2023-10-31T09:21:58-05:00 2022-12-31 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-01-01 030107360 Brattleboro Retreat BRAT 8022577785 1 Anna Marsh Lane Brattleboro VT 05302 Jill Meschke CFO 8022577785 2023-10-24 1 Jill Meschke 999009999 1 Joseph R Byrne P01289281 2077752387 2023-10-24 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Jill Meschke 1 Anna Marsh Lane Brattleboro VT 05302 81316345 0 X www.brattlebororetreat.org X 1834 VT Offering a continuum of care including Inpatient, Partial Hospitalization, Residential and Outpatient. 12 11 523 11 0 0 20923754 18133034 44084665 62446440 86451 92698 370169 -65219 65465039 80606953 0 6295 0 0 37359612 39180038 0 36000 36000 22634045 32684329 59993657 71906662 5471382 8700291 45190535 57546913 21872622 26049366 23317913 31497547 X Inspired by the courage of our patients, the Brattleboro Retreat is dedicated to children, adolescents and adults in their pursuit of recovery from mental illness and psychological trauma. We are committed to excellence in treatment, advocacy, education, research, and community service. We provide hope, healing, safety and privacy through a full continuum of medical and holistic services delivered by expert caregivers in a uniquely restorative Vermont setting. 1 0 58288459 6295 62363630 Offering a full continuum of care including inpatient and partial hospitalization, residential care for children, intensive outpatient services for adults, and traditional outpatient treatment for children and adolescents adults.Patient Days: Inpatient: 23,552, Partial: 4,541, Residential: 2,737, Outpatient: 22,295 58288459 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 523 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 VT X Jill Meschke 8022583716 1 Anna Marsh Lane Brattleboro VT 05301 Louis Josephson Past CEO 40.00 0.00 X X 222663 0 20060 Linda C Rossi CEO 40.00 0.00 X X 403143 0 15748 Thomas Huebner Board Chair 1.00 0.00 X X 0 0 0 Elizabeth Catlin Vice Chair 1.00 0.00 X X 0 0 0 Joshua Davis Assistant Secretary 1.00 0.00 X X 0 0 0 Adam Grinold Secretary 1.00 0.00 X X 0 0 0 Christopher Turley Acting Treasurer 1.00 0.00 X X 0 0 0 Kenneth Becker Trustee 1.00 0.00 X 0 0 0 Judi Fox Trustee 1.00 0.00 X 0 0 0 Justin Johnson Trustee 1.00 0.00 X 0 0 0 Kate O'Connor Trustee 1.00 0.00 X 0 0 0 Drew Pate Trustee 1.00 0.00 X 0 0 0 Joseph Pyle Trustee 1.00 0.00 X 0 0 0 Steven Van Loh Past Vice President Finance 40.00 0.00 X 143372 0 18927 William King Interim CFO 40.00 0.00 X 181597 0 0 Cheyenne Holland Past Interim CFO 40.00 0.00 X 116779 0 0 Karl Jeffries Chief Medical Officer 40.00 0.00 X 439101 0 59508 Lisa Lambert Medical Director of Impatient Services 40.00 0.00 X 438498 0 18237 Tracey Krasnow Unit Chief 40.00 0.00 X 273398 0 40678 Elizabeth H Joseph Staff Psychiatrist 40.00 0.00 X 277550 0 32966 Rachael E Kandath Staff Psychiatrist 40.00 0.00 X 285780 0 27822 2781881 0 233946 69 0 1 1 AHSA LLC PO Box 928 Edmond OK 730831928 Travel Nurse Provider 12365640 Sodexo PO Box 360170 Pittsburgh PA 152516170 Food/Housekeeping Services 3355329 Locumtenens PO Box 405547 Atlanta GA 303845547 Travel Physician Provider 1158677 Netsmart Technologies Inc PO Box 713519 Philadelphia PA 19171 Information Technology 826889 Barton Associates In PO Box 417844 Boston MA 022417844 Travel Physician Provider 800800 20 18041144 91890 14612 18133034 Patient Service Revenue 623990 104115747 104115747 Miscellaneous 900099 1084487 961900 122587 MSO Revenue 623990 779759 779759 Contractual/Char. Adj. 623990 -43533553 -43533553 62446440 102548 102548 236255 218664 17591 17591 17591 480878 490728 -9850 -9850 -9850 Joint Venture Earnings 900099 -82810 -82810 -82810 80606953 62241043 0 232876 X 6045 6045 250 250 1122289 1122289 30166231 25386950 4779281 382451 314019 68432 5356739 4395309 961430 2152328 1749421 402907 423568 423568 107243 107243 36000 36000 36000 36000 19546 19546 21546163 17122615 4423548 35419 35419 102508 86564 15944 1975754 1959731 16023 33886 31497 2389 389607 209015 180592 1967798 1047899 919899 753556 753556 Miscellaneous Expenses 2112648 2016408 96240 Provider Tax 1825012 1825012 Meals 790658 783786 6872 Medical Supplies 564963 564963 71906662 58288459 13582203 36000 X 2603533 10663329 9925163 17831624 1027878 0 2890283 3244359 150075 104154 1222576 945743 65467312 45007155 21911899 20460157 3807383 3358374 492049 412356 1159696 526817 45190535 57546913 10024175 7727161 9532832 8667978 356221 266417 1959394 9387810 21872622 26049366 X 19822573 28065471 3495340 3432076 23317913 31497547 45190535 57546913 8700291 -520657 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 48245 48245 0 Part II-B, Line 1: Line 1b relates to a portion of MSO VP's