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        <Explanation>GIFFORD MEDICAL CENTER, INC. IS A MEMBER OF THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS, THE BI-STATE PRIMARY CARE ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF GIFFORD MEDICAL CENTER AND THE OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. GIFFORD MEDICAL CENTER DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES.</Explanation>
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        <OtherCostOrOtherBasis>25695903</OtherCostOrOtherBasis>
        <Depreciation>16580500</Depreciation>
        <BookValue>9115403</BookValue>
      </Equipment>
      <OtherLandBuildings>
        <OtherCostOrOtherBasis>3097942</OtherCostOrOtherBasis>
        <Depreciation>1285129</Depreciation>
        <BookValue>1812813</BookValue>
      </OtherLandBuildings>
      <TotalOfBookValueLandBuildings>25885445</TotalOfBookValueLandBuildings>
      <FederalIncomeTaxLiability>0</FederalIncomeTaxLiability>
      <OtherLiabilities>
        <Description>EST AMT DUE TO THIRD PARTY</Description>
        <Amount>690965</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>INTEREST RATE SWAP AGREEMENT</Description>
        <Amount>3969343</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>4660308</TotalOfAmounts>
      <TotalRevenue>63734796</TotalRevenue>
      <TotalExpenses>61665394</TotalExpenses>
      <ExcessOrDeficitForYear>2069402</ExcessOrDeficitForYear>
      <NetUnrealizedGLOnInvestments>3013300</NetUnrealizedGLOnInvestments>
      <OtherAmount>-247167</OtherAmount>
      <TotalAdjustments>2766133</TotalAdjustments>
      <ExcessOrDeficitPerFS>4835535</ExcessOrDeficitPerFS>
      <TotRevenueEtcAuditedFinclStmt>63448676</TotRevenueEtcAuditedFinclStmt>
      <NetUnrealizedGainsInvestments>3013300</NetUnrealizedGainsInvestments>
      <OtherRevenues>-3318041</OtherRevenues>
      <RevenueNotRptdF990>-304741</RevenueNotRptdF990>
      <RevenueSubtotal>63753417</RevenueSubtotal>
      <OtherRevenuesNotIncluded>-18621</OtherRevenuesNotIncluded>
      <RevenueNotRptdOnFinStmt>-18621</RevenueNotRptdOnFinStmt>
      <TotalRevenuePerForm990>63734796</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>58613141</TotExpensesEtcAuditedFinclStmt>
      <OtherExpensesIncluded>18621</OtherExpensesIncluded>
      <ExpensesNotRptdF990>18621</ExpensesNotRptdF990>
      <ExpensesSubtotal>58594520</ExpensesSubtotal>
      <InvestmentExpensesNotIncluded2>5721</InvestmentExpensesNotIncluded2>
      <OtherExpensesNotIncluded>3065153</OtherExpensesNotIncluded>
      <ExpensesNotRptdOnFinStmt>3070874</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>61665394</TotalExpensesPerForm990>
      <Form990ScheduleDPartXIV>
        <Identifier>USE OF ENDOWMENT FUNDS</Identifier>
        <ReturnReference>SCHEDULE D, PART V, LINE 4</ReturnReference>
        <Explanation>THE TEMPORARILY RESTRICTED ENDOWMENT NET ASSETS ARE USED FOR HEALTH CARE SERVICES AND CAPITAL. THE PERMANENTLY RESTRICTED ENDOWMENT NET ASSETS ARE USED FOR INDIGENT CARE, COMMUNITY OUTREACH INITIATIVES, NURSING, BUILDINGS, MAINTENANCE AND OPERATIONS.</Explanation>
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      <Form990ScheduleDPartXIV>
        <Identifier>UNCERTAIN TAX POSITIONS</Identifier>
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        <Explanation>MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</Explanation>
      </Form990ScheduleDPartXIV>
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        <Identifier>OTHER RECONCILING CHANGE IN NET ASSETS</Identifier>
        <ReturnReference>SCHEDULE D, PART XI, LINE 8</ReturnReference>
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      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12</Identifier>
        <ReturnReference>SCHEDULE D, PART XII, LINE 2D</ReturnReference>
        <Explanation>$(3,065,153) BAD DEBT EXPENSE ( 247,167) CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT ( 5,721) INVESTMENT MANAGEMENT FEES ------------ $(3,318,041)</Explanation>
