2013-08-14T10:30:58-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 030181058 Porter Hospital Inc PORT 8023884701 37 Porter Drive Middlebury VT 05753 James L Daily 8023884701 2013-08-13 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-13 2011 2016-02-24 21:20:13Z James L Daily 37 Porter Drive Middlebury VT 05753 66180394 0 X www.portermedical.org X 1925 VT Critical Access Hospital 15 12 600 112 4365 0 264396 273702 59707047 64324546 305496 231890 64837 81920 60341776 64912058 43690 27412 0 0 33466592 37591507 0 0 0 24285991 30757362 57796273 68376281 2545503 -3464223 52225427 50403008 27689477 30458235 24535950 19944773 X The mission of Porter Medical Center and its subsidiary companies is to improve the health status of those served. The Organization will:a. Treat and care for the sick and injured;b. Provide, in cooperation with the community, as appropriate, a continuum of health services including out-patient services, rehabilitation, long-term care, and wellness/prevention programs;c. Ensure the delivery of high quality care available to all without regard to their ability to pay;d. Serve as a leader and catalyst in helping to determine, and provide for, the health needs of the community, while remaining a financially healthy organization. 1 1 59957617 27412 64164045 Porter Hospital, Inc. ("Porter") operates a not-for-profit critical access hospital with patient care services including emergency room, maternity and medical/surgical inpatient and outpatient care, and ancillary services including rehabilitation, laboratory testing, and diagnostic imaging services. As a critical access hospital, Porter staffs a total of 25 beds. Of the 25 beds, six beds are located in the maternity unit and three beds are located in the special care unit. The remaining beds are located on the Medical/Surgical unit. Porter recorded approximately 5,897 inpatient days during the year. Emergency Room visits totaled 17,071 for the year. Surgeries for the year totaled 3,252. Support services for both inpatients and outpatients include but are not limited to Laboratory, Diagnostic Imaging services, cardiac services, and rehabilitation facilities. Imaging includes radiology, nuclear medicine, MRI, ultrasound and CT Scan. Porter provides free care to patients who meet certain criteria. Foregone charges furnished under Porter's free care policy amounted to $1,176,170 with a cost of $576,850 for the fiscal year ending 9/30/12. Porter provides a number of community health outreach programs to the general public for free or at a minimal charge. The programs include but are not limited to diabetes education, breast cancer screening, prenatal classes, breastfeeding classes and CPR courses. Porter provides clinical office space to the Open Door Clinic. Finally, Porter has partnered with a local career center, as well as colleges to provide clinical exposure to their students with goals of developing future healthcare workers for the community. 59957617 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 68 0 1 600 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 VT X Pearl AB Teague 8023884701 37 Porter Drive Middlebury VT 05753 James L Daily 40.00 X X 0 372595 120642 Gerry Gossens 3.00 X 0 0 0 Ken Perine 3.00 X 0 0 0 Edwin Grant 3.00 X X 0 0 0 Peter DeGraff 3.00 X 0 0 0 Ann Hanson 3.00 X 0 0 0 Mike Kiernan MD 3.00 X 136949 0 34648 Fred Kniffin MD 40.00 X 242252 0 32002 Sue Ritter 3.00 X X 0 0 0 Benjamin Rosenberg MD 3.00 X 0 0 0 Robert Stetson 3.00 X 0 0 0 Joseph Sutton 3.00 X 0 0 0 Stephen Terry 