2016-08-15T07:56:01-05:00 2015-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-10-01 030179437 Springfield Hospital Inc SPRI 8028857629 25 Ridgewood Road Springfield VT 05156 Scott Whittemore CFO 8028857629 2016-08-12 1 Barbara J McGuan CPA P00219457 2077752387 2016-08-12 2014 2016-09-27 15:27:22Z Timothy Ford 25 Ridgewood Road Springfield VT 05156 62164153 0 X www.springfieldhospital.org X 1914 VT 25-Bed Critical Access Hospital 11 8 505 63 0 0 192161 111321 51270161 57814069 1058756 853303 -3971 -6790 52517107 58771903 3903902 956215 0 0 28794769 29248774 0 0 0 26379437 26366500 59078108 56571489 -6561001 2200414 40324114 39528850 22601713 22272696 17722401 17256154 X Our mission is to excel at providing personalized, quality care; where people come first. Our vision is to be the provider of choice by creating a professional environment where patients want to receive care, clinicians want to practice medicine, and employees want to work. Our plan is to accomplish this by:1. Empowering our caregivers with education, technology, and opportunities for personal and professional development;2. Creating an environment which builds collaborative relationships among clinicians, staff, and patients;3. Providing our communities with the educational resources and support to make informed decisions emphasizing prevention and wellness; and4. Offering safe, personalized, high quality care. 0 0 43638438 956215 57814069 Springfield Hospital (SH) is a 25-bed critical access hospital located in Springfield, VT. SH is a subsidiary of Springfield Medical Care Systems, a seven-site federally qualified health center network. SH also operates The Windham Center, a comprehensive inpatient mental health program in Bellows Falls, VT; off-site physical therapy services, three hospital-owned specialty clinics (ENT, general surgery, and orthopaedics), and an adult day care center in Springfield, VT.SH provides health services to residents throughout its catchment area. Many of the services benefit the elderly, the poor, the indigent, the underinsured, and the uninsured. SH receives minimal reimbursement from these programs, with 51% of Springfield Hospital revenue coming from Medicare and Medicaid funding.Springfield Hospital has a charity care policy under which patients who meet certain criteria will receive care without charge, or at amounts less than established rates. Patients qualify for 100% charity care at up to 200% of the federal poverty guideline (FPG) and 50% assistance up to 300% of the FPG. The Hospital does not bill patients nor pursue collection of amounts determined to qualify as charity care. For FY15, charges foregone for charity care, based on established rates, amounted to $2,518,000.Springfield Hospital also operates a number of specialty practices to provide needed specialty care, to health center patients. These clinics include Connecticut Valley ENT, Surgical Associates, and Connecticut Valley Orthopaedics. In addition, SH provides an outpatient oncology clinic serving patients needing treatment and minimizing their need to travel great distances for medical oncology. Charitable support in the form of gas cards and/or medication cards are provided to patients who do not have needed funds. This program is sponsored through donations and grant funding.Other community benefit programs include the following:Job Training and Shadowing Programs: These programs, in cooperation with Vocational Rehab and training programs through the State of Vermont, provide opportunities to gain on-the-job experience in the healthcare field. We also work with area high school students to provide opportunities for career education and summer employment. Healthcare Scholarships: Springfield Hospital raises funds that are then donated to individuals to further their educational pursuits in healthcare careers. In FY 2015, we donated four scholarships of $1,000 each, and also provide $3,200 annually to AHEC for the MedQuest and Advanced MedQuest programs during the school year.BeSeatSmart Program: This program helps residents comply with Vermont's child passenger restraint law, while ensuring the safety of our smallest patients. Approximately 45 infant restraints were provided during FY 2015. We estimate the value of this program to be $1,200 based on staff time to educate parents on the proper use and installation of the infant car seat and administrative assistant costs.Childbirth Education & Support Groups: The Childbirth Center of Springfield Hospital offers all