2016-08-11T14:14:02-05:00 2015-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2014-10-01 030177161 Carlos G Otis Health Care Center CARL 8023657920 PO Box 216 Townshend VT 053530216 Stephen A Brown CFO 8023657920 2016-08-09 1 Nicholas E Porto P01310283 2078792100 2016-08-09 2014 2016-12-15 16:53:06Z Grace Cottage Hospital Stephan Morse PO Box 216 Townshend VT 053530216 22199990 0 X www.gracecottage.org X 1949 VT Provision of health care services 10 9 214 107 0 0 381563 990744 20392276 21209060 242 186 0 0 20774081 22199990 0 0 0 0 12261442 13593203 0 0 254824 9449330 9442926 21710772 23036129 -936691 -836139 14414650 14293326 4706173 5454703 9708477 8838623 The Otis Health Care Center promotes excellence in healthcare and well being, putting people first. It aims to be the standard for patient care. 0 0 20798801 0 21209060 Grace Cottage Hospital is a critical access hospital offering 24-hour emergency services, inpatient acute and skilled care, 24-hour diagnostic imaging services, a full-service laboratory, a pharmacy, a variety of outpatient medical care services, including physical therapy, occupational therapy, and speech therapy, and a rural health clinic providing primary care and psychiatric services. 20798801 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 17 0 1 214 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephen A Brown 8023653601 185 Grafton Road Townshend VT 05353 X Alexandra Clark Trustee (eff. 11/14) 1.00 0.00 X 0 0 0 Martha Dale Trustee (eff. 11/14) 1.00 0.00 X 0 0 0 Stanley Holt Trustee (end 11/14) 1.00 0.00 X 0 0 0 John Nopper Trustee 1.00 0.00 X 0 0 0 Cheryl Sanctuary Trustee (eff. 11/14) 1.00 0.00 X 0 0 0 Timothy P Shafer MD Trustee/Family Physician 47.90 0.00 X 289398 0 31671 Allan Shirks Trustee 1.00 0.00 X 0 0 0 Stephan Morse President 1.00 0.00 X X 0 0 0 Deborah Boyle Vice President (end 11/14) 1.00 0.00 X X 0 0 0 Kevin Meyer Treas (end 11/14)/VP (eff. 11/14) 1.00 0.00 X X 0 0 0 Barry Emerson Trustee/Treasurer (eff. 11/14) 1.00 0.00 X X 0 0 0 J Walter Corcoran Secretary 1.00 1.00 X X 0 0 0 Roger Allbee Trustee (end 11/14)/CEO 24.00 1.00 X X 86400 0 0 Stephen A Brown CFO 46.00 0.00 X 194238 0 27901 Maurice Geurts MD Physician 61.20 0.00 X 358851 0 31671 Moss J Linder MD Physician 46.40 0.00 X 282035 0 28489 Ewa Arnold MD Physician 47.90 0.00 X 256263 0 29746 Amalia Lee Physician 34.10 0.00 X 180137 0 11133 Kimona Alin Physician 27.30 0.00 X 174333 0 25424 1821655 0 186035 19 0 1 0 Cerner Corporation PO Box 412702 Kansas City MO 64141 IT Support/Billing Outsourcing 453684 Leaders for Today LLC 981 Worcester Street Suite 1C Wellesley MA 02482 Billing/Medical Records 204657 2 830804 128288 31652 990744 Patient Service Revenue 621400 16548438 16548438 Pharmacy Revenue 446110 4098045 4098045 GCF Administration/Other 621400 268049 268049 Miscellaneous Revenue 621400 162778 162778 Meaningful Use Revenue 621990 131750 131750 21209060 186 186 22199990 21209060 0 186 655461 311458 344003 10087953 9270360 637604 179989 171879 157555 11625 2699 1972921 1776868 160119 35934 704989 632571 62123 10295 31789 31789 82527 82527 858246 783850 74396 216964 14142 200423 2399 650174 440137 194084 15953 742853 651967 88692 2194 270691 263365 7326 144330 128757 10746 4827 3605 3605 135833 105903 29930 1173369 1169349 4020 287249 243618 43097 534 Medical Supplies and La 3479432 3479432 Medicaid Tax 536205 536205 Provision for Bad Debt 529952 529952 Equipment Repair 299707 299707 23036129 20798801 1982504 254824 33632 4739 35506 11182 2382678 2132199 1267839 1444919 215049 139423 15477608 11819079 3880812 3658529 32165 28144 6566969 6874191 14414650 14293326 1490659 2190364 1190000 1065000 1088969 2199339 936545 0 4706173 5454703 X 6634557 5911185 505555 419356 2568365 2508082 9708477 8838623 14414650 14293326 X -836139 -33715 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4407 0 0 0 4407 0 Part II-B, Line 1: Carlos G. Otis Health Care Center is a member of the Vermont Association of Hospitals and Health Systems and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Carlos G. Otis Health Care Center in furtherance of its exempt purpose. Carlos G. Otis Health Care Center does not directly perform any lobbying activities. AHA, portion of dues available for lobbying: $515 VAHHS, portion of dues available for lobbying: $3,892 3073919 -146481 2927438 2642046 451855 19982 3073919 2608707 48373 15034 2642046 2636804 1267 99915 129279 2608707 2443026 186971 25839 19032 2636804 0.13230 0.85670 0.01100 0 1 1 30549 30549 6514053 4715415 1798638 8452940 7040802 1412138 480066 62862 417204 3658529 Beneficial interest in net assets of GCF 6376593 Deposits