
| SHELLEY SEWARD | ||||||||
| CHAIR (UNTIL FEB 2016) | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DAVID SANVILLE | ||||||||
| CFO | 32.00 | $154,100 | $0 | $18,619 | Yes (X) | |||
| CHRISTOPHER CONNOR | ||||||||
| PHYSICIAN | 40.00 | $319,196 | $0 | $9,532 | Yes (X) | |||
| HEIDI CRUZ | ||||||||
| PHYSICIAN | 40.00 | $228,267 | $0 | $24,467 | Yes (X) | |||
| ANDREW ROBINSON | ||||||||
| PHYSICIAN | 40.00 | $262,491 | $0 | $25,822 | Yes (X) | |||
| JOSEPH PERRAS | ||||||||
| PHYSICIAN | 40.00 | $269,686 | $0 | $24,467 | Yes (X) | |||
| PETER RAUERT | ||||||||
| PHYSICIAN | 40.00 | $321,358 | $0 | $12,941 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,566,648 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,791,248 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $669,774 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DEW CONSTRUCTION CORP | |||||
| 277 BLAIR PARK RD | WILLISTON | VT | 05495 | CONSTRUCTION | $4,328,115 |
| MARY HITCHCOCK MEMORIAL HOSPITAL | |||||
| ONE MEDICAL DRIVE | LEBANON | NH | 03756 | PROFESSIONAL AND PHYSICIAN SERVICES | $1,707,789 |
| EMERGENCY SERVICES OF NEW ENGLAND | |||||
| PO BOX 12 | CHESTER | VT | 05143 | PHYSICIAN ASST FOR EMERGENCY ROOM | $1,464,649 |
| SODEXO INC & AFFILIATES | |||||
| PO BOX 360170 | PITTSBURGH | PA | 15251 | MNGMT & SUPPORT STAFF - ENVMMNTL SRVS | $686,929 |
| DARTMOUTH-HITCHCOCK CLINIC | |||||
| ONE MEDICAL DRIVE | LEBANON | NH | 03756 | PROFESSIONAL AND PHYSICIAN SERVICES | $678,851 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $27,577 | FundraisingAmt |
| Government Grants | $556,032 | GovernmentGrantsAmt |
| All Other Contributions | $464,919 | AllOtherContributionsAmt |
| Noncash Contributions | $63,196 | NoncashContributionsAmt |
| Total Contributions | $1,048,528 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621110 | $87,851,070 | $87,851,070 |
| PROGRAM & MISC OTHER | 621110 | $2,553,705 | $2,553,705 |
| DSH/VAHHS REVENUE | 621110 | $187,766 | $187,766 |
| PROVISION FOR DOUBTFUL ACCOUNTS | 621110 | -$1,301,630 | -$1,301,630 |
| CONTRACTUAL ALLOWANCES | 621110 | -$40,334,930 | -$40,334,930 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $48,955,981 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $289,171 | TotalRevenueColumnAmt |
| Exclusion | $289,171 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,748 | 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 | $30,748 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,748 | TotalRevenueColumnAmt |
| Exclusion | $30,748 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,481,266 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $7,189 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,481,266 | SecuritiesAmt |
| Other | -$7,189 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,474,077 | TotalRevenueColumnAmt |
| Exclusion | $1,474,077 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $41,778 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $27,577 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $24,919 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,859 | TotalRevenueColumnAmt |
| Exclusion | $16,859 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EQUITY IN INCOME OF SUBSIDIARIES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $173,525 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $173,525 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $173,525 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,988,889 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,129,506 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,810,855 | 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 | $210,835 | TotalAmt |
| Program Services | $28,480 | ProgramServicesAmt |
| Management And General | $182,355 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,223,189 | TotalAmt |
| Program Services | $19,851,384 | ProgramServicesAmt |
| Management And General | $3,232,441 | ManagementAndGeneralAmt |
| Fundraising | $139,364 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $556,484 | TotalAmt |
| Program Services | $400,835 | ProgramServicesAmt |
| Management And General | $152,978 | ManagementAndGeneralAmt |
| Fundraising | $2,671 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,613,591 | TotalAmt |
| Program Services | $3,090,870 | ProgramServicesAmt |
| Management And General | $514,750 | ManagementAndGeneralAmt |
| Fundraising | $7,971 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,649,834 | TotalAmt |
| Program Services | $1,188,375 | ProgramServicesAmt |
| Management And General | $453,539 | ManagementAndGeneralAmt |
| Fundraising | $7,920 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,163 | TotalAmt |
| Management And General | $63,163 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,450 | TotalAmt |
| Management And General | $46,450 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,849,937 | TotalAmt |
| Program Services | $5,666,389 | ProgramServicesAmt |
| Management And General | $2,169,392 | ManagementAndGeneralAmt |
| Fundraising | $14,156 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,480 | TotalAmt |
| Program Services | $10,679 | ProgramServicesAmt |
| Management And General | $51,812 | ManagementAndGeneralAmt |
| Fundraising | $14,989 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,238 | TotalAmt |
