COPLEY HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COPLEY HOSPITAL INC (EIN 03-0179423)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-03-13
- IRS object ID
- 201240739349300819
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-13T10:56:20-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030179423 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COPL | NameControl |
| Phone | 8028884231 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Melvyn Patashnick | Name |
| Title | CEO | Title |
| Phone | 8028884231 | Phone |
| Date Signed | 2012-03-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Barbara J McGuan CPA | Name |
| Phone | 2077752387 | Phone |
| Date Prepared | 2012-03-05 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Melvyn Patashnick | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 50134497 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.copleyhealthsystems.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1934 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 530 | TotalNbrEmployees |
| Total Nbr Volunteers | 112 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 211733 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1479616 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 45564271 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 48281768 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 45023 | InvestmentIncomePriorYear |
| Investment Income Current Year | 301547 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 104609 | OtherRevenuePriorYear |
| Other Revenue Current Year | 69691 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 45925636 | TotalRevenuePriorYear |
| Total Revenue Current Year | 50132622 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 191667 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 412292 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 25305047 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 26806788 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 19202427 | OtherExpensePriorYear |
| Other Expenses Current Year | 20335254 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 44699141 | TotalExpensesPriorYear |
| Total Expenses Current Year | 47554334 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1226495 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2578288 | RevenuesLessExpensesCY |
| Total Assets BOY | 32180471 | TotalAssetsBOY |
| Total Assets EOY | 33665149 | TotalAssetsEOY |
| Total Liabilities BOY | 11636406 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10421163 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20544065 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 23243986 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | To oversee and coordinate the provision of services, to provide leadership in implementing the vision promoting wellness and to assure clear access to services regardless of ability to pay. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 43058251 | Expense |
| Grants | 412292 | Grants |
| Revenue | 48281768 | Revenue |
| Description | Copley Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement is critical to the hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Further, our mission is to serve the community with respect to providing healthcare services and healthcare education in keeping with the hospital's commitment to serve all members of its community. The Hospital offers free care and or subsidized care, care provided to persons covered by governmental programs at below cost, and health activities and programs to support the community and are considered where the need and/or individual's inability to pay coexists. These activities include a variety of services in the form of seminars, workshops, clinics, and screenings at minimal or no charge. | Description |
| Total Program Service Expense | 43058251 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 93 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 530 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kevin Dorain | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8028884231 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Michael Alexander | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Bryce Breton | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Brian Coles | |||||||
| Past Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Willa Farrell | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Elaine Nichols | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Nancy Putnam | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Elizabeth Rouse | |||||||
| Chair | 2.00 | X | 0 | 0 | 0 | X | |
| Jan Roy | |||||||
| Past Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Judy Shanley | |||||||
| Trustee/Auxiliary President | 2.00 | X | 0 | 0 | 0 | ||
| Brian Smale MD | |||||||
| Trustee | 2.00 | X | 312231 | 0 | 0 | ||
| John Steel | |||||||
| Treasurer | 2.00 | X | 0 | 0 | 0 | X | |
| Anne Vitaletti-Coughlin MD | |||||||
| Secretary | 2.00 | X | 0 | 0 | 0 | X | |
| Dana Wildes | |||||||
| Vice Chair | 2.00 | X | 0 | 0 | 0 | X | |
| Mark Woodward | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| David Yacovone | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Melvyn Patashnick | |||||||
| President and CEO | 40.00 | X | 259084 | 0 | 31415 | X | |
| Sharon Green | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Patrick Keith | |||||||
| Trustee/Med. Staff Pres. | 2.00 | X | 5913 | 0 | 0 | ||
| Rassoul Rangaviz | |||||||
| CFO | 40.00 | 164599 | 0 | 29542 | X | ||
| Bryan Huber MD | |||||||
| Physician | 40.00 | 668234 | 0 | 39092 | X | ||
| Eric Mullins MD | |||||||
| Physician | 40.00 | 527528 | 0 | 37423 | X | ||
| John Kaeding MD | |||||||
| Chief ER Physician | 40.00 | 276544 | 0 | 33980 | X | ||
| Neil Nigro MD | |||||||
| Physician | 40.00 | 240661 | 0 | 34336 | X | ||
| Mirjam McCormack | |||||||