3.00 X 0 0 0 Joan Donahue 3.00 X 0 0 0 Bill Townsend 3.00 X 0 0 0 Linn Larson MD 3.00 X 0 0 0 Kate McIntosh MD 3.00 X 0 0 0 Maureen McLaughlin 3.00 X 0 0 0 Marilyn Olejnik 40.00 X 0 200145 30673 Patricia Jannene 40.00 X 189797 0 40439 Alan D Ayer 40.00 X 270501 0 29528 Anders Holm 40.00 X 337196 0 42650 James A Malcolm 40.00 X 252691 0 30299 David B Turner 40.00 X 227987 0 35990 Kristofer Anderson 40.00 X 226581 0 17280 1883954 572740 414151 48 0 1 0 Fletcher Allen Health Care 111 Colchester Avenue Burlington VT 05401 Laboratory Services 644897 American Health Center 100 Griffin Road Portsmouth NH 03801 MRI Procedures 477341 Amicus Sten-Tel Transaction 62 Wildfire Drive Warren VT 05674 Transcription of Medical Records 213726 Mayo Collaborative Services Inc 200 SW 1st Street Rochester MN 55905 Laboratory Services 167461 Apogee Medical Management 2525 E Camelback Road Suite 1100 Phoenix AZ 85016 Medicare Billing 158868 8 103871 169831 273702 Patient Revenue 621110 118715611 118715611 Pharmacy Sales 621110 2282585 2282585 Miscellaneous Revenue 621110 1555949 1395448 4365 156136 Provision for Bad Debt 621110 -4827217 -4827217 Contractual/Char. Adj. 621110 -53402382 -53402382 64324546 231073 231073 143808 61888 81920 81920 81920 1206515 750 1206448 0 67 750 817 817 64912058 64164045 4365 469946 27412 27412 445851 445851 28615880 25055984 3559896 1333756 1167923 165833 5335308 4674158 661150 1860712 1632261 228451 1750500 1535581 214919 129144 113288 15856 27023 27023 7714947 6767738 947209 117355 102947 14408 2128645 1863933 264712 747983 656149 91834 2534470 2223298 311172 170228 149328 20900 339030 297405 41625 4799131 4209913 589218 1241869 1089397 152472 Medical Supplies 5487272 4813567 673705 Medicare Provider Tax 3569765 3131484 438281 68376281 59957617 8418664 0 4390 4090 3698570 3789945 15850 1000 11209509 10922662 250464 182544 1178244 1258811 571620 584376 48268740 21850157 28812904 26418583 2837029 3221907 2851219 2978834 142662 136650 652966 903606 52225427 50403008 5847877 9066835 22508 0 14220000 13885000 3338949 2297084 4260143 5209316 27689477 30458235 X 21283161 16576126 283888 272131 2968901 3096516 24535950 19944773 52225427 50403008 X -3464223 -1126954 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14963 14963 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 2185776 2185776 25607863 9478077 16129786 20242383 12372080 7870303 232718 232718 26418583 Beneficial Interest in Trusts 2978834 F 2978834 Estimated Third Party Payor Settlements 665000 Deferred Compensation 559266 Due to Affiliate 147572 Liability for Pension Benefits 3837478 5209316 64912058 68376281 -3464223 354304 -1481258 -1126954 -4591177 63819969 354304 -1419370 -1065066 64885035 27023 27023 64912058 68411146 61888 61888 68349258 27023 27023 68376281 Part XI, Line 8 - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan -1,608,873. Change in Beneficial Interest in Perpetual Trusts 127,615. Total to Schedule D, Part XI, Line 8: -1,481,258. Part XII, Line 2d - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan -1,608,873. Change in Beneficial Interest in Perpetual Trusts 127,615. Rental Expenses 61,888. Part XIII, Line 2d - Other Adjustments: Rental Expenses 61,888. 1 1 1 X 1 X 1 1 0 1 1 630582 630582 0.00920 10371960 7946078 2425882 0.03550 11002542 7946078 3056464 0.04470 11797 11797 0.00020 248708 248708 0.00360 79411 32367 47044 0.00070 27412 27412 0.00040 367328 32367 334961 0.00490 11369870 7978445 3391425 0.04960 1 2587452 51749 14279625 18007945 -3728320 X 1 1 1 1 Porter Hospital Inc