| Program Services | $42,228 | ProgramServicesAmt |
| Management And General | $14,372 | ManagementAndGeneralAmt |
| Fundraising | $638 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $868,493 | TotalAmt |
| Program Services | $179,194 | ProgramServicesAmt |
| Management And General | $684,494 | ManagementAndGeneralAmt |
| Fundraising | $4,805 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $609,327 | TotalAmt |
| Program Services | $581,923 | ProgramServicesAmt |
| Management And General | $27,404 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,131 | TotalAmt |
| Program Services | $53,163 | ProgramServicesAmt |
| Management And General | $27,961 | ManagementAndGeneralAmt |
| Fundraising | $7 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $437,532 | TotalAmt |
| Management And General | $437,532 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,124,980 | TotalAmt |
| Program Services | $2,124,980 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $715,485 | TotalAmt |
| Program Services | $462,684 | ProgramServicesAmt |
| Management And General | $250,350 | ManagementAndGeneralAmt |
| Fundraising | $2,451 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $3,631,905 | $3,467,785 | $153,354 | $10,766 |
| DUES/FEES/TAXES | $2,174,539 | $1,814,365 | $357,529 | $2,645 |
| UTILITIES | $719,271 | $45,301 | $673,970 | |
| FOOD EXPENSE | $300,618 | $4,152 | $296,466 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $595,062 | TotalAmt |
| Program Services | $397,923 | ProgramServicesAmt |
| Management And General | $189,814 | ManagementAndGeneralAmt |
| Fundraising | $7,325 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,606,544 | TotalAmt |
| Program Services | $39,410,710 | ProgramServicesAmt |
| Management And General | $9,980,126 | ManagementAndGeneralAmt |
| Fundraising | $215,708 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,667,684 | BOYAmt |
| EOY | $3,472,557 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $171,112 | BOYAmt |
| EOY | $171,778 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,293,424 | BOYAmt |
| EOY | $993,244 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,602,572 | BOYAmt |
| EOY | $5,368,536 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $469,956 | BOYAmt |
| EOY | $549,408 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,918 | BOYAmt |
| EOY | $325,675 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $44,413,027 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,680,451 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,480,431 | BOYAmt |
| EOY | $17,732,576 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,645,892 | BOYAmt |
| EOY | $13,735,024 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,885,626 | BOYAmt |
| EOY | $1,830,928 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,306,277 | BOYAmt |
| EOY | $2,583,826 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,798,892 | BOYAmt |
| EOY | $46,763,552 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,881,986 | BOYAmt |
| EOY | $4,180,684 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,796,357 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,267,740 | BOYAmt |
| EOY | $278,460 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,309,661 | BOYAmt |
| EOY | $22,529,812 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,255,744 | BOYAmt |
| EOY | $26,988,956 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,126,913 | BOYAmt |
| EOY | $12,429,466 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,638,019 | BOYAmt |
| EOY | $1,495,059 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,778,216 | BOYAmt |
| EOY | $5,850,071 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,543,148 | BOYAmt |
| EOY | $19,774,596 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,798,892 | BOYAmt |
| EOY | $46,763,552 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,382,345 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$656,894 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$494,003 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $11,575 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $11,575 | 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 HOSPITAL PAID $10,884 IN THE FORM OF DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (VAHHS). VAHHS IS A MEMBER-OWNED ORGANIZATION DEVOTED TO IMPROVING THE HEALTH STATUS OF COMMUNITIES THROUGHOUT VERMONT THROUGH ACTIVITIES WHICH INCLUDE ADVOCACY, POLICY DEVELOPMENT, EDUCATION AND RESEARCH. THE HOSPITAL ALSO PAID $691 IN THE FORM OF DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA). | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,431,980 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $420,076 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $184,485 | OtherExpendituresAmt |
| End Year Balance | $4,667,571 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,759,330 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$30,485 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $296,865 | OtherExpendituresAmt |
| End Year Balance | $4,431,980 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,645,093 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $312,380 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $198,143 | OtherExpendituresAmt |