| Physician | 40.00 | 299470 | 0 | 38947 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2754264 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 244735 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HP Cummings Construction Co | |||||
| PO Box 269 | Woodsville | NH | 037850269 | Building Contractor | 1093565 |
| Apogee Medical Equipment | |||||
| 2525 E Camelback Road Suite 1100 | Phoenix | AZ | 85016 | Hospitalist Services | 421822 |
| Fletcher Allen Health Care | |||||
| PO Box 1902 | Burlington | VT | 054021902 | Medical Services | 409019 |
| CPSG Inc | |||||
| PO Box 749 | Morrisville | VT | 05561 | Medical Services | 408485 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Physician Services | 320002 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Related Organizations | 1479366 | RelatedOrganizations |
| All Other Contributions | 250 | AllOtherContributions |
| Total Contributions | 1479616 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Net Patient Revenue | 621400 | 49173073 | 49173073 | |
| Cafeteria Revenue | 900099 | 282629 | $282,629 | |
| Miscellaneous Revenue | 621400 | 273589 | $273,589 | |
| Management Fees | 900099 | 118000 | $118,000 | |
| Provision for Bad Debt | 621400 | -1565523 | -1565523 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 48281768 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92665 | TotalRevenueColumn |
| Exclusion | $92,665 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 69691 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 69691 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 69691 | TotalRevenueColumn |
| Exclusion | $69,691 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 210757 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1875 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 208882 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 208882 | TotalRevenueColumn |
| Exclusion | $208,882 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 50132622 | TotalRevenueColumn |
| Related Or Exempt Function Income | 47607550 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,045,456 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 412292 | Total |
| Program Services | 412292 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 802784 | Total |
| Program Services | 318144 | ProgramServices |
| Management And General | 484640 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21103638 | Total |
| Program Services | 19448101 | ProgramServices |
| Management And General | 1655537 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 568455 | Total |
| Program Services | 528135 | ProgramServices |
| Management And General | 40320 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2874664 | Total |
| Program Services | 2637500 | ProgramServices |
| Management And General | 237164 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1457247 | Total |
| Program Services | 1316499 | ProgramServices |
| Management And General | 140748 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73731 | Total |
| Management And General | 73731 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44303 | Total |
| Management And General | 44303 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5870535 | Total |
| Program Services | 5245568 | ProgramServices |
| Management And General | 624967 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158522 | Total |
| Management And General | 158522 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7798893 | Total |
| Program Services | 7286911 | ProgramServices |
| Management And General | 511982 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1580953 | Total |
| Program Services | 1251306 | ProgramServices |
| Management And General | 329647 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60043 | Total |
| Program Services | 35643 | ProgramServices |
| Management And General | 24400 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72086 | Total |
| Program Services | 72086 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1806447 | Total |
| Program Services | 1683749 | ProgramServices |
| Management And General | 122698 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 525300 | Total |
| Program Services | 477876 | ProgramServices |
| Management And General | 47424 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Provider Tax Expense | Description |
| Total | 2344441 | Total |
| Program Services | 2344441 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47554334 | Total |
| Program Services | 43058251 | ProgramServices |
| Management And General | 4496083 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2425 | BOY |
| EOY | 2375 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9850724 | BOY |
| EOY | 10004309 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3453598 | BOY |
| EOY | 3757799 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1686877 | BOY |
| EOY | 1757339 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 975034 | BOY |
| EOY | 1174467 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 32442806 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20622600 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11629463 | BOY |
| EOY | 11820206 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3782207 | BOY |
| EOY | 3903840 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62121 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 738022 | BOY |
| EOY | 1244814 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32180471 | BOY |
| EOY | 33665149 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5600873 | BOY |
| EOY | 4479424 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 503 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3775000 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 3393972 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2260030 | BOY |
| EOY | 2547767 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11636406 | BOY |