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        <ReturnReference>SCHEDULE D, PART XII, LINE 4B</ReturnReference>
        <Explanation>$( 18,621) FUNDRAISING EVENT/GAMING EXPENSES</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25</Identifier>
        <ReturnReference>SCHEDULE D, PART XIII, LINE 2D</ReturnReference>
        <Explanation>$ 18,621 FUNDRAISING EVENT/GAMING EXPENSES</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1</Identifier>
        <ReturnReference>SCHEDULE D, PART XIII, LINE 4B</ReturnReference>
        <Explanation>$ 3,065,153 BAD DEBT EXPENSE</Explanation>
      </Form990ScheduleDPartXIV>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="IRS990ScheduleG">
      <EventsInformation>
        <NameOfEvent1>LAST MILE RIDE</NameOfEvent1>
        <GrossReceiptsEvent1>62135</GrossReceiptsEvent1>
        <CharitableContributionsEvent1>57759</CharitableContributionsEvent1>
        <GrossRevenueEvent1>4376</GrossRevenueEvent1>
        <CashPrizesEvent1>235</CashPrizesEvent1>
        <NonCashPrizesEvent1>1977</NonCashPrizesEvent1>
        <RentFacilityCostsEvent1>2598</RentFacilityCostsEvent1>
        <FoodAndBeverageEvent1>1215</FoodAndBeverageEvent1>
        <OtherDirectExpensesEvent1>8346</OtherDirectExpensesEvent1>
        <TotalNumberOfOtherEvents>0</TotalNumberOfOtherEvents>
        <GrossReceiptsTotal>62135</GrossReceiptsTotal>
        <CharitableContributionsTotal>57759</CharitableContributionsTotal>
        <GrossRevenueTotalEvents>4376</GrossRevenueTotalEvents>
        <CashPrizesTotalEvents>235</CashPrizesTotalEvents>
        <NonCashPrizesTotalEvents>1977</NonCashPrizesTotalEvents>
        <RentFacilityCostsTotalEvents>2598</RentFacilityCostsTotalEvents>
        <FoodAndBeverageTotalEvents>1215</FoodAndBeverageTotalEvents>
        <OtherDirectExpensesTotalEvents>8346</OtherDirectExpensesTotalEvents>
        <DirectExpenseSummaryEvents>14371</DirectExpenseSummaryEvents>
        <NetIncomeSummary>-9995</NetIncomeSummary>
      </EventsInformation>
    </IRS990ScheduleG>
    <IRS990ScheduleH documentId="IRS990ScheduleH">
      <CharityCarePolicy>true</CharityCarePolicy>
      <WrittenPolicy>true</WrittenPolicy>
      <PolicyAppliedToAllHospitals>X</PolicyAppliedToAllHospitals>
      <FPGReferenceFreeCare>true</FPGReferenceFreeCare>
      <OtherPercentage>
        <Other>X</Other>
        <FreeOtherPercentage>225.</FreeOtherPercentage>
      </OtherPercentage>
      <FPGReferenceDiscountedCare>true</FPGReferenceDiscountedCare>
      <Pcent300>X</Pcent300>
      <FreeDiscCareMedicallyIndigent>true</FreeDiscCareMedicallyIndigent>
      <AmountsBudgetedForCharityCare>true</AmountsBudgetedForCharityCare>
      <ExpensesExceededBudget>false</ExpensesExceededBudget>
      <AnnualCommunityBenefitReport>false</AnnualCommunityBenefitReport>
      <CharityCareAtCost>
        <TotalCommunityBenefitExpense>435791</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>435791</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00740</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <TotalCommunityBenefitExpense>9051471</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8259443</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>792028</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.01350</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <TotalCharityCare>
        <TotalCommunityBenefitExpense>9487262</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8259443</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>1227819</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.02090</PercentOfTotalExpense>
      </TotalCharityCare>
      <CommunityHealthServices>
        <TotalCommunityBenefitExpense>824961</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>338747</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>486214</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00830</PercentOfTotalExpense>