expectant mothers an opportunity to take a Childbirth Education Class. These free classes are designed to prepare women and their partners for the labor and birth process. Licensed Lactation Consultants provide lactation consulting services.Employee Donations For Community Causes: Throughout the year, the Hospital encourages employees to participate in and donate to fund-raising events in support of various associations that address community needs, like Relay for Life, Race for the Cure, Hearts of Hope, food and clothing drives for The Family Center, and the Santa Claus Club. EMS Preceptor Programs: Through Springfield Hospital's Emergency Department, area EMS continue their education by participating in a preceptor program, allowing personnel to observe patient care. In FY 2015, approximately 800 hours of clinical hours were utilized by District 11 EMS personnel. Hospital Based Support Groups: Springfield Hospital provides education and support groups on a variety of topics such as, diabetes education, Alzheimer's, breast cancer, and pulmonary rehabilitation. Group meetings average 8-10 participants and meet monthly for 1-2 hours in duration. These groups are free to participants, educational in nature, offer an opportunity for group discussion, and often include a guest speaker.Meeting Rooms: Free meeting room space is offered to community groups as available. Groups that offer information on health or wellness are given a priority; such as Alcoholics Anonymous, Vermont Department of Health. Training Site Partnerships: Springfield Hospital is a training site for Vermont Technical College for their Licensed Practical Nurses. The following schools also have students doing practicums: University of New Hampshire, University of Vermont, University of Massachusetts, Smith College, Antioch New England Graduate School, River Valley College, VTC, St Joseph's College of Maine, Castleton State College. The program utilization is estimated to exceed 1,700 hours for clinical work. Community Education: Springfield Hospital coordinates health promotion programs, open to the public, for AARP Safe Driver Program and American Heart Association CPR and First Aid classes. The Hospital also collaborates with the SMCS community health team in offering community health and wellness education programs throughout the year.Springfield Community: Springfield Hospital encourages employees to become an active volunteer to help improve the communities we call home. Employees donate their time in a variety of areas ranging from serving as Board Members for local groups. Employees also help organize and participate in fundraisers such as The Relay for Life, Susan G. Komen Race For the Cure, Springfield Hospital Annual Golf Tournament, and Apple Blossom Cotillion.Volunteer Service: Volunteer Services provide a variety of services to patients and visitors. The donation of time and fund-raising activities support programs that include Clerical Services, Activities Support at Adult Day Services, Materials Management Support, Inpatient Discharge Phone Calling Support and Special Services in the Emergency Department. In 2015, Springfield Hospital had 65 volunteers. These individuals volunteered a total of 7,254 hours.The Windham Center: The Windham Center is a 10-bed inpatient mental health unit that provides mental health services to residents of Windham and Windsor counties and other communities. Programs provide treatment for men and women who are 18 years of age and older. Multidisciplinary teams include psychiatrists, social workers, clinicians, drug and alcohol counselors, and nurses. The Windham Center serves the general population and financial assistance is available, based on need. The Windham Center had 400 admissions in 2015, and incurred $88k in charity care expense and $450k in non-reimbursed Medicaid and Medicare costs for the same period.Adult Day Care Service: Springfield Hospital operates adult day care service, located in Springfield, VT. A cost-effective choice in long term health care, Adult Day Service assists families with senior or disabled adults, over the age of 18, who face the challenge of losing their independence. The structured program offers a safe and protective environment where nutritious meals, social activities, health care services, nursing oversight, and coordination of needed social and support services are provided. Transportation is available through an arrangement with the local bus service, The Current, at a FY 2015 cost of approximately $32,000. During FY 2015, a total of 125 patients from throughout the region were served by the Adult Day Service. 