with Trustee 57346 Meaningful use receivable 123250 Other Receivables 12744 Estimated Third Party Payor Settlements 304258 6874191 X 22166275 0 22166275 33715 33715 22199990 23036129 0 23036129 0 23036129 Part V, Line 4: OHCC uses its endowment funds to assist in the provision of health care. Part X, Line 2: OHCC and the Foundation are tax-exempt corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(a) and had been classified as an organization that is not a private foundation under Section 509(a)(2). Management evaluated the Organization's tax positions and concluded the Organization has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 4b - Other Adjustments: Decrease in Beneficial Interest in Net Assets of GCF 33,715. 1 1 1 X 140.000000000000 1 X 1 1 0 1 1 161558 161558 0.00720 3601658 1376587 2225071 0.09890 3763216 1376587 2386629 0.10610 61537 9068 52469 0.00230 59271 59271 0.00260 120808 9068 111740 0.00490 3884024 1385655 2498369 0.11100 1 432206 125321 10562895 10009497 553398 X 1 1 1 1 Grace Cottage Hospital 185 Grafton Road Townshend VT 05353 www.gracecottage.org 830 X X X X Grace Cottage Hospital 1 0 0 1 X X X X X X X X X 14 1 1 0 1 X See Part V, Section C X 1 14 1 See Part V, Section C 1 0 1 X 140.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X 1 X 0 X X X X 1 X 1 1 Grace Cottage Hospital Part V, Section B, Line 5: As required by Vermont statute and Treasury Regulation 501(r), Grace Cottage Hospital conducts a Community Health Needs Assessment (CNHA) every three years. Our most recent CHNA was done collaboratively in 2015 with Brattleboro Memorial Hospital (BMH) and the Brattleboro Retreat. These three healthcare organizations focused on involving as many stakeholders and community members as possible in the data collection process, which took place from December 2014 to June 2015. Secondary data was collected from multiple sources including: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, Vermont Department of Health, Vermont Department of Labor, Vermont Department of Transportation, Vermont Foodbank, and Vermont Town and County Data Pages. The secondary data was benchmarked against state and national trends, where possible. Primary data was obtained through a consumer survey and a focus group for medically underserved populations. The consumer survey was distributed in both paper copy as well as online. In total, at least 699 surveys were collected for Windham County. The focus group was held to collect qualitative data on at-risk populations. The following medically underserved populations were represented in the focus group:o Elderly/Senior Population o HIV+ Individuals o Homeless Population o LGBTQ (Lesbian, Gay, Bisexual, Transgender and/or Questioning) Individuals o Low Income Population of Migrant/Undocumented Workers o Racial and Ethnic Minority PopulationsThe three hospitals set up a steering committee made up of individuals from the State of Vermont Department of Health, Brattleboro Memorial Hospital, Grace Cottage Hospital, The Brattleboro Retreat, United Way of Windham County, Agency of Human Services, Visiting Nurse Association & Hospice of VT & NH, Valley Cares, West River Valley Assisted Living, and Senior Solutions. Additionally, the participating organizations engaged a wide range of stakeholders through the surveys and focus groups, including health care providers, human service organizations, youth development organizations, schools and other nonprofit organizations. Grace Cottage identified the following as High Priority Significant Health Needs in our service area: Aging, Colon Cancer, Breast Cancer, Diabetes, Heart Disease/High Blood Pressure, and Mental Health.The 2015 Community Health Needs Assessment was adopted by the Grace Cottage Board of Trustees on July 17, 2015 and the Implementation Plan was approved by the Board on August 21, 2015. Grace Cottage Hospital continues to collaborate with BMH and the Brattleboro Retreat to improve community awareness of existing health and wellness programs and services to Windham County residents, which was one of the needs identified in the Community Health Needs Assessment. During fiscal year 2015, the three organizations published a comprehensive Health and Wellness Calendar, distributed county-wide, twice during the year, which included listings of all health and wellness events and classes for the public. In addition, the Wellness in Windham website (www.wellnessinwindham.org) was maintained by the three organizations with updated, current information on classes, programs, and services. Grace Cottage Hospital Part V, Section B, Line 6a: The 2015 Community Health Needs