| End Year Balance | $4,759,330 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,536,888 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $298,805 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $190,600 | OtherExpendituresAmt |
| End Year Balance | $4,645,093 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,362,400 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $174,488 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,536,888 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.90380 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.09620 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $410,000 | OtherCostOrOtherBasisAmt |
| Book Value | $410,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,762,365 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,021,980 | DepreciationAmt |
| Book Value | $8,740,385 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,873,502 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,443,879 | DepreciationAmt |
| Book Value | $2,429,623 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,367,160 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,214,592 | DepreciationAmt |
| Book Value | $6,152,568 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,732,576 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEFERRED FINANCING COST, NET | $136,421 |
| RENTAL DEPOSITS | $5,560 |
| EQUITY IN SUBSIDIARY | $2,286,190 |
| OTHER RECEIVABLES | $155,655 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,583,826 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| OTHER CURRENT LIABILITIES | $1,219,142 |
| EST. SETTLEMENTS W/ 3RD PARTY PAYORS | $824,244 |
| POST RETIREMENT BENEFIT OBLIGATION | $7,195,882 |
| MARY HITCHCOCK MEMORIAL HOSPITAL (RELATED) LINE OF CREDIT | $1,550,000 |
| MARY HITCHCOCK MEMORIAL HOSPITAL (RELATED) NOTE PAYABLE | $10,970,000 |
| DARTMOUTH-HITCHCOCK CLINIC (RELATED) ACCOUNTS PAYABLE | $760,033 |
| MARY HITCHCOCK MEMORIAL HOSPITAL (RELATED) ACCOUNTS PAYABLE | $10,511 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $22,529,812 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $50,816,462 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$656,894 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$494,002 | OtherRevenueAmt |
| Revenue Not Reported | -$1,150,896 | RevenueNotReportedAmt |
| Revenue Subtotal | $51,967,358 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $46,450 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$24,919 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $21,531 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $51,988,889 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $49,585,014 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $24,920 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $24,920 | ExpensesNotReportedAmt |
| Expenses Subtotal | $49,560,094 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $46,450 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $46,450 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $49,606,544 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | IN GENERAL, THE AMOUNT OF THE ORIGINAL GIFT AND ANY REQUIRED ACCUMULATIONS BY THE DONOR ARE NOT EXPENDABLE. HOWEVER, THE MARKET VALUE OF THE FUND MAY FALL BELOW THAT AMOUNT DEPENDING ON CURRENT FINANCIAL CONDITIONS IN THE UNDERLYING INVESTMENTS. UNDER THE POLICY OF THE HOSPITAL, THE ENDOWMENT ASSETS ARE INVESTED MODERATELY WITH THE INTENT OF PROVIDING A PREDICTABLE STREAM OF FUNDING TO THE HOSPITAL. THE HOSPITAL INVESTS IN EQUITY FUNDS, BOND FUNDS AND MONEY MARKET INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN LIMITED RISK CONSTRAINTS. ACTUAL RETURNS IN ANY YEAR MAY VARY FROM BUDGETED AMOUNTS DUE TO MARKET FLUCTUATIONS. |
| PART X, LINE 2: | ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ADDRESSES THE ACCOUNTING UNCERTAINTY OF INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF "MORE-LIKELY-THAN-NOT" FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON MEASUREMENT CLASSIFICATION, INTEREST AND PENALTIES AND DISCLOSURE. THE ORGANIZATION HAS DETERMINED THAT THE PROVISIONS OF SUBTOPIC 740-10 DO NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATIONS FOR FISCAL YEARS PRIOR TO 2013. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN FAIR VALUE ON INTEREST RATE SWAP 168,362. CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST-RETIREMENT PLANS -662,363. ROUNDING -1. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES -24,919. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | ROUNDING 1. FUNDRAISING EXPENSES 24,919. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $69,355 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $27,577 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $41,778 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $3,405 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $7,152 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $7,960 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $6,402 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $69,355 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $27,577 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $41,778 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $3,405 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $7,152 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $7,960 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,402 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $24,919 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $16,859 | NetIncomeSummaryAmt |