43638438 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 132 0 1 505 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 VT X Scott Whittemore 8028857629 25 Ridgewood Road Springfield VT 05156 Kathy Benson Director/Past Treasurer 1.00 2.00 X X 0 0 0 Albert St Pierre Chairperson 2.00 2.00 X X 0 0 0 Sarah Vail Secretary 2.00 2.00 X X 0 0 0 Katrina Harris DO Director & Hospitalist Physician 20.00 0.00 X 73282 0 1139 David Sandelman Director 1.00 0.00 X 0 0 0 Pete Peck Director 1.00 0.00 X 0 0 0 George Lamb Vice Chairperson 2.00 1.00 X X 0 0 0 Richard Marasa MD Director 40.00 0.00 X 493473 0 0 Jim Rumrill Director 1.00 0.00 X 0 0 0 Timothy Ford CEO/President 30.00 10.00 X X 0 233721 50555 Ronald Theissen Treasurer 1.00 0.00 X X 0 0 0 Kevin Anderson Past Director 1.00 1.00 X 0 0 0 Lori Muse Past Chairperson 1.00 2.00 X X 0 0 0 Cecil Beehler MD Chief Medical Officer 0.00 40.00 X 0 286489 22202 Andrew Majka CFO 30.00 10.00 X 0 228496 1854 David Muller MD Orthopaedic Surgeon 40.00 0.00 X 501899 0 38209 John Ciocchi MD General Surgeon 40.00 0.00 X 304440 0 33282 Kevin Dwyer MD Orthopaedic Surgeon 40.00 0.00 X 482475 0 39307 Craig Hofsess MD Anesthesiologist 40.00 0.00 X 308183 0 21759 Ann Bartlett MD Anesthesiologist 30.00 0.00 X 239149 0 16676 2402901 748706 224983 30 0 1 0 Emergency Services of New England PO Box 12 Chester VT 05143 Physician Services 3423435 HP Cummings Construction Co PO Box 269 Woodsville NH 037850269 Construction Services 920963 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Staffing Services 668207 Comprehensive Benefits Administrators PO Box 2365 South Burlington VT 05407 Benefit Management 545660 Richard Marasa MD PC 1 Walnut Hill Court Springfield VT 05156 Physician Services 511851 21 12650 10092 88579 5433 111321 Patient Service Revenue 622110 119561775 119561775 Adult Daycare Revenue 624120 1714866 1714866 Miscellaneous Revenue 622110 173114 22502 150612 Provision for Bad Debts 622110 -4129553 -4129553 Contractual Allowances 622110 -59506133 -59506133 57814069 223930 223930 3997318 3367945 629373 629373 629373 17515 12650 24305 -6790 -6790 58771903 57663457 0 997125 X 956215 956215 567894 567894 22691368 16555298 6136070 298305 218196 80109 4047725 2964856 1082869 1643482 1203809 439673 148918 148918 94249 94249 48896 48896 9664285 8143998 1520287 59851 59851 389313 148449 240864 1573568 503906 1069662 34490 5499 28991 320227 320227 2086605 2060214 26391 650784 611088 39696 Medical Supplies 5304698 5137085 167613 Healthcare Provider Tax 3173125 3173125 Other Expenses 896503 379091 517412 Repairs & Maintenance 722581 640701 81880 1198407 369014 829393 56571489 43638438 12933051 0 X 244645 169562 507857 1817190 9875972 9534763 389599 269753 651100 677682 40331626 26091035 14547207 14240591 13835526 12692983 71102 67202 201106 59124 40324114 39528850 8240372 5231940 6665000 6400000 4904525 4340856 2791816 6299900 22601713 22272696 X 17016131 16580334 212779 182329 493491 493491 17722401 17256154 40324114 39528850 X 2200414 -1200102 -1466559 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1012918 -5112 642625 1789 363392 1152978 122894 259120 3834 1012918 1034312 121514 2849 1152978 891334 150499 5504 2017 1034312 907834 7469 21131 2838 891334 1.00000 0.00000 0.00000 0 0 87157 87157 14098584 6162533 7936051 966627 494627 472000 23155211 18209885 4945326 2024047 1223990 800057 14240591 Due to Related Parties 145790 Other Current Liabilities 622226 Pension Liability 3372427 Estimated Third-Party Payor Settlements 2159457 6299900 55173332 -1200102 -1442254 -2642356 57815688 956215 956215 58771903 55639579 24305 24305 55615274 956215 956215 56571489 Part V, Line 4: The funds are used to fund capital and used as loan collateral. Part XI, Line 2d - Other Adjustments: Fundraising Expenses 24,305. Change in Value of Beneficial Interest in Remainder Trust -20,842. Change in Net Assets to Recognize Funded Status of Pension Plan -1,445,717. Part XI, Line 4b - Other Adjustments: Transfer to Affiliate 956,215. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 24,305. Part XII, Line 4b - Other Adjustments: Transfer to Affiliate 956,215. Golf Tournament 30165 12650 17515 2000 7097 4618 10590 30165 12650 17515 2000 7097 4618 10590 24305 -6790 1 1 X 1 X 1 X 1 1 1 0 0 1012483 0 1012483 0.01790 13540787 10258357 3282430 0.05800 14553270 10258357 4294913 0.07590 784940 784940 0.01390 784940 784940 0.01390 15338210 10258357 5079853 0.08980 1 1604360 18665842 18940713 -274871 X 1 1 1 1 Springfield Hospital 25 Ridgewood Road Springfield VT 05156 www.springfieldmed.org 854 X X X X Inpatient Psychiatric Unit Springfield Hospital Inc 1 0 0 1 X X X X X X X X X 12 1 0 1 1 X www.springfieldhospital.org X 1 12 1 www.springfieldhospital.org 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.springfieldhospital.org X www.springfieldhospital.org X X 1 X 0 X X X X X 1 X 0 0 Springfield Hospital, Inc. Part V, Section B, Line 5: A steering committee was formed to conduct this assessment, review the data, and recommend priorities and implementation strategis to SMCS Board of Directors. Members Include:- Steve Geller, Executive Director, Southeastern Vermont Community Action- Sarah Kemble, MD, MPH, Medical Director, Springfield Medical Care Systems- Wilda Pelton, Executive Director, Valley Health Connections- Lynn Raymond-Empey, Executive Director, Vermont Coalition of Clinics for the Uninsured- Becky Thomas, MPH, Director, Vermont Department of Health- Joyce Lemire, Executive Director, Senior Solutions- Anna Smith, Director, Marketing and Community Relations, Springfield HospitalGroup Discussions and in-person or telephone interviews provided input from the following sources:- The SMCS Community Health Team (a 100+ member community health team that meets monthly);- Medical Providers;- Community Advisory Committee;- General Public;- Area Businesses; - Community Health Officers; - Police, Fire and EMT;- Schools; - Town Officials;- Home Health/VNA;- Health Care and Rehabilitation Services of Vermont (Community Mental Health);- Council on Aging; and,- Southeastern Vermont Community ActionA community-wide survey (via Survey Monkey) was distributed throughout the community. The distribution included Board Members, all Springfield Medical Care Systems medical staff, SMCS employees, and Community Health Team members, asking them to help distribute to their email and/or contact lists. The survey was also advertised on the hospital webiste and in the local newspapers. The survey was available to be completed online or via paper copy, and was made available to Hospital, Valley Health Connections, all primary and specialty care offices, and Springfield Area Adult Day Service. A total of 440 responses were received. Springfield Hospital, Inc. Part V, Section B, Line 6b: Springfield Medical Care Systems, Inc. Springfield Hospital, Inc. Part V, Section B, Line 11: The Hospital is addressing the significant needs identified in its most recently conducted CHNA as follows:Improve Overall Access to Services1. Physician referral guide and Physician Referral Phone line for free consultation and assistance in place (802-885-7604)2. Recruitment of primary care/specialist providers as needed3. Developing Information/Welcome kit for The Windham Center for Psychiatric Care4. Communicate financial assistance availability and outreach and enrollment services available in partnership with Valley Health Connections5. Developed new website to raise awareness for range of services offered and how to access same6. Working with area Prevention Coalitions to improve prevention efforts7. Tobacco treatment programs ongoing8. Wellness, Recovery, Action Programs offered through SMCS Community Health Team Education Programs9. Prescription for Exercise program is ongoing in partnership with the Edgar May Health & Recreation Center10. Same day appointment policies are in place and walk-in services are offered at Springfield, Rockingham, Ludlow and Londonderry locations.11. Transportation program ongoing (Health Transit), administered by the SMCS Community Health Team for transportation assistance for wellness needs12. Fast Track Emergency Service is operational, 11 am - 7 pm daily13. Quality Improvement effort works to improve admission from ED to inpatient areas, and discharge procedures to reduce re-admissions.14. Outreach and enrollment for financial assistance and utilization of State Exchanges is ongoing in partnership with Valley Health Connections In Springfield.15. School immunization rates shared with clinicians to improve vaccination ratesImprove Health and Wellbeing of those Living with Mental Illness/Substance Abuse1. Working with HCRS to improve access for mental health patients2. Working with area partners in Adverse Childhood Experiences group to raise awareness and improve community action in regard to prevention3. Involved in community action (Project Action) regarding substance