Assessment was conducted with Brattleboro Memorial Hospital and The Brattleboro Retreat. Grace Cottage Hospital Part V, Section B, Line 11: Please see attached Implementation Plan for information on how the Hospital is addressing the significant needs identified in its most recently conducted CHNA.The community hospitals participating in the 2015 CHNA, Grace Cottage Hospital and Brattleboro Memorial Hospital, are not addressing Hepatitis C and Lyme disease at this time as other priority health care conditions have been selected to focus on. The needs identified in the CHNA finalized during fiscal year 2015 have been discussed as part of the Hospital's ongoing strategic planning process. Grace Cottage Hospital Part V, Section B, Line 13b: Generally, Grace Cottage Hospital uses the Federal Poverty Guidelines to determine eligibility for financial assistance. However, applications may be reviewed on a case by case basis and at times financial assistance granted even if a patient is above the prescribed FPG level or qualifies only for a lesser reduction in fees if there is a prevailing circumstance that justifies additional financial support. Grace Cottage Hospital Part V, Section B, Line 20e: Grace Cottage Hospital (GCH) located in rural, mountainous Townshend, VT provides services to patients, whether a community member or vacationer, through our Critical Access Hospital, Rural Health Clinic, and Outpatient Rehabilitation. Taking pride in the community we serve, we make every attempt possible to notify patients of The Reduced Fee Program and Formal Payment Plan options at GCH that will allow patients to receive care without undue hardship. The following are some of the steps currently in place, to notify patients of the available options: - All registration areas of the Critical Access Hospital, Rural Health Clinic, and Outpatient Rehabilitation Services have visible signs on display notifying patients of our Reduced Fee Program. - All registration staff upon verification of no insurance, limited insurance coverage with high patient responsibility portions, or communication from patient indicating difficulty with paying bill, will offer a Reduced Fee Application, Policy, and business card for our Resource Advocate, identifying the many services she provides to patients free of charge and her contact information. Staff will also offer to schedule an appointment for the patient with Resource Advocate for assistance in completing the Reduced Fee Application, troubleshooting issues with insurance, and/or applying for insurance coverage whether it is primary or secondary. - Patients receive at least 5 billing statements over the course of 120 day time frame (patients in a formal payment plan or whom have a billing issue arise may increase the number of statements to be received or increase the number of days to complete the 5 billing statement cycle). Every statement has a message that notifies them of the Reduced Fee Program and steps to take to get started. - Once a patient balance is past due (>30 days from date of first patient billing) Patient Accounts Specialists contact patients via phone in an attempt to alert patient to past due balance, offer a formal payment plan if balance unable to be paid in full. If/when patient indicates difficulty in paying their bill, Patient Accounts Specialists will notify patient of the Reduced Fee Program and offer to mail the application and policy to them. Patient Accounts Specialists note patients account with a briefing of the phone call. If a patient balance is aged >120 days from the date of the first billing statement and a potential to be sent to a third party collections agency the account is reviewed, if there is a note from patient accounts indicating a Reduced Fee application and policy have been mailed to the patient within the last 45 days a hold will be placed on transferring the balance to the third party collections agency. After 45-60 days if no Reduced Fee application or communication from the patient the balance will be transferred to the third party collections agency at that time. - All Reduced Fee applications are processed with required documentation to determine eligibility in accordance with our Sliding Fee Scale based on Federal Poverty Guidelines. If missing required documents, a written request is sent to the patient and application held while awaiting documents. All processed applications are filed, written notice of eligibility is mailed to the patient, eligibility is noted on patient's account and adjustments are made manually after insurance processing and prior to a billing statement being mailed to the