      </CommunityHealthServices>
      <HealthProfessionsEducation>
        <TotalCommunityBenefitExpense>52585</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>52585</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00090</PercentOfTotalExpense>
      </HealthProfessionsEducation>
      <SubsidizedHealthServices>
        <TotalCommunityBenefitExpense>10459358</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8238996</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2220362</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.03790</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <TotalOtherBenefits>
        <TotalCommunityBenefitExpense>11336904</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8577743</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2759161</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.04710</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <TotalCommunityBenefitExpense>20824166</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>16837186</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>3986980</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.06800</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <EconomicDevelopment>
        <TotalCommunityBuildingExpense>321</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>321</NetCommunityBuildingExpense>
      </EconomicDevelopment>
      <LeadershipDevelopment>
        <TotalCommunityBuildingExpense>749</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>749</NetCommunityBuildingExpense>
      </LeadershipDevelopment>
      <WorkforceDevelopment>
        <TotalCommunityBuildingExpense>235</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>235</NetCommunityBuildingExpense>
      </WorkforceDevelopment>
      <Total>
        <TotalCommunityBuildingExpense>1305</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>1305</NetCommunityBuildingExpense>
      </Total>
      <BadDebtExpenseReported>true</BadDebtExpenseReported>
      <BadDebtExpenseAmount>3065153</BadDebtExpenseAmount>
      <AmountAttributableTo>324906</AmountAttributableTo>
      <AmountReimbursedByMedicare>17137100</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>16572792</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>564308</MedicareSurplusOrShortfall>
      <CostingMethodologyUsed>
        <CostToChargeRatio>X</CostToChargeRatio>
      </CostingMethodologyUsed>
      <WrittenDebtCollectionPolicy>true</WrittenDebtCollectionPolicy>
      <ProvisionForCharityCare>true</ProvisionForCharityCare>
      <NumberOfHospitalFacilities>1</NumberOfHospitalFacilities>
      <Form990ScheduleHPartVSectionA>
        <FacilityNumber>1</FacilityNumber>
        <Name>
          <BusinessNameLine1>GIFFORD MEDICAL CENTER INC</BusinessNameLine1>
        </Name>
        <Address>
          <AddressLine1>PO BOX 2000</AddressLine1>
          <City>RANDOLPH</City>
          <State>VT</State>
          <ZIPCode>05060</ZIPCode>
        </Address>
        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
        <CriticalAccessHospital>X</CriticalAccessHospital>
        <Er24Hours>X</Er24Hours>
      </Form990ScheduleHPartVSectionA>
      <Form990ScheduleHPartVSectionB>
        <HospitalFacilityName>
          <BusinessNameLine1>GIFFORD MEDICAL CENTER INC</BusinessNameLine1>
        </HospitalFacilityName>
        <HospitalFacilityNumber>1</HospitalFacilityNumber>
        <EligibilityCriteriaExplained>true</EligibilityCriteriaExplained>
        <UsesFPGFree>true</UsesFPGFree>
        <FPGFreePercent>225.</FPGFreePercent>
        <UsesFPGDiscounted>true</UsesFPGDiscounted>
        <FPGDiscountPercent>300.</FPGDiscountPercent>
        <ExplainsBasis>true</ExplainsBasis>
        <IncomeLevel>X</IncomeLevel>
        <MedicalIndigency>X</MedicalIndigency>
        <InsuranceStatus>X</InsuranceStatus>
        <MedicaidMedicare>X</MedicaidMedicare>
        <StateRegulation>X</StateRegulation>