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 | 225.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $278,858 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $278,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,274,994 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,080,450 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,194,544 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08460 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,553,852 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,080,450 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,473,402 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09020 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $294,193 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $294,193 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00590 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,565 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,565 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,678,134 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,375,284 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,302,850 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10690 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,950 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,950 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,026,842 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,375,284 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,651,558 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,580,694 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,455,734 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,124,960 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.20410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $615,260 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $20,370,474 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $20,185,183 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $185,291 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINDSOR HOSPITAL CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 289 COUNTY ROAD | AddressLine1Txt |
| City | WINDSOR | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05089 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISTINCT PART REHAB UNIT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINDSOR HOSPITAL CORPORATION | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SCHEDULE O | 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 | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SCHEDULE O | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 225.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SCHEDULE O | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SCHEDULE O | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WINDSOR HOSPITAL CORPORATION | PART V, SECTION B, LINE 5: METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE MT. ASCUTNEY HOSPITAL SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. AT THE BEGINNING OF THE SURVEY, RESPONDENTS WERE ASKED TO INDICATE THE REGION THEY PRIMARILY SERVE OR ARE MOST FAMILIAR WITH. A TOTAL OF 33 KEY STAKEHOLDER RESPONDENTS INDICATED THAT THEIR RESPONSES WERE REFLECTIVE OF THE GREATER WINDSOR SERVICE AREA. RESPONDENTS REPRESENTED THE FOLLOWING SECTORS: HUMAN SERVICE/SOCIAL SERVICE 21% MENTAL /BEHAVIORAL HEALTH 3% HOME HEALTH CARE 6% PRIMARY HEALTH CARE 12% MEDICAL SUBSPECIALTY 6% PUBLIC SAFETY/FIRE 3% EMERGENCY MEDICAL SERVICES 3% EDUCATION/YOUTH SERVICES 6% MUNICIPAL/COUNTY GOVERNMENT 6% COMMUNITY MEMBER/VOLUNTEER 6% |
| WINDSOR HOSPITAL CORPORATION | PART V, SECTION B, LINE 6A: OTHER FACILITIES WERE DARTMOUTH HITCHCOCK MEDICAL CENTER, ALICE PECK DAY MEMORIAL HOSPITAL, NEW LONDON HOSPITAL AND VALLEY REGIONAL HOSPITAL. |
| WINDSOR HOSPITAL CORPORATION | PART V, SECTION B, LINE 7D: A BENEFIT REPORT WAS PREPARED AND MADE AVAILABLE AND DISTRIBUTED THROUGH 5 COMMUNITY PRESENTATIONS, CONDUCTED BY THE COMMUNITY BENEFIT STAFF, AS WELL AS A THOROUGH PRESENTATION MADE TO THE HOSPITAL'S BOARD OF TRUSTEES. THE MT. ASCUTNEY COMMUNITY HEALTH FOUNDATION AND COMMITTEE, AS WELL AS THE WINDSOR AREA COMMUNITY PARTNERSHIP, PARTICIPATED IN THE DISTRIBUTION OF THE REPORT. THE CHNA AND ALL INFORMATION IN THE NEEDS ASSESSMENT IS AVAILABLE FOR STAKEHOLDERS. THE CHNA IS ALSO AVAILABLE VIA PAPER COPY FOR PUBLIC INSPECTION UPON REQUEST AT THE HOSPITAL'S MAIN INFORMATION DESK. IT IS ALSO AVAILABLE PROMINENTLY ON THE HOSPITAL'S OPENING/HOME WEBPAGE. WWW.MTASCUTNEYHOSPITAL.ORG. |