patient, and all applications are documented on a yearly spreadsheet showing household members, date of application (eligibility begin date), expiration date, whether they are eligible, percentage they are eligible for, and comments for case by case applications that identifies parameters for this approval/denial ie: only one date of service. Grace Cottage Hospital Part V, Section B, Line 22d: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. If/when a patient is found to be eligible for financial assistance, the charges are discounted appropriately. For fiscal year 2016, Grace Cottage Hospital is moving toward full implementation of the Amount Generally Billed methodology, in compliance with final 501(r) regulations. Grace Cottage Hospital Part V, Section B, Line 23: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. If/when a patient is found to be eligible for financial assistance, the charges are discounted appropriately. For fiscal year 2016, Grace Cottage Hospital is moving toward full implementation of the Amount Generally Billed methodology, in compliance with final 501(r) regulations. Grace Cottage Hospital Part V, Section B, Line 24: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. If/when a patient is found to be eligible for financial assistance, the charges are discounted appropriately. For fiscal year 2016, Grace Cottage Hospital is moving toward full implementation of the Amount Generally Billed methodology, in compliance with final 501(r) regulations. Schedule H, Part V, Section B, Line 7a: The Hospital's 2015 CHNA is available on its website at: http://gracecottage.org/wp-content/uploads/2015/12/2015-Community-Health-Needs-Assessment-Final.pdf Schedule H, Part V, Section B, Line 10a: The Hospital's 2015 Implementation Plan is available on its website at: http://gracecottage.org/wp-content/uploads/2015/12/2015-CHN-Implementation-Plan.pdf Schedule H, Part V, Section B, Line 16a-16c: The Hospital's Financial Assistance Policy is available on its website at: http://gracecottage.org/wp-content/uploads/2015/11/Reduced-Fee-Care-Policy.pdf The Hospital's Financial Assistance Application is available on its website at:http://gracecottage.org/wp-content/uploads/2015/11/Free-or-Reduced-Fee-Care-Application.pdfThe Hospital's Plain Language Summary is available on its website at:http://gracecottage.org/patients-visitors/billing-and-insurance/free-or-reduced-fee-care/ Part V, Section B, Lines 4 and 9: Pursuant to IRS instructions, lines 4 and 9 denote the tax year in which the CHNA and Implementation Strategy were adopted, which is 2014. However, both were adopted in the Hospital's fiscal year 2015. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Grace Cottage Hospital Part V, Section B, line 16a website: See Part V, Section C Grace Cottage Hospital Part V, Section B, line 16b website: See Part V, Section C Grace Cottage Hospital Part V, Section B, line 16c website: See Part V, Section C 2 Messenger Valley Pharmacy 170 Grafton Road Townshend VT 05353 Pharmacy Grace Cottage Family Health 185 Grafton Road Townshend VT 05353 Rural health clinic Part I, Line 3c: N/A Part I, Line 6a: N/A Part I, Line 7: The amounts reported for Charity Care and Means-Tested Government Programs were calculated using a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. Part I, Line 7g: N/A Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 529,952. Part II, Community Building Activities: See previous footnotes. Part III, Line 2: The cost of the bad debt expense reported on line 2 was calculated by applying the ratio of patient care cost-to-charges (calculated on Worksheet 2) to the total bad debt expense. The amount of bad debt expense for accounts written off as bad debt is the account balance after all charity care discounts, contractual allowances, and insurance/patient payments have been applied. Any cash collected on accounts previously written off is included as an offset to bad debt expense. Part III, Line 3: The amount of bad debt expense (at cost) attributable to patients eligible under our charity care policy reported on line 3 was estimated based on a review of Reduced Fee/Free Care Applications. The number of approved completed applications versus the number of incomplete applications was compared and a ratio applied to the Charity Care balance to estimate this number. It is felt that this estimate should actually be much higher because, though we work hard to educate our patients regarding the charity care policy, including having a Resource Advocate to help patients complete them if they require assistance, many of the applications we distribute to patients