use and abuse to improve treatment and prevention efforts4. Utilize Hub and Spoke program for medically-assisted substance abuse patients5. LICSW services embedded into all primary care practice locations6. Hold community events and educational programs to help raise awareness and educate the public regarding mental health issues. Adverse Childhood Experiences and Alzheimer's Disease were two topics addressed in the past year.Improve Access to Oral Health Care For Children and Adults1. Added additional operatory to Ludlow Dental site to increase capacity2. Ronald McDonald Dental Mobile program is no longer made available to SMCS area3. Grant awarded to expand dental in new location, Chester Family Dental, Chester, VT4. Financial assistance outreach and enrollment is ongoing 5. Guide to Fluoride Levels in Public Water Systems distributed to all clinicians.6. Distribute free toothbrushes/toothpaste to those in need through our primary care practice locations Springfield Hospital, Inc. Part V, Section B, Line 20e: A patient financial counselor meets with patient prior to discharge if medical condition allows. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Springfield Hospital, Inc. Part V, Section B, line 16a website: www.springfieldhospital.org Springfield Hospital, Inc. Part V, Section B, line 16b website: www.springfieldhospital.org 6 The Windham Center 1 Hospital Court 12 Bellows Falls VT 05101 Inpatient Psych Unit Connecticut Valley Orthopaedics and Spor 29 Ridgewood Rd Springfield VT 05156 Specialty Practice Surgical Associates 29 Ridgewood Rd Springfield VT 05156 Specialty Practice Springfield Hospital Rehabilitation Serv 100 River Street Springfield VT 05156 Physical Therapy Springfield Area Adult Day Services 266 River Street Springfield VT 05156 Adult Day Services Connecticut Valley ENT 29 Ridgewood Rd Springfield VT 05156 Specialty Practice Part I, Line 7g: Amount represents funding required by Springfield Medical Care Syetems in order to operate, conduct, and provide various medical services to the community served. Part III, Line 2: The Organization used the cost to charge ratio calculated on Worksheet 2 multiplied by bad debt expense per the Organization's audited financial statements. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.There were no significant changes to the allowance for doubtful accounts in 2015 or 2014. Part III, Line 8: Worksheet A from the Form 990 Instructions was used to determine the amount reported on Line 6. Part III, Line 9b: Financial assistance is written off from charges before any collection efforts are made. Part VI, Line 2: Our planning process is participative and incorporates ongoing public input regarding community health care, hospital services, and new opportunities. Conducted on an annual basis, planning includes information from various sources as outlined below: - Public Input is invited at any time through our website, e-mail, or regular mail. 1) A community needs assessment tool is available on our website's home page, www.springfieldmed.org, that provides ongoing opportunity for community feedback. 2) A Community Relations Line offers an invitation to provide feedback directly to the Quality & Systems Improvement Department via phone or email. This contact information can be found on the home page of our website, www.springfieldmed.org, by calling 802-885-7299, or by e-mailing communityrelations@springfieldmed.org.3) A Community Advisory Committee was formed as a result of our public meetings. This group meets on an ongoing basis for open dialog regarding needs assessment and to receive ongoing feedback regarding services. Suggestions or information may be sent to Anna Smith, Marketing & Community Relations, Springfield Medical Care Systems, 25 Ridgewood Road, Springfield, VT 05156, or e-mail annasmith@springfieldmed.org. - Ongoing information is received throughout the year to help us with our quality improvement initiatives. Our patient satisfaction survey process is conducted in cooperation with N.R.C. Picker, and monitors quality and services on a monthly basis.