| WINDSOR HOSPITAL CORPORATION | PART V, SECTION B, LINE 11: COMMUNITY HEALTH ISSUES HAVE BEEN DETERMINED TO BE THE FOLLOWING 11 HEALTH NEEDS AND THE FOLLOWING ACTIONS HAVE BEEN ACHIEVED IN 2016 AS PART OF OUR IMPLEMENTATION PLAN.1. ALCOHOL AND DRUG MISUSE INCLUDING HEROIN AND USE OF PAIN MEDICATIONSA) INITIATED REVISIONS TO THE CONSUMER GUIDE FOR SUBSTANCE USE TREATMENTB) FORMED A TASK FORCE TO PROMOTE MORE TIMELY ACCESS TO TREATMENT SERVICESC) MEDICATION ASSISTED THERAPY, COUNSELING AND SUPPORT FOR ADDICTED MOMS IS OFFERED THROUGH THE PEDIATRIC CLINICD) PARTNERSHIP WITH BLUE CROSS BLUE SHIELD TO PROVIDE SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) TRAINING FOR SUBSTANCE USE THROUGHOUT THE CLINIC AND EDE) FORMATION OF THE MULTIDISCIPLINARY FUNCTIONAL RECOVERY TEAM AND CONSULT SERVICE FOR CHRONIC PAIN PATIENTSF) CARE MANAGEMENT PROVIDED THROUGH THE CHT AND SPOKE STAFFG) A PLETHORA OF EDUCATION AND PREVENTION INITIATIVES INCLUDING "BE AWARE DON'T SHARE," "MOST DANGEROUS LEFTOVERS," "DRUG TAKE BACK," PROM AND GRAD SEASON EDUCATION, RETAILER COMPLIANCE RECOGNITION, WORK WITH VERMONT LEAGUE OF CITIES AND TOWNS AND REGIONAL PLANNING BOARDS REGARDING EDUCATION ON THE IMPACT OF MARIJUANA LEGALIZATION2. ACCESS TO MENTAL HEALTHA) REVISION OF BROCHURE OF LOCAL MENTAL HEALTH COUNSELORSB) WRAP WORKSHOPSC) COMPLETED AGREEMENT TO EMBED MASTERS LEVEL CLINICIANS IN PEDIATRIC CLINICS OF MAHHC AND OHC, IN ADDITION TO THE ALREADY FUNCTIONING HCRS CLINICIAN IN THE ADULT CLINICD) PARTNERSHIP IN INTERAGENCY CARE MANAGEMENT, PATCH AND THE WINDSOR DRUG TASK FORCE WITH HCRS3. ACCESS TO DENTAL CAREA) DENTAL CLINIC PROVIDED IN WINDSOR ELEMENTARY SCHOOL MAY 10-19, 2016, AND NEW GRANT FROM NORTHEAST DELTA DENTAL RECEIVED FOR 2017 CLINICB) APPLICATION OF FLUORIDE IN PEDIATRIC CLINICSC) OUTREACH TO RECRUIT A LOCAL DENTISTD) DENTAL VOUCHERS FOR CARE THROUGH WINDSOR COMMUNITY HEALTH CLINIC4. ACCESS TO AFFORDABLE HEALTH INSURANCE, COST OF PRESCRIPTION DRUGSA) WINDSOR/WOODSTOCK NAVIGATOR PROGRAM AND WINDSOR COMMUNITY HEALTH CLINIC ASSISTANTS WITH VERMONT HEALTH CONNECT, AND MEDICARE AND MEDICAID APPLICATIONSB) CFO COMMUNICATION WITH VERMONT HEALTH CONNECT AND GREEN MOUNTAIN CARE BOARD C) MEDICARE BOOT CAMPS PROVIDED IN BOTH WINDSOR AND WOODSTOCK5. NUTRITION/ACCESS TO AFFORDABLE FOODA) MEMBERSHIP IN THE UPPER VALLEY HUNGER COUNCILB) WORK WITH THE SCHOOL AND WINDSOR FOOD SHELF TO PROVIDE SUMMER FOOD PROGRAMC) PROMOTION OF CASH CROP PROGRAM AND FARMERS MARKET COUPONSD) PROMOTION OF VEGETABLE INTAKE THROUGH PRODUCT FOR VEGETABLE SAUCES AND SPICESE) SUMMER FOOD DRIVE FOR THE FOOD SHELFF) STRATEGIC PLANNING FOR 3-4-506. LACK OF PHYSICAL ACTIVITY, NEED FOR RECREATIONAL OPPORTUNITIES AND ACTIVE LIVINGA) HEALTH IN PLANNING IMPLEMENTATION GUIDE INCLUDES PHYSICAL ACTIVITYB) STRATEGIC PLANNING FOR 3-4-507. INCOME, POVERTY AND FAMILY STRESSA) PATCH SERVICES AT THE WINDSOR CONNECTION RESOURCE CENTER FROM OCTOBER 2015 THROUGH AUGUST 2016 INCLUDE 183 VISITS FOR ECONOMIC SERVICES, 836 VISITS FOR MENTAL HEALTH COUNSELING AND 16 VISITS FOR EMPLOYMENT COUNSELINGB) TWO PARENT-TO-PARENT COLLABORATIVE PROBLEM-SOLVING PROGRAMS HAVE BEEN COMPLETED WITH THE THIRD PROGRAM TO BEGIN IN OCTOBERC) A FAMILY WELLNESS PROGRAM HAS BEEN EMBEDDED IN THE PEDIATRIC CLINIC BASED ON THE RESEARCH EFFECTIVE VERMONT FAMILY-BASED APPROACH PROGRAM AFTER RECEIPT OF GRANT FUNDING AND CONSULTATION AND TRAINING WITH DR. HUDZIAK AND HIS STAFF8. ACCESS TO TRANSPORTATIONA) PARTICIPATING IN REGIONAL TRANSPORTATION COALITIONB) VOLUNTEERS IN ACTION PROVISION OF RIDESC) USE OF TRANSPORTATION VOUCHERSD) SUCCESSFUL RECEIPT OF RIDES TO WELLNESS DEMONSTRATION AND INNOVATION COORDINATED ACCESS AND MOBILITY PROGRAM9. ACCESS TO PRIMARY HEALTH CAREA) INITIATION OF TEAM-BASED CARE MODEL ON APRIL 25, 2016B) IN 2016 PATIENT CENTERED MEDICAL HOME RECEIVED A SCORE OF 73.8 IN RESPONSE TO THE QUESTION GOT APPOINTMENT FOR CHECKUPS/ROUTINE CARE WHEN NEEDED COMPARED TO THE NRC AVERAGE OF 71.3 AND RECEIVED A SCORE OF 74 IN RESPONSE TO THE QUESTION GOT URGENT CARE WHEN NEEDED COMPARED TO THE NRC AVERAGE OF 67.110. HEALTH CARE FOR SENIORSA) INTERAGENCY CARE MANAGEMENT IN PARTNERSHIP WITH SENIOR SOLUTIONSB) PARTICIPATION IN GERIATRIC WORKFORCE ENHANCEMENT PROGRAM AT BOTH MAHHC AND OHC11. TOBACCO USE/SMOKINGA) REGULAR CESSATION GROUPS AND 1:1 COUNSELING HAS BEEN PROVIDEDB) PREVENTION ACTIVITIES TO DECREASE TOBACCO ADVERTISINGC) STRATEGIC PLANNING FOR 3-4-50D) COMMUNITY EDUCATION ABOUT THE IMPACT OF VAPING PROVIDED |
| WINDSOR HOSPITAL CORPORATION | PART V, SECTION B, LINE 13H: MAHHC APPLIES A DISCOUNT TO THE FAP ELIGIBLE PATIENT'S GROSS CHARGES TO ALL BALANCES WHERE THERE IS NO INSURANCE, OR TO MEDICALLY NECESSARY SERVICES PROCESSED BY INSURANCE CARRIERS RESULTING IN A BALANCE, WHICH THE PATIENT IS EXPECTED TO PAY. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | PART I, LINE 7. A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. A COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENTS SEGMENTS. A COST-TO-CHARGE RATIO WAS USED. |
| PART I, LINE 7G: | PART I, LINE 7G. PHYSICIAN CLINIC COSTS INCLUDED WITHIN SUBSIDIZED HEALTH SERVICES ARE $5,302,850 OF THE TOTAL COMMUNITY BENEFIT EXPENSES AND $10,375,284 OF THE DIRECT OFFSETTING REVENUE. |
| PART III, LINE 2: | BAD DEBT EXPENSE IS DERIVED FROM THE WRITE OFF OF PATIENT ACCOUNTS AFTER THEY HAVE BEEN SENT 4 STATEMENTS OVER A COURSE OF 120 DAYS. ALSO, BAD DEBT EXPENSE CONTAINS ESTIMATES FOR FUTURE WRITE-OFFS BASED ON MANAGEMENT'S JUDGEMENTS AND FINANCIAL MODELS. |