        <ExplainsApplicationMethod>true</ExplainsApplicationMethod>
        <IncludesPublicityMeasures>true</IncludesPublicityMeasures>
        <PostedOnWebsite>X</PostedOnWebsite>
        <PostedInEmergencyRoom>X</PostedInEmergencyRoom>
        <PostedInAdmissionOffice>X</PostedInAdmissionOffice>
        <AvailableOnRequest>X</AvailableOnRequest>
        <OtherPublicity>X</OtherPublicity>
        <ActionsOnNonpayment>true</ActionsOnNonpayment>
        <CollectionActivities>false</CollectionActivities>
        <NotifyUponAdmission>X</NotifyUponAdmission>
        <NotifyBeforeDischarge>X</NotifyBeforeDischarge>
        <NotifiedAllPatients>X</NotifiedAllPatients>
        <DocumentedDetermination>X</DocumentedDetermination>
        <NondiscrimEmergencyCarePolicy>true</NondiscrimEmergencyCarePolicy>
        <MedicareRate>X</MedicareRate>
        <AmountsGenerallyBilled>false</AmountsGenerallyBilled>
        <GrossCharges>false</GrossCharges>
      </Form990ScheduleHPartVSectionB>
      <Form990ScheduleHPartVI>
        <Identifier>PERCENT OF TOTAL EXPENSE</Identifier>
        <ReturnReference>SCHEDULE H, PART I, LINE 7, COLUMN F</ReturnReference>
        <Explanation>TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SUBSIDIZED SERVICES</Identifier>
        <ReturnReference>SCHEDULE H, PART I, LINE 7G</ReturnReference>
        <Explanation>THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHC) IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G, WITH A NET SUBSIDY FROM RHCS OF $2,032,811. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. GIFFORD MEDICAL CENTER CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COSTING METHODOLOGY</Identifier>
        <ReturnReference>SCHEDULE H, PART I, LINE 7G</ReturnReference>
        <Explanation>THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 6.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COMMUNITY BUILDING ACTIVITIES</Identifier>
        <ReturnReference>SCHEDULE H, PART II</ReturnReference>
        <Explanation>INCLUDED IN PART II AS COMMUNITY BUILDING ACTIVITIES, ARE THE VERMONT LAW SCHOOL DIVERSITY DAY, HARTFORD HIGH SCHOOL CAREER CENTER, VERMONT WOMEN'S ECONOMIC OPPORTUNITY CONFERENCE, AND A CAREER DAY. THESE ACTIVITIES PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, INCLUDING POVERTY, HOMELESSNESS, AND UNEMPLOYMENT.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>BAD DEBT EXPENSE</Identifier>
        <ReturnReference>SCHEDULE H, PART III, SECTION A, LINE 4</ReturnReference>
        <Explanation>THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ORGANIZATION CALCULATED BAD DEBT USING THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS PER THE AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COMMUNITY BENEFIT</Identifier>
        <ReturnReference>SCHEDULE H, PART III, SECTION B, LINE 8</ReturnReference>
        <Explanation>SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COLLECTION POLICY</Identifier>
        <ReturnReference>SCHEDULE H, PART III, SECTION C, LINE 9B</ReturnReference>
        <Explanation>THE APPLICATION FOR AND APPROVAL OF FINANCIAL ASSISTANCE CAN OCCUR BEFORE, DURING OR AFTER TREATMENT SO LONG AS THE ACCOUNT HAS NOT BEEN WRITTEN OFF TO BAD DEBT PRIOR TO RECEIPT OF A COMPLETED APPLICATION AND THE NECESSARY DOCUMENTATION. ACCOUNTS SENT TO BAD DEBT AFTER REQUIRED INFORMATION HAS BEEN RECEIVED CAN BE RETURNED FROM COLLECTIONS FOR PROCESSING WITHOUT PENALTY TO THE APPLICANT. GIFFORD MEDICAL CENTER, INC., ENCOURAGES THE APPLICATION PROCESS TO BEGIN AS EARLY AS POSSIBLE.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>MEASURES TO PUBLICIZE THE POLICY</Identifier>
        <ReturnReference>SCHEDULE H, PART V, LINE 13</ReturnReference>
        <Explanation>GIFFORD MEDICAL CENTER CONTACTS ANY UNINSURED PATIENTS THAT REGISTER WITH THE HOSPITAL TO SEE IF THEY ARE IN NEED OF FINANCIAL ASSISTANCE.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>NEEDS ASSESSMENT</Identifier>