37 Porter Drive Middlebury VT 05753

X X X X Porter Hospital Inc 1 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X X X X X X 1 X X 1 X X X X 1 X 0 0 12 Porter Internal Medicine

116 Porter Drive Middlebury VT 05753

Physician Clinic Neshobe Family Medicine

61 Court Drive Brandon VT 05733

Family Physician Clinic Bristol Internal Medicine

61 Pine Street Bristol VT 05443

Physician Clinic Tapestry Midwifery

20 Armory Lane Vergennes VT 05491

Physician Clinic Porter Cardiology

115 Porter Drive Middlebury VT 05753

Physician Clinic Middlebury Pediatric & Adolescent Med

1330 Exchange Street 201 Middlebury VT 05753

Physician Clinic Little City Family Practice

10 North Street Vergennes VT 05491

Family Physician Clinic Addison Associates in OBGYN

116 Porter Drive Middlebury VT 05753

OB/GYN Addison Family Medicine

82 Catamount Park Middlebury VT 05753

Family Physician Clinic Partners in Palliative & Home Care

108 Porter Drive Middlebury VT 05753

Physician Clinic Porter Ear Nose & Throat

1330 Exchange Street 202 Middlebury VT 05753

Physician Clinic Champlian Valley Orthopedics

1436 Exchange Street Middlebury VT 05753

Physician Clinic Part I, Line 6a: The annual community benefit report is prepared by Porter Medical Center, the parent Company of Porter Hospital, Inc. Part I, Line 7: The Organization used a cost-to-charge ratio as its methodology for calculating amounts on Lines 7a & 7b. An actual costing methodology was used to calculate the amounts on lines 7e, 7g & 7i. Part I, Line 7g: The Organization included as subsidized health services costs attributable to Partners in Pallative Care, a physician clinic. Total costs related to this physician clinic are $47,044. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect for services rendered from third-party payors, patients and others. Management provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Accounts are considered delinquent and subsequently written off as uncollectible based on individual credit evaluation and specific circumstances of the account.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third- party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts. For receivables associates with self- pay patients (which included 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 rate if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost. The Organization believes that there was an estimated 2% of bad debt expense that more aptly reflected amounts written off for patients eligible under the Organization's financial assistance policy as free care. The Organization used the Medicare Cost Report to report Medicare allowable costs of care related to the payments on Schedule H, Part III, Section B. Medicare, Line 6. Part III, Line 9b: Porter Hospital, Inc. recognizes that it has a responsibility to provide care to all patients regardless of their ability to pay and make available financial assistance for those patients that have been identified as financially needy through written documentation. Information regarding financial assistance is made available upon request. Porter Hospital, Inc. Part V, Section B, Line 11h: The Organization uses asset levels to calculate the amounts charged to patients, but only monetary assets, no other property. Porter Hospital, Inc. Part V, Section B, Line 19d: The Organization will initially bill a patient not having insurance the Organization's standard and customary gross charges. Upon knowledge that the patient may be medically indigent and require financial assistance, the Organization will initiate the process of financial counseling and assistance whereby the patient would receive an adjusted bill reflective of the financial assistance provided, i.e. a zero bill for 100% free care or discounted bill. Porter Hospital, Inc. Part V, Section B, Line 20: The Organization does bill gross charges to patients when the patient has no form of insurance. The Organization will and does provide discounts as needed to patients that are in the position of having no insurance. These discounts range from 10% to 100% of the charge depending upon financial need. Part VI, Line 2: Porter Hospital, Inc. maintains an active list of Quality Improvement Projects and Initiatives that are identified by our clinical staff in response to either internal or external assessments of how we can implement "best practices" for our patients. The list of projects and initiatives is updated annually as part of the State of Vermont's Act 53. Porter Hospital's Community Advisory Committee assess community needs biennially. The results of the assessment are posted on Porter Medical Center's Web Site. Part VI, Line 3: Porter Hospital's Financial Assistance Program is posted on the Porter Medical Center Web Site. In addition, all patients receive a brochure entitled "Important Information About your rights and responsibilities as a patient". The brochure states that the patient has the right to receive the most appropriate medical treatment available regardless of ability to pay and receive information about financial assistance. Part VI, Line 4: Porter Hospital, Inc. is the major provider of health care in Addison County, Vermont. Porter Hospital, Inc. also provides services to residents of northern Rutland County (Vermont), Essex County (Vermont), New York and elsewhere in this region. Part VI, Line 5: Porter Hospital, Inc. provides rent free clinic space and vouchers for no-cost ancillary services to the local Open Door