| PART III, LINE 4: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. BALANCES STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE PROVISION FOR DOUBTFUL ACCOUNTS AND A CREDIT TO ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR DOUBTFUL ACCOUNTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR DOUBTFUL ACCOUNTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR DOUBTFUL ACCOUNTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACTUAL WRITE-OFFS ARE CHARGED AGAINST THE PROVISION FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | PART III, LINE 8. THE SHORTFALL REPRESENTS THE PPS REIMBURSEMENT DIFFERENCE ON THE REHAB UNITS. SINCE THE REIMBURSEMENT DOES NOT COVER THE COSTS OF THESE UNITS, A SUBSIDY IS CREATED. BECAUSE THE HOSPITAL DETERMINED THAT THESE SERVICES ARE IMPORTANT TO OUR SERVICE AREA, THE HOSPITAL COVERS THE SUBSIDY. THE COSTING METHODOLOGY USED ABOVE WAS THE COST TO CHARGE RATIO. |
| PART III, LINE 9B: | PART III, LINE 9B. MAHHC'S COLLECTION POLICY AND CHARITABLE CARE POLICIES ARE CONSISTENTLY APPLIED TO ALL PATIENTS. OUR COLLECTION POLICY APPLIES TO ANY BALANCE OWED BY THE PATIENT WHETHER IT IS A BALANCE AFTER INSURANCE, A BALANCE WITH NO INSURANCE, OR A BALANCE AFTER AN ADJUSTMENT FOR PARTIAL CHARITABLE CARE. STATEMENTS, CREDIT REPORTING, COLLECTION EFFORTS, AND WRITE-OFF CRITERIA ARE THE SAME FOR ALL LIKE BALANCES, REGARDLESS OF THE REASON FOR THE BALANCE AND REGARDLESS OF WHETHER IT IS A BALANCE AFTER CHARITABLE CARE OR NOT. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE THE APPROPRIATE ADJUSTMENT ON THEIR BILL. IF A BALANCE REMAINS AFTER THAT ADJUSTMENT, THEY ARE BILLED ACCORDING TO THE COLLECTION POLICY, FOR THE REMAINDER. |
| PART VI, LINE 2: | THE NEEDS OF THE COMMUNITY, BEYOND THE COMMUNITY HEALTH NEEDS ASSESSMENT, ARE ASSESSED THROUGH ONGOING REVIEW OF HEALTH INDICATORS SUCH AS THE YOUTH RISK BEHAVIOR SURVEY AND BRFSS. HOWEVER, EACH OF THE COMMUNITY SELF-MANAGEMENT PROGRAMS AND WELLNESS SESSIONS ARE EVALUATED AND FEEDBACK IS INCORPORATED IN THE DEVELOPMENT OF FUTURE SESSIONS. ALSO, ONECARE VT (ACCOUNTABLE CARE ORGANIZATION) PROVIDES THE HOSPITAL WITH OUTCOMES DATA (SUCH AS COPD, USE OF HOSPICE, FREQUENT ADMISSIONS TO EMERGENCY ROOM) WHERE THE HOSPITAL CAN EVALUATE PROGRAMING AND QUALITY. THE HOSPITAL ALSO HAS A COMMUNITY HEALTH TEAM EMBEDDED IN OUR AMBULATORY CARE CLINICS WHO RESPOND TO THE NEEDS OF REFERRED INDIVIDUALS THE HOSPITAL LEADS THE WINDSOR HSA COORDINATED CARE COMMITTEE WHICH IS A PARTNERSHIP OF REGIONAL HEALTH AND HUMAN SERVICES AGENCIES. THE CHARTER OF THIS GROUP IS TO IMPROVE THE QUALITY OF CARE, PATIENT SATISFACTION AND COSTS OF CARE AS SUCH WE REPORT AND RESPOND TO QUALITY OUTCOMES MEASURES OF NEED. |
| PART VI, LINE 3: | WINDSOR COMMUNITY HEALTH CLINIC (A DEPARTMENT WITHIN THE HOSPITAL) PROVIDES INFORMATION AND ONE-ON-ONE ASSISTANCE WITH ANY INDIVIDUAL THAT IS IDENTIFIED WITHOUT INSURANCE. THIS BEGINS AT THE TIME THAT A PATIENT PRESENTS FOR THEIR HEALTH CARE APPOINTMENT; THE REGISTRATION STAFF MAKE THE INTRODUCTION AND PROVIDE INFORMATION TO THE PATIENT ON THE SERVICES. ALSO, A REFERRAL FROM THE PHYSICIAN/PROVIDER MAY DIRECT A PATIENT TO THIS DEPARTMENT. THE STAFF OF THIS DEPARTMENT ASSIST PATIENTS IN APPLYING FOR HEALTH INSURANCE, WHETHER ON THE COMMERCIAL "EXCHANGE", OR IN GOVERNMENTAL INSURERS. THEY ALSO PROVIDE INFORMATION ON AND THE APPLICATION FOR FINANCIAL ASSISTANCE; OFTEN TIME, ASSISTING PATIENTS WITH COMPLETING THE APPLICATION. THIS IS A DEDICATED STAFF THAT IS ON SITE DURING THE NORMAL BUSINESS HOURS WHEN THE MAJORITY OF PATIENTS WOULD BE SEEKING CARE. |
| PART VI, LINE 4: | MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, HARTLAND, WOODSTOCK, SPRINGFIELD, WEATHERSFIELD, BROWNSVILLE, VT AND CORNISH, AND CLAREMONT, NH. MAHHC IS THE LARGEST EMPLOYER IN THE TOWN OF WINDSOR, WITH MANY OF ITS RESIDENTS HAVING LOWER THAN AVERAGE PAYING JOBS AND STRUGGLE WITH FINANCIAL STABILITY; INCLUDING TRANSPORTATION DIFFICULTIES. |
| PART VI, LINE 5: | MAHHC HAS ESTABLISHED A DIRECTOR OF COMMUNITY HEALTH, A COMMUNITY HEALTH COMMITTEE WHICH IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES AND COMMUNITY HEALTH OUTREACH DEPT. OUR STAFF ORGANIZES AND LEADS THE MT. ASCUTNEY PREVENTION PARTNERSHIP WHOSE ROLE IS TO IMPLEMENT HEALTH PROMOTION AND PREVENTION PROGRAM FOR HIGH RISK BEHAVIORS SUCH AS ALCOHOL, TOBACCO, AND DRUG ABUSE. WE PROMOTE EXERCISE AND NUTRITION PROGRAMS AS WELL AS ENVIRONMENTAL STRATEGIES TO REDUCE AND PREVENT HIGH RISK BEHAVIOR. WE LEAD THE FOLLOWING COMMUNITY PARTNERSHIPS THAT SERVE AS VEHICLES OF HEALTH PROMOTION; WINDSOR AREA COMMUNITY PARTNERSHIP, WINDSOR PATCH TEAM, BLUEPRINT EXTENDED TEAM, WINDSOR HSA COORDINATION CARE COMMITTEE AND WINDSOR AREA DRUG TASK FORCE. MISSION STATEMENTS ARE AVAILABLE PER REQUEST. |
| PART VI, LINE 6: | THE HOSPITAL COMMUNITY BENEFIT STAFF IS AN ACTIVE PARTICIPANT IN REGIONAL COMMUNITY HEALTH COMMITTEE, WHICH IS LEAD AND ORGANIZED BY DARTMOUTH-HITCHCOCK. THE HOSPITAL IS AFFILIATED, FORMALLY, WITH DARTMOUTH-HITCHCOCK. AS ARE OTHER LOCAL HOSPITALS, ALICE PECK DAY MEMORIAL HOSPITAL AND NEW LONDON HOSPITAL. VALLEY REGIONAL HOSPITAL IS ALSO PART OF THE REGIONAL COMMUNITY HEALTH COMMITTEE. THE PARTICIPANTS COLLABORATE, COMPARE SOLUTIONS AND OFFER SUPPORT TO EACH OTHER AS ALL ARE SERVING OVERLAPPING SERVICE AREAS. |
| PART VI, LINE 7: | THERE IS NO STATE OF VERMONT REQUIREMENT TO FILE THE COMMUNITY BENEFIT REPORT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN SMITH MD | ||||||||||||||
| TRUSTEE | $2,600 | $165,555 | $2,350 | $0 | $0 | $774 | $0 | $65,725 | $0 | $17,550 | $4,950 | $249,604 | $0 | $0 |
| MARIA PADIN MD | ||||||||||||||
| DH REPRESENTATIVE | $0 | $362,321 | $0 | $0 | $0 | $10,041 | $0 | $18,811 | $0 | $17,798 | $0 | $408,971 | $0 | $0 |
| WILLIAM PALMER MD | ||||||||||||||