        <Explanation>IDENTIFYING AND MEETING THE COMMUNITY'S HEALTH CARE NEEDS WOULD NOT BE POSSIBLE WITHOUT INPUT FROM THE PUBLIC. GIFFORD MEDICAL CENTER PROVIDES AMPLE OPPORTUNITIES FOR THE PUBLIC TO PROVIDE BOTH INPUT AND ACTIVELY PARTICIPATE IN MEDICAL CENTER ACTIVITIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, ANNUAL HOSPITAL REPORT CARD MEETINGS, PATIENT SATISFACTION SURVEYS AND ONE-ON-ONE COMMENTS TO HOSPITAL STAFF AND BOARD MEMBERS HELP DIRECT STRATEGIC PLANNING AND OPERATIONAL DECISIONS. EVERY THREE YEARS, GIFFORD ENGAGES IN AN EXTENSIVE STRATEGIC PLANNING PROCESS THAT RESULTS IN THE IDENTIFICATION AND IMPLEMENTATION OF A LIST OF INITIATIVES THE HOSPITAL STRIVES TO ACHIEVE OVER THE COMING THREE YEARS. SUCCESS AT ACHIEVING THOSE INITIATIVES THROUGHOUT, AND BY THE CONCLUSION, OF THE THREE-YEAR PERIOD IS EXTENSIVELY MONITORED BY THE HOSPITAL'S LEADERS, INCLUDING ITS VOLUNTEER BOARD OF TRUSTEES.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE</Identifier>
        <Explanation>PATIENTS ARE ADVISED OF COMMUNITY OUTREACH AND ARE ENCOURAGED TO SET UP AN APPOINTMENT TO MEET WITH THE APPROPRIATE GIFFORD MEDICAL CENTER PERSONNEL. THE PATIENTS ARE ALSO DIRECTED TO GMC'S WEBSITE FOR AN EXPLANATION OF THE FREE CARE POLICY PROCESS.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COMMUNITY INFORMATION</Identifier>
        <Explanation>IN ADDITION TO THE CLINICAL OFFICES LOCATED ON THE ORGANIZATION'S MAIN CAMPUS IN RANDOLPH, VERMONT, THE ORGANIZATION OPERATES COMMUNITY HEALTH CARE CENTERS LOCATED IN BETHEL, CHELSEA, ROCHESTER, SHARON, BERLIN, RANDOLPH, AND WHITE RIVER JUNCTION, VERMONT. THE RANDOLPH/BAINTREE AREA PROVIDES THE MOST VISITS AND IS LOCATED IN ORANGE COUNTY, VERMONT. ORANGE COUNTY DEMOGRAPHICS SHOW APPROXIMATELY 16.2% OVER THE AGE OF 65 AND 20.1% UNDER 18 YEARS. OVER 97% ARE WHITE, WITH 50.2% FEMALE. THE AVERAGE HOUSEHOLD INCOME IS $52,407, WITH THE POVERTY LEVEL AT 10.6%, COMPARED TO THE STATE'S 11.3%.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PROMOTION OF COMMUNITY HEALTH</Identifier>
        <Explanation>AS A COMMUNITY HOSPITAL, GIFFORD MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE WE SERVE BY PROVIDING AND ASSURING ACCESS TO AFFORDABLE AND HIGH-QUALITY HEALTH CARE, AND BY PROMOTING THE HEALTH AND WELL-BEING OF EVERYONE IN OUR SERVICE AREA. WE OFFER DIAGNOSTIC TECHNOLOGIES THAT INCLUDE A 64-SLICE CT SCANNER, A MOBILE MRI UNIT, A FILMLESS RADIOLOGY SYSTEM, DIGITAL MAMMOGRAPHY AND STEREOTACTIC BREAST BIOPSIES. OUR 25-BED CRITICAL ACCESS HOSPITAL HAS A BIRTHING CENTER THAT IS RECOGNIZED AROUND THE STATE. WE HAVE A 24-HOUR EMERGENCY DEPARTMENT, A 30-BED NURSING HOME WITH AN EXTENSIVE WAITING LIST AND NUMEROUS QUALITY AWARDS TO ITS CREDIT, A CHILDCARE CENTER, AN ADULT DAY PROGRAM AND SO MUCH MORE. WE'RE EXTREMELY PROUD OF THOSE ADDITIONS, OUR PROGRESSIVE CAN-DO ATTITUDE, AND OUR FINANCIAL STABILITY. THE FOLLOWING ARE THE ACTIVITIES FOR 2012: AS PART OF GIFFORD'S EXPANDED EFFORTS UNDER THE VERMONT BLUEPRINT FOR HEALTH, A CHRONIC ILLNESS SUPPORT GROUP - CHRONIC HEALTHSHARE CONSORTIUM - IS LAUNCHED AND BEGINS MEETING MONTHLY. THE MENIG EXTENDED CARE FACILITY IS NAMED AMONG NATION'S TOP 39 NURSING HOMES BY U.S. NEWS AND WORLD REPORT, WHICH RELEASED A LIST OF "2012 HONOR ROLL" NURSING HOMES. MENIG WAS THE ONLY NURSING HOME CHOSEN IN VERMONT AND NEIGHBORING NEW HAMPSHIRE. A VERMONT HOUSE OF REPRESENTATIVES RESOLUTION RECOGNIZES "THE OUTSTANDING HEALTH CARE SERVICES PROVIDED BY GIFFORD MEDICAL CENTER. THE RESOLUTION IS IN HONOR OF GIFFORD'S MORE THAN 100 YEARS OF SERVICE TO THE RANDOLPH AREA AND FOR ITS MANY RECENT AWARDS. THE DIABETES EDUCATION EXPO FOCUSES ON TEETH AND FEET AND HOW DIABETICS CAN KEEP BOTH HEALTHY. IT IS THE 7TH ANNUAL EXPOSITION ORGANIZED BY THE DIABETES CLINIC ESPECIALLY FOR THE GROWING DIABETES POPULATION. THE BLUEPRINT TEAM GROWS TO INCLUDE A BEHAVIORAL HEALTH SPECIALIST (SOCIAL WORKER) AND A SECOND CARE COORDINATOR. GOV. PETER SHUMLIN VISITS THE