- Community participation and presentations are made on a regular basis to local public service and public gatherings. Outreach activity for planning and partnering with local boards, community services, and membership organizations is ongoing. This includes partnering with Vermont's Blueprint For Health, the VT Chronic Care Collaborative, the Edgar May Health & Recreation Center, emergency planning, career/education, and youth and elderly services agencies, to name a few, and provides ongoing community input. - A Community Health Team is now fully operational, meeting monthly to collaborate and partner with area agencies to remove barriers and improve access and quality of care. The team now exceeds 100 participants. New members are welcomed at each meeting as word of the team spreads throughout the community. The quarterly Community Advisory Group is an extension of this group and all members of the Community Health Team are invited to participate as often as they wish. - Our Board of Directors and Corporators provide ongoing participation through local representation. As a small community hospital, representatives interact regularly with community members and are available to answer questions or receive feedback. - Our volunteer network, whose annual participation of over 12,000 volunteer hours, creates ongoing opportunities for patient interaction and community outreach activities. - Public meetings and events are held throughout the year allowing our community to be directly involved in our work, and public comment and suggestions are invited. Part VI, Line 3: Enrollment counselors are available at physician practice offices, at Valley Health Connections on River Street in Springfield, VT, and at Springfield Hospital to meet privately to consult with patients about their eligibility for a variety of public programs and/or financial assistance. Information is provided through certified navigators and enrollment counselors, distributed to the community via our Community Health Team and area social service agencies, and is included in every welcome packet to new patients. It is also available via our website. Part VI, Line 4: The Organization is a non-profit corporation directed by a dedicated Board of Directors comprised of patients and community members. The service area includes 14 towns located in the Vermont counties of Windsor (eight towns) and Windham (three towns) and New Hampshire counties of Sullivan (two towns) and Cheshire (one town). Springfield Medical Care Systems, the parent corporation, provides and coordinates care from seven health center locations in the towns of Springfield, Ludlow, Chester, and Rockingham, VT, and Charlestown NH. Springfield Hospital is located in Springfield, VT. The service area is rural, primarily white, and has an older, lower income population. The community includes uninsured and Medicaid patients which represents 25% of the patient population. In NH, MUPs include Alstead, Acworth, Charlestown, Langdon and Walpole. In VT, MUPs include Rockingham, Athens, Grafton and Westminster in Windham County and Ludlow, Plymouth, Weston, and Reading in Windsor County. In addition to Springfield Hospital other area hospitals serving a portion of the service area include Brattleboro Memorial Hospital and Grace Cottage Hospital in Vermont and Valley Regional Hospital, Cheshire Medical Center, and Dartmouth-Hitchcock Medical Center in New Hampshire. Springfield Medical Care Systems maintains collaborative working relationships with each of these institutions.Median Population by Age (2010 Census source: USA.com)Windsor County: 45.8 Windham County: 44.9Vermont: 41.5 US: 37.2Cheshire County: 40.7 Sullivan County: 43.9 NH: 41.1 Median Household IncomeWindsor County: $50,893 Windham County: $46,714 Vermont: $51,841US: $51,914Cheshire County: $48,030Sullivan County: $50,689NH: $63,277Population in PovertyWindsor County: 9.73%Windham County: 11.13%Vermont: 11.12%US: 13.82%Cheshire County: 11.8%Sullivan County: 10.04%NH: 8.29% Part VI, Line 5: The health of our area communities and access to quality health care is served through the community health center network of the organization's parent corporation, Springfield Medical Care Systems, which is the primary source of preventive and coordinated care in our service area. The organization is directed by a Board of Directors comprised of community members and patients. Free health screenings, education programs and support groups are offered throughout the year. Financial assistance is communicated broadly across the service area, available to all who qualify based on a sliding fee scale, and includes dental and reduced pharmacy assistance. Part VI, Line 6: Springfield Hospital is a subsidiary of Springfield Medical Care Systems (SMCS). SMCS is comprised of a network of primary care offices (federally-qualified health centers) that provide ongoing care and outreach to our local communities, employing a medical home model of care, and focusing on prevention and efficient care management in cooperation with the Chronic Care Collaborative and the Vermont Blueprint for Health. Need for specialty services is referred by SMCS' health center medical staff to Springfield Hospital and its outpatient specialty clinicians, or to designated tertiary care facilities for the appropriate level of care as needed. 