are not returned. Knowing our patient population as we do, we believe it is primarily attributable to patients not wanting to share the income information. Part III, Line 4: Please see responses above for information regarding costing methodology. Please see Footnote 1 on Page 9 of the attached financial statements for the footnote that addresses bad debt. Part III, Line 8: Medicare allowable costs reported in the Medicare Cost Report are reported in accordance with CMS Guidelines using the cost-to-charge ratio methodology. Part III, Line 9b: Grace Cottage Hospital does not pursue collections actions against patients for amounts qualified for financial assistance. If a patient is unable to pay a balance in full after reduced fees and financial assistance have been applied, the patient is required to setup an acceptable payment plan per the collections policy. Any patient making acceptable monthly payments on their balance will not be at risk for further collections actions and/or forfeiture of their reduced fee care or financial assistance. However, any balance remaining after that discount that goes unpaid as agreed upon will follow the collections actions outlined in the Hospital's collection policy. Failure to resolve the balance in full or any missed payments will result in forfeiture of reduced fees and/or financial assistance, and the patient's account will be placed with a collections agency for further action. Additionally, the patient will not be eligible for reduced fees or financial assistance until a substantial effort is put forth to rectify the outstanding balance. Part VI, Line 2: Grace Cottage Hospital is such a small hospital in a rural, relatively sparsely populated area that our community leaders, patients, and members of the public are quick to inform our administrators and our medical staff about how Grace Cottage serves the healthcare needs of the public. Grace Cottage's small size ensures that we can be responsive to community requests made via our website, e-mails to members of our staff, or informal face-to-face meetings with people in the communities we serve. Part VI, Line 3: Although we are Vermont's smallest Critical Access Hospital, Grace Cottage Hospital believes that quality health care should be available to all; and that we all have a responsibility to help others in need regardless of their ability to pay. Posters and brochures detailing the availability of help with billing, public programs, and charity care are displayed in high traffic areas throughout the Hospital, rural health clinic and pharmacy, as well as listed on the Hospital's website. The staff reaches out to patients in a variety of ways to ensure that they are aware that help is available. During fiscal year 2015, the Hospital employed a Patient Resource Advocate to help uninsured and underinsured patients locate and procure services for which they may qualify. The Patient Resource Advocate's services were free of charge for community members between the ages of 18-64 years (those 65 and older were encouraged to contact Senior Solutions, formerly Southeastern Vermont Council on Aging). The Hospital's Patient Resource Advocate helped many people with a wide variety of resource issues, helping to fill out necessary forms and making connections for patients with other federal, state and local resources. This employee was an expert in filling out reduced fee applications, finding sources for reduced-cost or free prescription medications, and locating other avenues of support. Part VI, Line 4: Grace Cottage Hospital plays a vital role in healthcare for this rural, mountainous community. Its federal designation as a critical access hospital recognizes its importance in providing health care to an otherwise medically underserved community. The Hospital's emergency department is especially vital to members of the community, who would otherwise have to travel many miles on winding, mountainous highways to reach emergency medical care at another hospital. Grace Cottage Hospital is located in Windham County, in southeastern Vermont. According to the U.S. Census Bureau, Windham County has an estimated total of 43,714 residents. Grace Cottage Hospital's patient base is approximately 26,000 residents, mostly from 21 surrounding towns. The median household income of Windham County, Vermont, is $50,234 (U.S. Census Bureau "Quick Facts," updated 2013). Income statistics for the total population served by Grace Cottage Hospital are not available because Grace Cottage only requires income information from patients requesting reduced fees or free care. Part VI, Line 5: Grace Cottage Hospital