MENIG EXTENDED CARE FACILITY TO OFFER THANKS TO THE STATE'S TOP NURSING HOME, CALLING IT A "TRIBUTE TO THE COMMUNITY. "WE'RE PROUD OF YOU. THANK YOU FROM THE BOTTOM OF OUR HEARTS," THE GOVERNER SAID TO RESIDENTS, FAMILIES AND STAFF MEMBERS. THE GOVERNOR'S VISIT CAME IN THE WAKE OF THE U.S. NEWS REPORT "2012 HONOR ROLL" LISTING. GIFFORD PROVIDES FREE ASSISTANCE WITH ADVANCE DIRECTIVES IN CONJUNCTION WITH NATIONAL HEALTHCARE DECISIONS DAY. LONG-TIME PEDIATRICIAN DR. LOU DINICOLA RECEIVES A NATIONAL AWARD FOR HIS WORK AROUND CHILDHOOD IMMUNIZATIONS. DR. DINICOLA IS RECOGNIZED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S NATIONAL CENTER FOR IMMUNIZATION AND RESPIRATORY DISEASES AND THE CDC FOUNDATION AS THE FIRST EVER "CDC CHILDHOOD IMMUNIZATION CHAMPION FOR THE STATE OF VERMONT. FOR AN EIGHTH CONSECUTIVE YEAR, THE MENIG EXTENDED CARE FACILITY RECEIVES A NURSING HOME QUALITY RECOGNITION FROM THE VERMONT DEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING. A FREE TALK ON MEDICARE INSURANCE, WHY IT'S IMPORTANT. WHY PARTICIPATING IN MEDICARE PART B IS BENEFICIAL AND WHAT ONE'S CHOICES ARE UNDER MEDICARE PART D IS OFFERED. THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS GRANTS ACCREDITATION WITH COMMENDATION TO THE CANCER PROGRAM AT GIFFORD. GIFFORD'S CANCER PROGRAM, WHICH INCLUDES OUTPATIENT CHEMOTHERAPY, HAS BEEN ACCREDITED SINCE 1965. GIFFORD IS AWARDED A HOSPITAL OF CHOICE AWARD FROM THE AMERICAN ALLIANCE OF HEALTHCARE PROVIDERS FOR "COURTEOUS, COMPASSIONATE AND CARING SERVICES FOR PATIENTS, FAMILY AND THE COMMUNITY: THE RANKING PLACES GIFFORD AMONG "AMERICA'S MOST CUSTOMER-FRIENDLY HOSPITALS." FREE CLASSES ARE OFFERED AND SOON A SUPPORT GROUP STARTS FOR THE STATE'S MANY HOME CAREGIVERS. HEALTHIER LIVING WORKSHOPS - FREE SIX-WEEK CLASSES FOR THE CHRONICALLY ILL - ARE OFFERED THROUGH THE YEAR AT GIFFORD. A NEW WORKSHOP FOCUSES ON CHRONIC PAIN. FOOD CHOICES IN THE GIFFORD CAFETERIA GET EVEN HEALTHIER AS THE HOSPITAL TRANSITIONS TO A HEALTHY BREAKFAST BAR; HEALTHIER, LOWER SALT MEATS; LESS BUTTER AND HEAVY CREAM IN FOODS; AND MORE GRAINS AND LEGUMES AS STARCHES. THE CT SCANNER IS UPGRADED FROM A 40-SLICE MODEL TO A 64-SLICE MODEL, OFFERING PATIENTS FASTER SERVICE, CLEARER IMAGING AND LESS RADIATION. A NEW SYSTEM, A CAREPOINT WORKSTATION, FOR TRANSMITTING EKGS FROM AMBULANCES IN THE FIELD TO THE GIFFORD EMERGENCY DEPARTMENT IS BROUGHT ONLINE. THE SYSTEM, GENEROUSLY PAID FOR BY THE GIFFORD AUXILIARY, IS FOR USE WITH HEART ATTACK PATIENTS TO DETERMINE IF THEY SHOULD BE BROUGHT TO GIFFORD OR DIRECTLY TO A CARDIAC CATHETERIZATION LAB AT DARTMOUTH-HITCHCOCK MEDICAL CENTER OR FLETCHER ALLEN HEALTH CARE. ALL GIFFORD GROUNDS GO SMOKE-FREE IN CONCERT WITH THE GREAT AMERICAN SMOKE OUT ON NOV. 15.</Explanation>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
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        <NamePerson>STEVEN J FISHER MD</NamePerson>
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      <Form990ScheduleJPartII>
        <NamePerson>JON-RICHARD KNOFF MD</NamePerson>
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      </Form990ScheduleJPartII>
      <Form990ScheduleJPartIII>
        <Identifier>COMPENSATION CONTINGENT ON REVENUES</Identifier>
        <ReturnReference>SCHEDULE J, PART I, LINE 5A</ReturnReference>
        <Explanation>IN ADDITION TO THEIR SALARIES, PHYSICIANS EMPLOYED BY GIFFORD MEDICAL CENTER, INC. RECEIVE A YEAR-END BONUS ON PRODUCTIVITY OR RVU'S.</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="IRS990ScheduleK">
      <Form990ScheduleKPartI>
        <IssuerName>
          <BusinessNameLine1>VERMONT EDUCATIONAL &amp; HEALTH BUILDING FINANCING AG</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>237154467</IssuerEIN>
        <CUSIPNumber>9241608B3</CUSIPNumber>
        <DateIssued>2010-09-01</DateIssued>
        <IssuePrice>20430000</IssuePrice>
        <DescriptionOfPurpose>TO FINANCE GIFFORD'S CAPITAL PROJE</DescriptionOfPurpose>