1 Springfield Medical Care Systems Inc 25 Ridgewood Rd Springfield VT 05156 030284813 501(c)(3) 956215 The Organization received a contribution to be used for the benefit of Springfield Medical Care System, a related organization. The Organization transferred this money to Springfield Medical Care System to be used for its intended purpose. 1 0 Part I, Line 2: All assistance provided by the Organization during the year was to Springfield Medical Care System, a related organization, which has the same bookkeeper as the Organization and, therefore, no monitoring is deemed necessary. 0 0 0 0 0 0 0 1 0 Richard Marasa MD Director 493473 0 0 0 0 0 0 0 0 0 493473 0 0 0 Timothy Ford CEO/President 0 233721 0 0 0 0 0 19531 0 31024 0 284276 0 0 Cecil Beehler MD Chief Medical Officer 0 286489 0 0 0 0 0 4407 0 17795 0 308691 0 0 Andrew Majka CFO 0 221189 0 0 0 7307 0 1854 0 0 0 230350 0 0 David Muller MD Orthopaedic Surgeon 488177 0 13722 0 0 0 4780 0 33429 0 540108 0 0 0 John Ciocchi MD General Surgeon 303640 0 800 0 0 0 0 0 33282 0 337722 0 0 0 Kevin Dwyer MD Orthopaedic Surgeon 482475 0 0 0 0 0 6584 0 32723 0 521782 0 0 0 Craig Hofsess MD Anesthesiologist 308183 0 0 0 0 0 0 0 21759 0 329942 0 0 0 Ann Bartlett MD Anesthesiologist 239149 0 0 0 0 0 4805 0 11871 0 255825 0 0 0 Part I, Line 3 Springfield Medical Care Systems, Inc., a related organization, establishes the compensation for the Organization's CEO. Springfield Medical Care Systems, Inc. uses a variety of resources to establish compensation as follows: 1. Compensation committee 2. Independent compensation consultant 3. Written employment contract 4. Compensation survey/study 5. Approval by the board/compensation committee Part I, Line 7 John Ciocchi received bonus compensation of $800 in 2014 for conducting endoscopy procedures on his scheduled off-day. Form 990, Part VI, Section A, line 6 The Organization has corporators. Form 990, Part VI, Section A, line 7a The Organization has corporators who elect board members. Form 990, Part VI, Section A, line 7b The corporators approve the selection of the Organization's auditors and approve by-law changes. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by the Organization's Chief Financial Officer upon completion. Form 990, Part VI, Section B, line 12c All officers, directors, trustees, and key employees must completed a conflict of interest statement annually. In addition, they must recuse themselves from voting on issues where a conflict is actual or implied. Form 990, Part VI, Section B, line 15a The parent organization has a compensation committee which uses an independent compensation consultant who performs a market analysis on similar health care providers with similar revenue in order to establish the base salary of the CEO. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part IX, line 11g Collection Services: Program service expenses 0. Management and general expenses 71,658. Fundraising expenses 0. Total expenses 71,658. Purchased Services: Program service expenses 2,411,454. Management and general expenses 545,845. Fundraising expenses 0. Total expenses 2,957,299. Contracted Services: Program service expenses 4,206,505. Management and general expenses 636,871. Fundraising expenses 0. Total expenses 4,843,376. Locum Expense: Program service expenses 1,526,039. Management and general expenses 239,824. Fundraising expenses 0. Total expenses 1,765,863. Consulting Services: Program service expenses 0. Management and general expenses 26,089. Fundraising expenses 0. Total expenses 26,089. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Springfield Hospital, Inc. 25 Ridgewood Road Springfield, VT 05156 EIN: 03-0179437 Springfield Hospital, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Net Assets to Recognize Funded Status of Pension Plan -1,445,717. Change in Value of Beneficial Interest in Remainder Trust -20,842. Springfield Medical Care Systems Inc 25 Ridgewood Road PO Box 2003 Springfield VT 05156 030284813 Primary medical care, support and enabling VT 501(c)(3) Line 3 N/A 0 0 1 0 1 1 0 0 0 0 1 0 0 1 0 1 0 1 1 0