| EOY | 10421163 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16756858 | BOY |
| EOY | 19340146 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91431 | BOY |
| EOY | 110214 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3695776 | BOY |
| EOY | 3793626 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20544065 | BOY |
| EOY | 23243986 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32180471 | BOY |
| EOY | 33665149 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2578288 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 121633 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $18,434 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 18434 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 158876 | OtherCostOrOtherBasis |
| Book Value | 158876 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16154089 | OtherCostOrOtherBasis |
| Depreciation | 9149806 | Depreciation |
| Book Value | 7004283 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15465777 | OtherCostOrOtherBasis |
| Depreciation | 11099025 | Depreciation |
| Book Value | 4366752 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 664064 | OtherCostOrOtherBasis |
| Depreciation | 373769 | Depreciation |
| Book Value | 290295 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11820206 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Beneficial Interest in Net Assets of Copley Health Systems, Inc. | Description |
| Book Value | 3903840 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3903840 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Deferred Compensation | $747,767 |
| Estimated Third Party Payor Settlements | $1,800,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2547767 | TotalOfAmounts |
| Total Revenue | 50132622 | TotalRevenue |
| Total Expenses | 47554334 | TotalExpenses |
| Excess Or Deficit For Year | 2578288 | ExcessOrDeficitForYear |
| Other | $121,633 | OtherAmount |
| Total Adjustments | 121633 | TotalAdjustments |
| Excess Or Deficit Per FS | 2699921 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 50254255 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 121633 | OtherRevenues |
| Revenue Not Rptd F990 | 121633 | RevenueNotRptdF990 |
| Revenue Subtotal | 50132622 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 50132622 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 47554334 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 47554334 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 47554334 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Change in beneficial interest in net assets of Copley Health Systems, Inc. 121,633. |
| Part XII, Line 2d - Other Adjustments: | Change in beneficial interest in net assets of Copley Health Systems, Inc. 121,633. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 225.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2976 | PersonsServed |
| Total Community Benefit Expense | 602790 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 602790 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01270 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10328842 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6193110 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4135732 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08700 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2976 | PersonsServed |
| Total Community Benefit Expense | 10931632 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6193110 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4738522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09970 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6127 | PersonsServed |
| Total Community Benefit Expense | 198887 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 65875 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 133012 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00280 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2930659 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2074148 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 856511 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01800 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 413803 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 413803 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00870 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6127 | PersonsServed |
| Total Community Benefit Expense | 3543349 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2140023 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1403326 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02950 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 9103 | PersonsServed |
| Total Community Benefit Expense | 14474981 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8333133 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6141848 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12920 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $862,088 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12107896 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12234337 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -126441 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| ExplanationExplanation |
|---|
| Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. |
| Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to a physician clinic. |
| Part III, Line 4: Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating collectibility of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provisions 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, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). 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 significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill 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 off against the allowance for doubtful accounts.The Organization utilized a cost to charge ratio as the costing methodology used to determine the amount of bad debt expense at cost. |