        <Defeased>false</Defeased>
        <OnBehalfOfIssuer>false</OnBehalfOfIssuer>
        <PoolFinancing>false</PoolFinancing>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartII>
        <AmountRetired>0</AmountRetired>
        <AmountBondDefeased>0</AmountBondDefeased>
        <TotalProceeds>20430000</TotalProceeds>
        <AmountInReserveFund>0</AmountInReserveFund>
        <CapitalizedInterest>0</CapitalizedInterest>
        <RefundingEscrow>20310307</RefundingEscrow>
        <IssuanceCostsFromProceeds>119693</IssuanceCostsFromProceeds>
        <CreditEnhancement>0</CreditEnhancement>
        <WorkingCapitalExpenditures>0</WorkingCapitalExpenditures>
        <CapitalExpenditures>0</CapitalExpenditures>
        <OtherSpentProceeds>0</OtherSpentProceeds>
        <AmountUnspent>0</AmountUnspent>
        <YearOfSubstCompletion>2010</YearOfSubstCompletion>
        <CurrentRefunding>true</CurrentRefunding>
        <AdvanceRefunding>false</AdvanceRefunding>
        <FinalAllocationMade>true</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>true</AdequateBooksAndRecdsMaintaind>
      </Form990ScheduleKPartII>
      <Form990ScheduleKPartIII>
        <OwningBondFinancedProperty>false</OwningBondFinancedProperty>
        <AnyLeaseArrangements>false</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>false</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>false</AnyResearchAgreements>
        <PrcntgePrvtBusinessUseByOthers>0</PrcntgePrvtBusinessUseByOthers>
        <PostIssuanceComplianceProcdrs>true</PostIssuanceComplianceProcdrs>
      </Form990ScheduleKPartIII>
      <Form990ScheduleKPartIV>
        <Form8038TFiled>false</Form8038TFiled>
        <VariableRateIssue>true</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>true</HedgeIdentifiedInBooksAndRecds>
        <NameOfHedgeProvider>
          <BusinessNameLine1>DEUTSCHE BANK</BusinessNameLine1>
        </NameOfHedgeProvider>
        <TermOfHedge>26.</TermOfHedge>
        <SuperintegratedHedge>false</SuperintegratedHedge>
        <HedgeTerminated>false</HedgeTerminated>
        <GrossProceedsInvestedInGIC>false</GrossProceedsInvestedInGIC>
        <NameOfGICProvider>
          <BusinessNameLine1>0</BusinessNameLine1>
        </NameOfGICProvider>
        <GrossProceedsInvested>false</GrossProceedsInvested>
        <ExceptionToRebate>false</ExceptionToRebate>
      </Form990ScheduleKPartIV>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="IRS990ScheduleL">
      <TotalBalanceDue>0</TotalBalanceDue>
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>RANDOLPH COAL OIL CO</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>SEE PART V.</Relationship>
        <AmountOfTransaction>433836</AmountOfTransaction>
        <DescriptionOfTransaction>SEE PART V.</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
      </Form990ScheduleLPartIV>
      <Form990ScheduleLPartV>
        <Identifier>BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS</Identifier>
        <ReturnReference>SCHEDULE L, PART IV, LINE 1</ReturnReference>
        <Explanation>KAREN GILLESPIE KORROW, GMC BOARD MEMBER, IS THE OWNER OF RANDOLPH COAL &amp; OIL CO., FROM WHICH GMC PURCHASED FUEL AT FMV DURING THE YEAR.</Explanation>
      </Form990ScheduleLPartV>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <GeneralExplanation>
        <Identifier>OTHER PROGRAM SERVICE ACCOMPLISHMENTS</Identifier>
        <ReturnReference>FORM 990, PART III, LINE 4D</ReturnReference>
        <Explanation>GIFFORD MEDICAL CENTER OFFERS VARIOUS OTHER HEALTH CARE SERVICES TO THE CENTRAL VERMONT AREA. OTHER SERVICES AVAILABLE INCLUDE ANESTHESIOLOGY, RADIOLOGY, LABORATORY, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, ELECTROCARDIOLOGY, CHEMOTHERAPY, EMERGENCY, SKILLED NURSING, LABOR AND DELIVERY, NURSERY, RADIOISOTOPE, AND ELECTROENCEPHALOGRAPHY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>ORGANIZATION'S MEMBERS</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINES 6, 7A, &amp; 7B</ReturnReference>