Clinic in its role as a catalyst in the delivery of health care services to its entire community.Porter Hospital, Inc. offers free and low cost community education programs on health care topics including memory loss, dementia, breast cancer screening, basic diabetes, CPR, smoking cessation, parenting, prenatal exercise and breast feeding.A majority of the governing body is comprised of persons who reside in its service area and who are neither employees nor contractors of Porter Hospital, Inc. nor family members thereof. Medical staff privileges are extended to all qualified physicians in the community.Surplus funds are invested in technology, facilities and programs. Porter Hospital and the local Career Center collaborate on a new Health Careers Education program. Part VI, Line 6: Porter Hospital, Inc. and Helen Porter Nursing Home, Inc. are wholly owned subsidiaries of Porter Medical Center. Through its subsidiaries, Porter Medical Center provides a continuum of health services including in-patient care, out-patient care, short-term rehabilitation, long-term rehabilitation, long-term care, dementia care, wellness programs and prevention programs. Reports Filed With States Part VI, Line 7 VT 1 Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 27412 FMV Use of space on Hospital Campus and satellite physician practice site Operational Assistance 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Porter Hospital provides physician office space on campus as well as at one of Porter Hospital's off-site physician practice office to the Open Door Clinic. Porter Hospital provides this in-kind, non-cash assistance to further the mission of out-reach to the medically needy within the Addison County healthcare community. This support dovetails with the mission of the Blueprint for Health to stabilize chronic health conditions for the most fragile social-economic population. X X X X 0 1 0 0 0 0 0 0 0 James L Daily 0 315089 0 0 0 57506 0 91450 0 29192 0 493237 0 0 Mike Kiernan MD 126517 0 0 0 10432 0 4909 0 29739 0 171597 0 0 0 Fred Kniffin MD 237397 0 0 0 4855 0 12033 0 19969 0 274254 0 0 0 Marilyn Olejnik 0 176398 0 20000 0 3747 0 5998 0 24675 0 230818 0 0 Patricia Jannene 179793 0 0 0 10004 0 9378 0 31061 0 230236 0 0 0 Alan D Ayer 262584 0 0 0 7917 0 7350 0 22178 0 300029 0 0 0 Anders Holm 336843 0 0 0 353 0 9800 0 32850 0 379846 0 0 0 James A Malcolm 249607 0 0 0 3084 0 7350 0 22949 0 282990 0 0 0 David B Turner 227767 0 0 0 220 0 6997 0 28993 0 263977 0 0 0 Kristofer Anderson 226419 0 0 0 162 0 6838 0 10442 0 243861 0 0 0 Part I, Line 4b James Daily, President/CEO, participates in a 457(f) plan, and received $79,200 from the plan during FY 9/30/12. Vermont Educational and Health Buildings Financing Agency 237154467 9241607X6 2005-06-17 15430000 Funding for new Construction 0 0 0 1545000 15430000 4974901 207863 170152 10077084 2005 0 0 1 1 0 0 0 0 1 0 1 0 0 0 1 Remora LLC An entity more than 5% owned directly by Bill Townsend, Board Director 144034 Rental of Property 0 New Program Services Form 990, Part III, line 2 During FY 2012, Porter Hospital acquired a specialty physician practice, Champlain Valley Orthopedic to further complement the health care and service needs of the Addison County community. Changes in Program Services Form 990, Part III, line 3 During FY 2012 Porter Hospital eliminated its palliative care practice. These services are incorporated in the existing practices. Form 990, Part VI, Section A, line 6 Porter Medical Center, Inc. is the parent holding company and sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to appoint Hospital directors. Form 990, Part VI, Section A, line 7b Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to approve major hospital expenditures and approve hospital long-term borrowings. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by management and the finance committee before filing. The form 990 is also made available electronically to the Board of Directors before filing. Form 990, Part VI, Section B, line 12c The Organization's CFO is responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. When bids are solicited to include the business of a Board member, those bids are reviewed by the Board of Directors to assure adherence to the Hospital's lowest bid policy. When an issue comes up to a vote and it is connected, in any way, to the business of a Board member, the member must recuse him/herself from the vote. Form 990, Part VI, Section B, line 15a The Organization's executive committee reviews comparative data prepared by a consultant prior to referral of compensation to the board of directors. The board of directors review the findings of the consultant and vote to approve the 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 354,304. Change in Net Assets to Recognize Funded Status of Pension Plan -1,608,873. Change in Beneficial Interest in Perpetual Trusts 127,615. Total to Form 990, Part XI, Line 5: -1,126,954. Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 11b, II N/A 0 Porter Management Services Inc 37 Porter Drive Middlebury VT 05753 030308242 Management Services VT 501(c)(3) Line 11b, II Porter Medical Center Inc 0 Helen Porter Nursing Home Inc DBA Helen Porter Healthcare & Rehab Center 37 Porter Drive Middlebury VT 05753 030306549 Nursing Home VT 501(c)(3) Line 3 Porter Medical Center Inc 0 Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 11b, II Porter Medical Center Inc 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0