| Part III, Line 8: The Organization used a cost report model as the costing methodology to determine the amount of allowable Medicare costs. |
| Part III, Line 9b: Financial Assistance is available to guarantors who meet the eligibility requirements. Income level, household size, residency status, etc, determine eligibility. Federal Poverty Level guidelines are utilized to determine the amount of assistance a household may be eligible for. For the patient's convenience, all statements have an abbreviated version of the Financial Assistance Application on the back. Copley personnel also help patients review and apply for appropriate state-sponsored programs. |
| Part VI, Line 2: Copley Hospital is part of an Integrated Health Systems (I.H.S.) team in our community. Together we are working to address community healthcare. Reaching out to the community to achieve meaningful public participation is integral to Copley's mission and to inform the I.H.S. Copley completed a Community Healthcare Needs Assessment in 2011 and will update the document in 2012. For our assessments, Copley gathers and analyzes information about the greater Lamoille Valley community and its healthcare needs through various means including: - Analyzing and responding to health trends in our patients, through aggregate data from our Workplace Wellness program and through aggregate data from our I.H.S. team with the Copley Service Area Blueprint for Health initiative. - We survey community members, community leaders, including health and community service providers, school administrators and others who have knowledge of and serve to meet population-based health needs. We review data of Vermonters' health, health practices and behavioral risks published by Vermont Department of Health, BISHCA, Blueprint and Federal Centers for Disesase Control. We have formed a community based advisory committee to develop an implementation plan to address identified community health needs. - We also host an annual Community Forum that is open to the public to discuss community health needs. - The hospital is governed by a volunteer board of trustees made up of local citizens representing a cross section of the community served. - We maintain involvement in a number of community groups within our service area. - Copley continues to work collaboratively with other organizations to identify and address community health needs. Our collaborations include but are not limited to the Integrated Health Team of the Copley Area Blueprint for Health Initiative, Lamoille Home Health and Hospice, The Manor (long term residential care), Lamoille Community Connections, Behavioral Health and Wellness, Lamoille Prevention Campaign (substance abuse), the Morrisville district office of the Vermont Department of Health, United Way, Lamoille Valley Fit and Healthy Council, Lamoille Valley Tobacco Task Force, and Leadership Lamoille through the Chamber of Commerce. |
| Part VI, Line 3: Information about Copley's Charitable Care policy, which includes helping patients apply for assistance under federal, state or local government programs, is posted by each registration desk (Main Lobby and Emergency Department). It is also available, along with the application form, online on the Hospital's website in addition to the "Hospital Report Card" website of the Vermont Department of Banking, Insurance, Securities and Health Care Administration. Details are also included in the Patient Guide for inpatients, families and visitors. Copley's Charitable Care program is also promoted in our philanthropy efforts as many donors give to the program. All care providers may refer patients to the Hospital's Patient Financial Services counselors or to Patient and Family Services to connect them to assistance. |
| Part VI, Line 4: Copley Health Systems (CHS) is an essential health care resource in the rural greater Lamoille County area of Vermont. Our services include a 25-bed Critical Access community hospital, low-income elderly housing and an independent living facility. Copley Hospital's services include 24 hour/7 days a week emergency services, women's and children's services, general surgery, primary care including laboratory services and diagnostic imaging; and an excellent orthopaedic service given our proximity to major ski areas. Our patients are largely the elderly and low-income families in a rural area. Nearly a third are below 200% of poverty level. We serve all patients, regardless of ability to pay. Chronic health conditions impact many adults in our area. We are working to increase access to healthcare and work with members of our community to improve their self management of chronic conditions such as diabetes, high blood pressure, high cholesterol, asthma and obesity. We are also helping people quit tobacco. Copley provides services for residents whose next nearest hospital may be an hour away in good weather. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Professional Services Group Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 530 Washington Highway No 12 | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 043358048 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 412292 | AmountOfCashGrant |
| Purpose Of Grant | Support obstetrics and gynecology services to residents of Lamoille County. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The Organization obtains financial information from the grantee to determine the amount of funds to be granted. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Brian Smale MD | |||||||||||||
| 312231 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 312231 | 0 | 0 | 0 |
| Melvyn Patashnick | |||||||||||||
| 223903 | 0 | 0 | 0 | 35181 | 0 | 9695 | 0 | 21720 | 0 | 290499 | 0 | 0 | 0 |
| Rassoul Rangaviz | |||||||||||||
| 157957 | 0 | 0 | 0 | 6642 | 0 | 6448 | 0 | 23094 | 0 | 194141 | 0 | 0 | 0 |
| Bryan Huber MD | |||||||||||||
| 478280 | 0 | 172644 | 0 | 17310 | 0 | 9800 | 0 | 29292 | 0 | 707326 | 0 | 0 | 0 |