        <Explanation>THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF THOSE PERSONS SERVING AS CORPORATORS. TO BE ELIGIBLE TO SERVE AS A CORPORATOR, AN INDIVIDUAL MUST SUPPORT THE MISSION AND PURPOSES OF THE ORGANIZATION. CORPORATORS ARE NOMINATED BY THE NOMINATING COMMITTEE AND ELECTED BY MAJORITY VOTE OF THE CORPORATORS PRESENT AT THE ANNUAL MEETING OF THE CORPORATORS, AND SERVE A TERM OF THREE YEARS. THE CORPORATORS SHALL ELECT TRUSTEES OF THE ORGANIZATION, WHO MANAGE AND CONDUCT THE AFFAIRS OF THE ORGANIZATION. THE CORPORATORS MAKE NO OTHER GOVERNANCE DECISIONS FOR THE ORGANIZATION, NOR ARE THE DECISIONS OF THE BOARD OF TRUSTEES SUBJECT TO APPROVAL BY THE CORPORATORS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>REVIEW OF THE FORM 990</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 11B</ReturnReference>
        <Explanation>THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FIRST REVIEWS THE FORM 990. THEN THE FULL BOARD OF TRUSTEES REVIEWS THE FORM 990 AT ONE OF THE BOARD MEETINGS BEFORE FILING.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>CONFLICT OF INTEREST POLICY</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>GIFFORD MEDICAL CENTER, INC. REQUIRES BOARD MEMBERS TO COMPLETE A YEARLY CONFLICT OF INTEREST SURVEY. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY TRUSTEE SHALL BE DISCLOSED TO THE OTHER BOARD MEMBERS. ANY TRUSTEE HAVING DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE PRESENT FOR DISCUSSION OF THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE AND THAT THE TRUSTEE ABSTAINED FROM VOTING AND DISCUSSION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>COMPENSATION REVIEW</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINES 15A &amp; 15B</ReturnReference>
        <Explanation>GIFFORD USES A BOARD COMPENSATION COMMITTEE WITH INPUT AND DATA FROM AN INDEPENDENT SOURCE. THE EVALUATION AND RECOMMENDATION IS THEN PRESENTED TO THE BOARD OF TRUSTEES FOR APPROVAL. TO EVALUATE THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES, THE COMPENSATION REVIEW IS ADMINISTERED BY HUMAN RESOURCES AND THE CEO. THE HUMAN RESOURCES DEPARTMENT HAS SOME INTERNAL AND EXTERNAL SOURCES THAT ARE UTILIZED TO COMPARE COMPENSATION AMOUNTS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>DOCUMENT DISCLOSURE</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE, ANOTHER'S WEBSITE AND UPON REQUEST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER CHANGES IN NET ASSETS</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 5</ReturnReference>
        <Explanation>$ 3,013,300 NET UNREALIZED GAIN ON INVESTMENTS ( 247,167) CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT ------------ $ 2,766,133</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
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        <NameOfDisregardedEntity>
          <BusinessNameLine1>GIFFORD HEALTH CARE INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>44 SOUTH MAIN STREET</AddressLine1>
          <City>RANDOLPH</City>
          <State>VT</State>
          <ZIPCode>05060</ZIPCode>
        </AddressUS>
        <EIN>460938716</EIN>
        <PrimaryActivities>PARENT</PrimaryActivities>
        <LegalDomicileState>VT</LegalDomicileState>
        <ExemptCodeSection>APPLIED FOR</ExemptCodeSection>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
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      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
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      <PerformOfServicesByOtherOrgs>false</PerformOfServicesByOtherOrgs>
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      <SharingOfPaidEmployees>false</SharingOfPaidEmployees>
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      <ReimbursementPaidByOtherOrg>false</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
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</Return>