| TRUSTEE | $0 | $190,051 | $0 | $0 | $0 | $774 | $0 | $128,733 | $0 | $10,127 | $0 | $329,685 | $0 | $0 |
| VINCENT FUSCA III | ||||||||||||||
| TRUSTEE | $0 | $319,756 | $0 | $0 | $0 | $10,231 | $0 | $39,074 | $0 | $1,484 | $0 | $370,545 | $0 | $0 |
| DEANNA S HOWARD | ||||||||||||||
| DH REPRESENTATIVE | $0 | $241,203 | $0 | $0 | $0 | $2,286 | $0 | $57,260 | $0 | $7,871 | $0 | $308,620 | $0 | $0 |
| MATTHEW S HOUDE | ||||||||||||||
| DH REPRESENTATIVE | $0 | $128,834 | $0 | $0 | $0 | $0 | $0 | $8,150 | $0 | $19,150 | $0 | $156,134 | $0 | $0 |
| STEVEN D SURGENOR MD | ||||||||||||||
| TRUSETEE | $0 | $357,013 | $0 | $75,000 | $0 | $21,891 | $0 | $38,212 | $0 | $20,126 | $0 | $512,242 | $0 | $0 |
| GAY LANDSTROM | ||||||||||||||
| INTERIM CEO (EFFECTIVE 6/16/16) | $0 | $544,531 | $0 | $50,000 | $0 | $2,711 | $0 | $26,823 | $0 | $17,248 | $0 | $641,313 | $0 | $0 |
| KEVIN DONOVAN | ||||||||||||||
| CEO (THROUGH 6/15/16) | $6,600 | $303,563 | $0 | $0 | $0 | $4,713 | $0 | $39,743 | $0 | $20,041 | $6,600 | $368,060 | $0 | $0 |
| DAVID SANVILLE | ||||||||||||||
| CFO | $145,999 | $0 | $7,640 | $0 | $461 | $0 | $0 | $0 | $18,619 | $0 | $172,719 | $0 | $0 | $0 |
| CHRISTOPHER CONNOR | ||||||||||||||
| PHYSICIAN | $318,164 | $0 | $0 | $0 | $1,032 | $0 | $0 | $0 | $9,532 | $0 | $328,728 | $0 | $0 | $0 |
| HEIDI CRUZ | ||||||||||||||
| PHYSICIAN | $227,907 | $0 | $0 | $0 | $360 | $0 | $0 | $0 | $24,467 | $0 | $252,734 | $0 | $0 | $0 |
| ANDREW ROBINSON | ||||||||||||||
| PHYSICIAN | $194,459 | $0 | $67,000 | $0 | $1,032 | $0 | $0 | $0 | $25,822 | $0 | $288,313 | $0 | $0 | $0 |
| JOSEPH PERRAS | ||||||||||||||
| PHYSICIAN | $261,946 | $0 | $7,500 | $0 | $240 | $0 | $0 | $0 | $24,467 | $0 | $294,153 | $0 | $0 | $0 |
| PETER RAUERT | ||||||||||||||
| PHYSICIAN | $320,326 | $0 | $0 | $0 | $1,032 | $0 | $0 | $0 | $12,941 | $0 | $334,299 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO IS PAID BY MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION. |
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION, PAID GAY LANDSTROM $1,211, KEVIN DONOVAN $4,713 AND VINCENT FUSCA $5,587. DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, PAID MARIA PADIN $9,531 AND STEPHEN D SURGENOR $21,453. |
| PART I, LINE 7 | STEVEN SMITH, MD RECEIVED BONUSES WHICH WERE BASED UPON RELATIVE VALUE UNITS (RVU'S). |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 5 | ContributionCnt |
| Noncash Contributions Rpt F990 | $63,196 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (1) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 32B: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL USES TIAA-CREF TO PROCESS AND SELL NON-CASH CONTRIBUTIONS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER IS A PART OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM, WHICH OWNS FOR-PROFIT SUBSIDIARIES THAT PROVIDE SERVICES AND SUPPORT THE MISSION OF THE ORGANIZATION. AS A RESULT, SOME OFFICERS OF THE MAHHC ALSO MAY BE OFFICERS OF FOR-PROFIT ENTITIES WITHIN THE HEALTHCARE SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 6 | DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | DARTMOUTH-HITCHCOCK HEALTH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF MAHHC'S BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER HAS THE RIGHT TO RATIFY MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD; APPROVE THE DISSOLUTION OR LIQUIDATION OF MAHHC; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS. |
| FORM 990, PART VI, SECTION B, LINE 11 | BOARD OF TRUSTEES REVIEWED PRIOR TO FILING, PROVIDED MULTIPLE DAYS TO PROVIDE FEEDBACK AND/OR QUESTIONS AND HOSPITAL THEN FILED AFTER THERE WAS SATISFACTION. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE FINANCE AND AUDIT COMMITTEE MONITOR AND REPORT TO THE BOARD OF DIRECTORS |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE COMMITTEE OF THE BOARD MEETS ANNUALLY TO REVIEW COMPENSATION FOR THE CEO, USING INDEPENDENT SURVEYS OF AREA COMPENSATION FOR EXECUTIVES OF VARIOUS SIZED HOSPITALS. OTHER OFFICERS AND KEY EMPLOYEES SALARIES ARE DETERMINED, BY THE HR DEPARTMENT USING COMPARABLE MARKET DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL INTERNAL POLICIES, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST |
| FORM 990, PART IX, LINE 11G | CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 3,716,103. MANAGEMENT AND GENERAL EXPENSES 611,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,327,188. PROFESSIONAL/CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,950,286. MANAGEMENT AND GENERAL EXPENSES 1,558,307. FUNDRAISING EXPENSES 14,156. TOTAL EXPENSES 3,522,749. |
| FORM 990, PART XI, LINE 9: | CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST RETIREMENT PLANS -662,363. CHANGE IN FAIR VALUE ON INTEREST RATE SWAP 168,362. ROUNDING -2. |
| FORM 990, PART XII, LINE 3B: | THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER. |
| SCHEDULE H, PART V, LINE 7A: | HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/COMMUNITY-SERVICES/ COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS |
| SCHEDULE H, PART V, LINE 10A: | HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/ DOCUMENTS/CHNA%20IMPLEMENTATION%20PLAN%202015-2.PDF |
| SCHEDULE H, PART V, LINE 16A: | HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/ DOCUMENTS/MAH%20FINANCIAL%20ASSISTANCE%20POLICY.PDF |