salary in the amount of $2,781. Line 1i includes the portion of AHA and VAHHS dues related to lobbying and the portion of lobbying expense paid to MMR, a lobbying firm. 3636809 -357159 3279650 3686428 -49619 3636809 4965555 -1279127 3686428 7094433 389087 2517965 4965555 7046470 47963 7094433 1.00000 0.00000 0.00000 0 0 120033 120033 51736933 33480353 18256580 11115515 9563712 1551803 2494831 1963090 531741 20460157 Deferred Compensation Obligation 30657 Deferred Provider Relief Funds 109384 Due to Third-Party Payors 5832988 Other Long-Term Liabilities 3414781 9387810 80283124 -520657 218664 -301993 80585117 19546 2290 21836 80606953 72103490 218664 218664 71884826 19546 2290 21836 71906662 Part V, Line 4: These funds consist of assets held by a trustee under an indenture agreement and funds set aside by the Board for capital improvements, over which the Board retains control and may, at its discretion, use for other purposes such as short-term operating needs. Part XI, Line 2d - Other Adjustments: Rental Expenses 218,664. Part XI, Line 4b - Other Adjustments: Loss on Disposal of Asset 2,290. Part XII, Line 2d - Other Adjustments: Rental Expenses 218,664. Part XII, Line 4b - Other Adjustments: Loss on Disposal of Asset 2,290. X X X 1 Robert Szpila 140 Guilford St Brattleboro VT 05301 See Narrative in Part IV 0 106857 36000 70857 106857 36000 70857 VT Form 990, Schedule G, Part I, Line 2b, Section ii Activity: Description of Activities: Honor Louis, Summer Appeal, Employee Camp, Winter Appeal, Individual Donor, Bequest Planning, Strategy, Database Management, and Donor Communications. 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 2168095 2168095 0.03020 36567238 35347988 1219250 0.01700 38735333 35347988 3387345 0.04720 369830 369830 0.00510 14952634 6956148 7996486 0.11120 15322464 6956148 8366316 0.11630 54057797 42304136 11753661 0.16350 250 250 0.00000 6045 6045 0.00010 6295 6295 0.00010 1 0 8662765 15784295 -7121530 X 1 1 1 1 Brattleboro Retreat 1 Anna Marsh Lane Brattleboro VT 05301 www.brattlebororetreat.org 939 X Brattleboro Retreat 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X www.brattlebororetreat.org/info X 1 21 1 www.brattlebororetreat.org/info 1 0 1 X 250.000000000000 400.000000000000 X X 1 1 X X X 1 X https://www.brattlebororetreat.org/patient-financial-services X https://www.brattlebororetreat.org/patient-financial-services X https://www.brattlebororetreat.org/patient-financial-services X X X X X X 1 X 0 X X X X 1 X 0 0 Brattleboro Retreat Part V, Section B, Line 5: Because of its diverse and extensive service area, the Retreat defines its service area at both the county and state levels, and assesses the health needs of both areas. This gives planners a detailed understanding of the needs of the local populations as well as Vermont as a whole. The Community Health Needs Assessment (CHNA) was therefore divided into two phases: Phase I for Windham County and Phase II for the state of Vermont.For Phase I (Windham County), the Retreat partnered with Grace Cottage Hospital and Brattleboro Memorial Hospital to gather and assess both quantitative and qualitative data. The three health care organizations developed a steering committee, made up of representatives from each of the hospitals as well as from the Vermont Department of Health, Brattleboro Office, to guide the qualitative research and collect and analyze the quantitative data. The Windham County CHNA Steering Committee planned and conducted qualitative research, which included a countywide survey and a focus group on health care needs of minority and underserved populations. During the research process, the Steering Committee consulted with Vermont Agency of Human Services District Leadership Team and the Clinical Planning Group of the Vermont Blueprint for Health-Brattleboro Service Area.In Phase II (statewide), the Retreat gathered and assessed quantitative and qualitative data on mental health and addiction in the state of Vermont. Additionally, qualitative data was collected from community stakeholders across the state of Vermont through an online survey that was widely distributed across the state. During this phase of research, the Retreat consulted with the Vermont Department of Health, the Brattleboro Retreat's Consumer Advisory Council as well as a range of Retreat staff members, including clinical and administrative staff.Once the qualitative and quantitative data were collected and analyzed, planners reviewed the community health needs that emerged as a result of conducting the assessment. They carefully assessed each need, identified the major themes and developed broader priority areas to encompass these