| Eric Mullins MD | |||||||||||||
| 472129 | 0 | 30440 | 0 | 24959 | 0 | 9800 | 0 | 27623 | 0 | 564951 | 0 | 0 | 0 |
| John Kaeding MD | |||||||||||||
| 258405 | 0 | 0 | 0 | 18139 | 0 | 9800 | 0 | 24180 | 0 | 310524 | 0 | 0 | 0 |
| Neil Nigro MD | |||||||||||||
| 240424 | 0 | 0 | 0 | 237 | 0 | 9264 | 0 | 25072 | 0 | 274997 | 0 | 0 | 0 |
| Mirjam McCormack | |||||||||||||
| 299208 | 0 | 0 | 0 | 262 | 0 | 9800 | 0 | 29147 | 0 | 338417 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 5 | Bryan Huber, a highest compensated employee, received a bonus of $172,644. Eric Mullins, a highest compensated employee, received a bonus of $30,440. Each of the individuals were paid an incentive bonus based upon the gross revenue they produced individually for the hospital. The bonus is triggered when the individual produces a certain level of revenue. The bonus is 20% of the excess revenue produced over that level. There is a cap on the amount of bonus the indivdual can receive. | |
| Part III | Form 990, Part VII, Line 5: Dr. Brian Smale, a member of the board of trustees is an owner of Green Mountain General Surgery. Copley Hospital paid Green Mountain General Surgery for surgical services that Dr. Smale provided through his Organization to the Hospital. Copley Hospital paid Green Mountain General Surgery $312,231 for these services. Dr. Smale's compensation for services rendered specifically to the Hospital was not available as Green Mountain General Surgery is an unrelated organization. | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Green Mountain General Surgery | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | An Entity more than 35% owned by Brian Smale, Trustee of the Organization | Relationship |
| Amount Of Transaction | 312231 | AmountOfTransaction |
| Description Of Transaction | Independent Contractor Arrangement | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Copley Hospital, Inc. is a member organization whose sole corporate member is Copley Health Systems, Inc. Copley Health Systems, Inc. and the Hospital share the same board of trustees. | |
| Form 990, Part VI, Section A, line 7a | Copley Hospital, Inc. shares the same board as Copley Health Systems, Inc. Each year, the members of Copley Health Systems, Inc. will hold an annual meeting. The purposes of the annual meeting shall include the election of members to the Corporation, the election of Trustees to the Corporation's Board of Trustees, the election of the community member at large of the governance and bylaws committee, and the transaction of such other business as may properly come before the membership. The Board shall consist of up to twenty-one elected members, the Chief Executive Officer of the Corporation, the President of the Medical Staff of Copley Hospital, Inc., and the President of Copley Hospital Auxiliary, Inc., all as voting members. All Trustees must be members of the Corporation. | |
| Form 990, Part VI, Section B, line 11 | The finance committee reviews the Form 990 prior to submission. A complete copy of the form is made available to all members of the governing body through the finance office. | |
| The Governance Committee reviews the statements and surveys completed by interested persons and maintains a list of individuals who may be considered disqualified persons under IRS regulations. The Governance Committee reports the results of its reviews annually to the Board. The internal Compliance Committee of the Corporation reviews any potential conflict of interest which involves an interested person who is not a trustee or officer of the Corporation. The internal Compliance Committee reports the results of its reviews annually to the Board. | Form 990, Part VI, Section B, line 12c | |
| The CEO's pay is determined through the use of an outside compensation firm. Senior leadership and other highly compensated individuals have their pay ranges determined through market data from Astron Solutions. The compensation for the CEO is approved by the Board. | Form 990, Part VI, Section B, line 15 | |
| The governing documents are made available upon request. The conflict of interest policy and Matrix are available upon request. The financial statements are summarized in an annual report that is available to the public. The Hospital also submits both their budget and actual financial information to the State of Vermont's Department of Banking, Insurance, Securities & Health Care Administration. | Form 990, Part VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Change in beneficial interest in net assets of Copley Health Systems, Inc. 121,633. Total to Form 990, Part XI, Line 5: 121,633. | Form 990, Part XI, line 5: |
| Oversight of Audit | The audit process has not changed from prior year. | Form 990, Part XI, Line 2c: |
| Prior year numbers have been restated to present revenue net of contractual allowances and charity care. Bad debt expense has also been netted against revenue in accordance with the new Accounting Pronouncement ASC 954. | Form 990, Part I, Lines 8-18: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Lamoille Area Housing Corporation Copley Terrace Project | |||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030270255 | Subsidized Elderly Housing | VT | 501(c)(3) | Line 9 | Copley Health Systems Inc | 0 | |
| Copley Health Systems Inc | |||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030301457 | Support of Copley Hospital | VT | 501(c)(3) | Line 11b, II | 0 | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Health Center Building Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030220357 | EIN |
| Primary Activity | Office Building Rental | PrimaryActivity |
| Legal Domicile State | VT | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Health Systems Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Health Center Building | ||
| K | 29500 | FMV |
| Health Center Building | ||
| J | 49884 | FMV |