| SCHEDULE H, PART V, LINE 16B: | HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/ DOCUMENTS/FINANCIAL%20ASSISTANCE%20APPLICATION.PDF |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HISTORIC HOMES OF RUNNEMEDE | |||||||||||
| 289 COUNTY ROAD | WINDSOR | VT | 05089 | 237396147 | PROVIDING SVCS FOR THE AGING | VT | 501(C)(3) | 9 | WINDSOR HOSPITAL CORPORATION | Yes (1) | |
| MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION INC | |||||||||||
| 289 COUNTY ROAD | WINDSOR | VT | 05089 | 030300481 | HEALTH EDUCATION & PROMOTION | VT | 501(C)(3) | 3 | WINDSOR HOSPITAL CORPORATION | Yes (1) | |
| DARTMOUTH-HITCHCOCK MEDICAL CENTER | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 222715483 | SUPPORTING ORG | NH | 501(C)(3) | 11 TYPE I | 0 | N/A | |
| MARY HITCHCOCK MEMORIAL HOSPITAL | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 020222140 | HOSPITAL | NH | 501(C)(3) | 3 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| DARTMOUTH-HITCHCOCK CLINIC | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 222519596 | PHYS SVCS | NH | 501(C)(3) | 9 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| HITCHCOCK FOUNDATION | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 020222139 | HLTHCRE RSRCH | NH | 501(C)(3) | 7 | DARTMOUTH-HITCHCOCK CLINIC | 0 | |
| HAMDEN RISK RETENTION GROUP INC | |||||||||||
| 30 MAIN STREET SUITE 330 | BURLINGTON | VT | 05401 | 208530788 | SELF INS | VT | 501(C)(3) | 11 TYPE I | DARTMOUTH-HITCHCOCK CLINIC | 0 | |
| THE NEW LONDON HOSPITAL ASSOC INC | |||||||||||
| 273 COUNTY ROAD | NEW LONDON | NH | 03257 | 020222171 | HOSPITAL | NH | 501(C)(3) | 3 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| EVERWELL INC | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 352506275 | SUPPORTING ORG | NH | 501(C)(3) | 11 TYPE I | 0 | N/A | |
| VISITING NURSE ASSOCIATION AND HOSPICE OF VT AND NH INC | |||||||||||
| 205 BILLINGS FARM RD NO 5 | WILDER | VT | 05088 | 036006494 | HOME HEALTH & HOSPICE SVCS | VT | 501(C)(3) | 9 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| CHESHIRE MEDICAL CENTER | |||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020354549 | HOSPITAL | NH | 501(C)(3) | 3 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| ALICE PECK DAY MEMORIAL HOSPITAL | |||||||||||
| 10 ALICE PECK DAY DR | LEBANON | NH | 03766 | 020222791 | HOSPITAL | NH | 501(C)(3) | 3 | DARTMOUTH-HITCHCOCK HEALTH | 0 | |
| SURGERY CENTER OF GREATER NASHUA | |||||||||||
| 10 PROSPECT ST NO 101 | NASHUA | NH | 03060 | 461084049 | DAY SURGERY CENTER | NH | 501(C)(3) | 3 | 0 | N/A | |
| CHESHIRE HEALTH FOUNDATION | |||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020202220 | SUPPORTING ORG | NH | 501(C)(3) | 11 TYPE II | CHESHIRE MEDICAL CENTER | 0 | |
| DARTMOUTH-HITCHCOCK HEALTH | |||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 264812335 | PARENT ORG | NH | 501(C)(3) | 9 | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| ONE CARE VT ACOLLC | |||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 455399218 | SHARED SAVING | VT | N/A |
| DH MASTER INVESTMENT PARTNERSHIP | |||||||
| ONE MED CTR DR | LEBANON | NH | 03756 | 020505863 | POOLED INVESTMENT | NH | N/A |
| NEW ENGLAND PHARMACY COLLAB | |||||||
| ONE MED CTR DR | LEBANON | NH | 03756 | 263819035 | GROUP PURCHASING | NH | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IMAGINECARE INC | ||||||||||||||
| 35 CENTERRA PARKWAY | LEBANON | NH | 03766 | 813105071 | SOFTWARE TECHNOLOGY | DE | N/A | C | 0 | |||||
| HITCHCOCK HEALTH CONNECT INC | ||||||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 800908979 | TELEHEALTH | DE | N/A | C | 0 | |||||
| POMPANOOSUC INVESTMENT CORPORATION | ||||||||||||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 020352330 | RL ESTATE HLD | NH | N/A | C | 0 | |||||
| HAMDEN ASSURANCE COMPANY LIMITED | ||||||||||||||
| 980121409 | LIAB INSUR | N/A | C | 0 | CANONS COURT 22 VICTORIA STREET | HAMILTON | HM EX | BD | BD | |||||
| KEARSARGE COMMUNITY SERVICES INC | ||||||||||||||
| 273 COUNTY RD | NEW LONDON | NH | 03257 | 020460136 | REAL EST HLDG | NH | N/A | C | 0 | |||||
| NEW LONDON PHYSICIAN GROUP INC | ||||||||||||||
| 273 COUNTY RD | NEW LONDON | NH | 03257 | 020494420 | PHYSICIAN GROUP | NH | N/A | C | 0 | |||||
| NEW LONDON MEDICAL CENTER EAST INC | ||||||||||||||
| 273 COUNTY RD | NEW LONDON | NH | 03257 | 020480857 | REAL EST HLDG | NH | N/A | C | 0 | |||||
| KEENE HEALTH SERVICES | ||||||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374997 | REAL EST HLDG | NH | N/A | C | 0 | |||||
| KEENE HEALTH REALTY | ||||||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374998 | REAL EST HLDG | NH | N/A | C | 0 | |||||
| KEENE HEALTH ENTERPRISES | ||||||||||||||
| 580 COURT STREET | KEENE | NH | 03431 | 020374999 | REAL EST HLDG | NH | N/A | C | 0 | |||||
| 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 | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||
| E | $10,970,000 | ACTUAL |
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||
| E | $1,550,000 | ACTUAL |
| HISTORIC HOMES OF RUNNEMEDE | ||
| Q | $149,952 | ACTUAL |
| MT ASCUTNEY HOSPITAL HEALTH FOUNDATION | ||
| S | $66,862 | ACTUAL |
| NEW ENGLAND ALLIANCE FOR HEALTH LLC | ||
| P | $540,249 | ACTUAL |
| DARTMOUTH-HITCHCOCK CLINIC | ||
| O | $2,791,000 | ACTUAL |
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||
| P | $81,499 | ACTUAL |