needs. Planners carried out this process by focusing only on needs and priority areas that fall within the mission and scope of the Brattleboro Retreat, namely in mental health and addiction treatment, as well as within the Retreat's capacity to make an impact. Planners also worked to identify needs that were supported by quantitative research data OR were identified in the community input process, through either of the surveys or the focus group. Once the planners identified some potential priority areas, they shared the results of the needs assessment as well as the recommended priority areas with the Brattleboro Retreat's Consumer Advisory Council and a group of Retreat staff members that included both clinical and administrative staff from various departments. Brattleboro Retreat Part V, Section B, Line 6a: Brattleboro Memorial Hospital and Grace Cottage Hospital Brattleboro Retreat Part V, Section B, Line 11: See attached implementation strategy. Part II, Community Building Activities: Anna Hunt Marsh founded the Brattleboro Retreat in 1834 with the hope of advancing the care and treatment of people with mental illness. She was a prominent resident of Hinsdale and the region's most successful woman at that time. The Retreat continues to honor her vision today by encouraging young people to enter the field of healthcare with the Anna Hunt Marsh Scholarship.Additionally, the Retreat supports a variety of other community programs. Part III, Line 4: See Pages 8-10 of audited financial statements for footnote disclosure. Part III, Line 8: A cost to charge ratio was used to determine the amount reported on Line 6. Part III, Line 9b: Included in our debt collection policy there is a section that if a patient is known to qualify for Charity Care upon admission then the eligibility guideline is followed at the time of admission to capture that information. Part VI, Line 2: In 2022, the Brattleboro Retreat served 2,844 children, adolescents and adults in inpatient, residential, ambulatory, outpatient, and school programs.The impact of the Retreat's services upon its patients and their families and communities is often dramatic and life-saving; especially as fewer and fewer healthcare organizations choose to offer a full continuum of mental health and addiction care services. Meanwhile, the number of patients seeking treatment for mental health and substance abuse issues continues to rise throughout the region and the nation. The Retreat strives to meet this increasing demand for services by renovating and updating facilities and patient care areas and utilizing the latest in treatment modalities to improve health care outcomes for the populations served.In 2022, the Brattleboro Retreat served 1,695 individuals in our outpatient programs. Three hundred and fifty-nine (359) children were served across all programs. Eight (8) children were served in our residential programs.The Retreat continued to meet the need for quality psychiatric and addiction care coupled with an ongoing trend of higher inpatient acuity by strengthened its clinical expertise. This included the continued roll out of evidence-based practices throughout the hospital's programs along with an expansion of required clinical skills trainings involving both psychiatric and co-morbid medical conditions offered through the Retreat's Clinical Education department.The Retreat also continued to make important strides forward in improving its financial systems with the goal of strengthening cash flows and establishing a more predictable operating margin.Summary of Process for Openness and Public Participation:The Brattleboro Retreat keeps the community informed with regular appearances and/or memberships with the Brattleboro Select Board, Building a Better Brattleboro, Brattleboro Development and Credit Corporation (BDCC), Brattleboro Chamber of Commerce, the Windham County Legislative Delegation, Southeastern Vermont Economic Development Strategies (SeVEDS), the Rotary Club of Brattleboro, and ongoing collaborations with other community organizations including Brattleboro Memorial Hospital, Grace Cottage Hospital, Health Care and Rehabilitation Services (HCRS), Rescue Inc., the Brattleboro Police Dept., and area schools.In addition to its regular treatment and professional education services, the Brattleboro Retreat offers numerous programs to the community free of charge, including various lectures, forums, and special educational events. The feedback of patients, their families, and community members is of great importance to the Brattleboro Retreat.Strategic Plan & Financial Information:In 2022 the Brattleboro Retreat spent approximately $500K on capital