is a Critical Access Hospital located in rural, mountainous Townshend, Vermont. The Hospital is served by a Board of Trustees consisting of local citizens active in community businesses and organizations. Only one of the ten trustees, a physician, is a hospital employee. All trustees reside in the Hospital's service area and bring a wealth of community input to the Hospital's strategic planning process. The Hospital extends medical staff privileges to all qualified physicians in the community.Grace Cottage Hospital applies any surplus funds towards improving its ability to provide quality patient care and being an integral part of assuring the health and well-being of the communities we serve. For example, in view of the fact that Mental Health was identified as a High Priority Significant Need in our Community Health Needs Assessment, Grace Cottage doubled the size of our behavioral health team during fiscal year 2015. Despite its small size, Grace Cottage Hospital is committed to giving back to the community to the greatest extent possible. Thanks to the Vermont Blueprint for Health, Grace Cottage's Community Health Team has been able to provide free consultations, open to everyone in the community served by Grace Cottage. Members of the Community Health Team, including a registered nurse, health coach, diabetes educator, and a behavioral health specialist work with patients one-on-one, conduct support groups, and also attend area senior lunches and provide screenings at area organizations (such as Neighborhood Connections). In addition, the Community Health Team interacts with another Vermont Blueprint for Health program, SASH (Support and Services at Home), and provides, free of charge, the infrastructure required for the SASH coordinator in this area (office space, supplies, equipment). Grace Cottage Hospital is a very active partner in numerous community collaborations and programs, including (but not limited to):- West River Valley Thrives: supporting and promoting healthy lifestyle choices, with an emphasis on the prevention of alcohol, tobacco, and other drug use by young people. - Townshend Community Hope and Action: promoting a healthy, connected community through area events.- West River Valley Food Group/Vermont Food Bank: organizing the procurement and distribution of food to those in need. - West River Valley Dental Coalition: comprised of Grace Cottage, Neighborhood Connections, Stratton Foundation, Norwich University, and area school nurses, to promote dental health awareness and dental services in the area for all in need of dental care. - West River Valley Transportation Initiative: A collaboration between the Windham Regional Commission, Brattleboro Memorial Hospital, Grace Cottage Hospital, Windham Central Supervisory Union, and Southeastern Vermont Transit, this group has been working together for several years to improve public bus and van transportation in the Route 30 corridor between Brattleboro and Jamaica, VT. A Transit Feasibility Study was completed in 2015, in preparation for a Congestion Mitigation Air Quality grant application in 2016. - Regional Clinical Performance Committee: a collaborative between Grace Cottage Hospital and Brattleboro Memorial Hospital to evaluate and share clinical performance metrics. - Community Wellness: In 2015, there were a total of 3,246 wellness visits. Wellness activities included dance meditation, strong bones exercise classes, meditation circle, weight control programs, and yoga. Tobacco cessation classes at Grace Cottage Hospital were held by a member of Grace Cottage's Community Health Team, under the auspices of Vermont's Blueprint for Health program.For the fourth consecutive year, Grace Cottage Hospital employees collaborated with Brattleboro Memorial Hospital and The Brattleboro Retreat to organize and implement a Community Health Festival. Over 50 area non-profit organizations and more than 500 members of the community attended the Health Festival on September 19, 2015. In addition, Brattleboro Memorial Hospital, The Brattleboro Retreat, and Grace Cottage Hospital collaborated on a Wellness in Windham website and Health Education calendar. Grace Cottage employees also assisted in coordinating a community blood drive in Newfane, Vermont, in conjunction with the American Red Cross.In addition, area non-profit organizations providing health-related and emergency preparedness-related services to the community are provided with meeting and training space at the Hospital. In response to the last Community Health Needs Assessment, the Hospital has worked collaboratively with local schools and organizations to promote healthy, fun activities and provides opportunities that make the most of staying as healthy as possible. Heavily promoted activities include a 5K in the spring, a 17.7-mile bike ride in the summer, and a Poker Walk in the fall, among others. Grace Cottage Hospital plays a pivotal role in Emergency/Disaster Preparedness in this rural, mountainous area of Windham County, Vermont. The Hospital works collaboratively with:- the local town volunteer fire and first responder rescue departments; - the regional ambulance service, Rescue Inc.;- Windham County Regional Commission - the Local Emergency Planning Committee covering the towns that Grace Cottage serves;- the local Citizens Emergency Response Team (CERT); - the local Radio Amateur Civil Emergency Service (RACES) - West River Radio Club meets and stores equipment at Grace Cottage Hospital; - Vermont Association of Hospitals and Health Systems; - Vermont Department of Health. Grace Cottage Hospital houses the local non-profit transport ambulance service, Rescue Inc., free of charge, on the Hospital grounds, providing an ambulance garage and two rooms for use by rescue personnel. Rescue Inc. is based in Brattleboro, VT, 18 miles away; the branch that is located at Grace Cottage 24 hours a day, 365 days a year, is known as Rescue Inc. Division Two.Grace Cottage Hospital staff participate in onsite training for disaster preparedness as well as offsite training with other hospitals. Part VI, Line 6: N/A Part VI, Line 7, Reports Filed With States VT X X 0 0 0 0 0 0 0 1 0 Timothy P Shafer MD Trustee/Family Physician 255790 0 30390 0 3218 0 7800 0 23871 0 321069 0 0 0 Stephen A Brown CFO 180123 0 0 0 14115 0 4030 0 23871 0 222139 0 0 0 Maurice Geurts MD Physician 329193 0 27200 0 2458 0 7800 0 23871 0 390522 0 0 0 Moss J Linder MD Physician 274162 0 5025 0 2848 0 4618 0 23871 0 310524 0 0 0 Ewa Arnold MD Physician 227505 0 26600 0 2158 0 5875 0 23871 0 286009 0 0 0 Amalia Lee Physician 177979 0 0 0 2158 0 0 0 11133 0 191270 0 0 0 Kimona Alin Physician 154169 0 0 0 20164 0 4493 0 20931 0 199757 0 0 0 Part I, Line 7 Physician contracts provide the opportunity to receive additional payments for productivity above minimum thresholds. For the period reported, four physicians listed in Part VII were under such a contract: Dr. Maurice Geurts, Dr. Moss Linder, Dr. Ewa Arnold, and Dr. Timothy Shafer, who received incentive compensation payments of $27,200, $5,025, $26,600, and $30,390, respectively. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is initially reviewed in detail by Carlos G. Otis Health Care Center's key finance employees. Thereafter, the final draft is provided to the full Board for review prior to filing with the IRS. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to the Board of Trustees and each Trustee signs to confirm that they have thoroughly read, understand, and agree to comply with the conflict of interest policy. Form 990, Part VI, Section B, line 15 CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted and voted on by the full Board annually. The Board used external market compensation data to determine the CEO's initial compensation when hired and annually uses such data to compare OHCC's CEO compensation with that of other hospital executives in the Northeast region. The CEO is excused from Board discussion and voting on issues surrounding CEO compensation and benefits. Compensation of other hospital employees: The CEO reviews the salaries of employees annually and determines compensation based on performance and salary ranges, using regional salary range data for comparison. Form 990, Part VI, Section C, line 19 Upon request, Carlos G. Otis Health Care Center, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part VII, Section A: The compensation reported for Dr. Timothy Shafer was for his services as a full-time physician. He was not compensated for his services as members of OHCC's Board of Trustees. Form 990, Part XI, line 9: Decrease in Beneficial Interest in Net Assets of GCF -33,715. Form 990, Part XI, Line 2c: The Finance and Audit Committee oversees the audit process for the Carlos G. Otis Health Care Center, Inc. and Grace Cottage Foundation, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for both fiscal years. Grace Cottage Foundation Inc PO Box 1 Townshend VT 05353 030343282 Solicit contributions for the funding of health care services by OHCC VT 501(c)(3) Line 11a, I Carlos G Otis Health Care Center 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Grace Cottage Foundation Inc Q 268049 Actual per books Grace Cottage Foundation Inc C 830804 Actual per books