improvements. The depreciation schedule was $2.0M. As a private not-for- profit organization, copies of the strategic plan are not publicly available. Part VI, Line 3: At the time of admission, patients receive counseling about their eligibility for assistance under various governmental programs as well as the organization's charity care policy. Part VI, Line 4: The Brattleboro Retreat is located in Brattleboro, Vermont, which is in the southeastern corner of Vermont-on the border with both New Hampshire and Massachusetts. Brattleboro is a small, rural town with an estimated population of 11,332. The estimated population for Windham County is 42,222. The state of Vermont has an estimated population of 623,989. (U.S. Census estimate, July 1, 2019).The Retreat plays a vital role as a large provider of mental health services. It provides treatment to individuals of all ages from throughout the Northeast, accepts high numbers of Medicare and Medicaid funded patients and provides services offered by few other hospitals. In addition, the Retreat provides an array of outpatient services to people in the local area. These services include outpatient counseling as well as partial hospital and intensive outpatient mental health.The Brattleboro Retreat is the only mental health and specialty hospital in Vermont and one of the few in New England. In Vermont, there are four medical hospitals with psychiatric units. The Retreat is the largest provider of inpatient psychiatric services in the state and operates roughly the same number of psychiatric beds as the other four hospitals combined. The Retreat is also the only mental health hospital in Vermont for children and adolescents. Many area medical hospitals have downsized or eliminated their psychiatric beds in recent years, particularly those in New Hampshire. Most psychiatric units also exclusively serve adults with few inpatient programs available for children and adolescents. The Retreat is dedicated to serving this population. The relatively low population of Vermont and the greater population to the south necessitate drawing from a broad and diverse area. The Retreat's geographic location also facilitates this regional draw. While the majority of inpatient admissions to the Retreat come from the state of Vermont, patients also come from other states. The demographics of income, race, poverty etc., vary greatly across the catchment area and are therefore difficult to characterize. According to the data collected in the American Community Survey (ACS) and the Puerto Rico Community Survey (PRCS) conducted annually by the U.S. Census Bureau, the estimated median household income of Vermont residents is $60,076. Eleven percent of Vermonters live in poverty and 4.9 percent of Vermonters are without health insurance. In 2022, 83 percent of the Retreat's funding came from public sources-32 percent from Medicare and 51 percent from Medicaid/State programs. Part VI, Line 6: Vermont Program for Quality in Healthcare-provides advocacy for access to health-care services in Vermont. X 0 1 X 1 0 0 0 0 0 0 0 0 Karl Jeffries Chief Medical Officer 409070 0 0 0 30031 0 9150 0 50358 0 498609 0 0 0 Lisa Lambert Medical Director of Impatient Servic 438102 0 0 0 396 0 9150 0 9087 0 456735 0 0 0 Linda C Rossi CEO 371163 0 0 0 31980 0 3888 0 11860 0 418891 0 0 0 Tracey Krasnow Unit Chief 272989 0 0 0 409 0 4523 0 36155 0 314076 0 0 0 Rachael E Kandath Staff Psychiatrist 277495 0 0 0 8285 0 8676 0 19146 0 313602 0 0 0 Elizabeth H Joseph Staff Psychiatrist 276935 0 0 0 615 0 2834 0 30132 0 310516 0 0 0 Louis Josephson Past CEO 133799 0 0 0 88864 0 0 0 20060 0 242723 0 0 0 William King Interim CFO 181597 0 0 0 0 0 0 0 0 0 181597 0 0 0 Steven Van Loh Past Vice President Finance 112104 0 0 0 31268 0 0 0 18927 0 162299 0 0 0 Part I, Line 1a During calendar year 2022, Louis Josephson, Past CEO, Linda Rossi, CEO, and Karl Jeffries, Chief Medical Officer each received a housing allowance which is included as part of their taxable compensation. Part I, Line 1b The Board of Directors approved the housing allowances provided by the Organization. Part I, Line 4a During 2022, Steven Van Loh, Past Vice President of Finance, received a severance payment of $31,268. Form 990, Part VII, Line 5: During the calendar year 2022, Brattleboro Retreat paid Mazars USA LLP, an unrelated organization, $181,597 and $116,779 for services provided by William King and Cheyenne Holland as Interim CFOs. Brattleboro Retreat is not able to determine the compensation paid to William King and Cheyenne Holland, only the amount paid to Mazars USA LLP. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-07-15 11245000 Refund Series 2011A Bonds 0 0 0 A 2550193 11245000 97745 11147255 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 1 Date Rebate Computation Performed Issuer Name: Vermont Educational and Health Buildings Financing Agency Date the Rebate Computation was Performed: 12/20/2021 Form 990, Part III, line 2 As 2022 continued to mark a year of recovery from pandemic-related program changes, Brattleboro Retreat was able to bring several new service offerings for its outpatients in 2022: Specialty Medication Clinic: offering esketamine treatment for persons with treatment-resistant depression, administered under medical supervision. Transcranial Magnetic Stimulation: offering non-invasive outpatient treatment using powerful magnetic fields, for persons with treatment-resistant depression. Healthcare Professionals and First Responders: a specialty partial hospitalization and intensive outpatient program designed to meet the specific needs of healthcare professionals and first responders, offered via telehealth. Form 990, Part VI, Section B, line 11b The Governing Body will receive the prepared 990 electronically for their review and approval prior to filing the return, followed by a presentation at their next full board meeting. Form 990, Part VI, Section B, line 12c A. The Brattleboro Retreat accepts the responsibility for the provision of optimum care and services to its patient population, and therefore must protect the integrity of clinical decision making and the provision of treatment and care to all patients. B. The Brattleboro Retreat will disclose any existing or potential conflicts of interest for those who provide care, treatment and services as well as management and governance activities. C. The Brattleboro Retreat will routinely review its existing relationship and its staff's relationships, with other care providers, educational institutions and payers to ensure that all relationships are within law and regulation and to identify and determine if conflicts of interest exist. D. Regardless of any fiduciary relationship with any healthcare provider (licensed clinical practitioner, vendor, educational institution, payer, outside resource agency, etc.), the hospital and its representative staff (including medical staff), will strive to provide optimum care to patients following appropriate utilization of resources standards. Care provided to patients will not be dependent upon financial relationships or fiduciary responsibilities. a. Tests, studies, treatments or procedures deemed usual and routine in the diagnosis, management or treatment of disease processes; as standard in the healthcare community, will not be withheld from any patient (unless the patient exercises his/her patient right to refuse treatment). b. Any healthcare provider who feels there is a conflict of interest in patient management and their relationship with the facility, must contact administration and notify the Chief Executive Officer immediately. E. Discussion at the administrative level will be initiated, whereby problem resolution will be the primary goal. In the interim, the Head of the service/department with jurisdiction over the healthcare provider will arrange for coverage of the patient; until resolution has been reached. F. If resolution cannot be reached at the administrative level, the matter will be forwarded to an Executive Committee of the Governing Body, who will meet as soon as practicable, however no later than one week after notification of issue. The Governing Body's primary purpose is to assure that optimum patient care and treatment is provided, regardless of fiduciary relationships, while maintaining a fair and just review of all circumstances surrounding the issue. The determination of the Governing Body will be final. G. No contract or transaction entered into by the corporation known as the Brattleboro Retreat, shall be affected by the fact that a director, member or officer of the corporation was personally interested in the contract or transaction or was personally interested in or a director or officer of a corporation that was personally interested in the contract or transaction. H. A member of the Governing Body or a member of a committee, when called upon to cast a vote for or against a matter which personally involves such individual, shall disclose himself/herself ineligible to vote on the grounds of conflict of interest. In cases where conflict of interest is not clearly apparent, or when such conflict is not declared by a person who in the opinion of other members has potential conflict, the conflict of interest issue may be brought before the body who will vote on such issue to determine whether or not a conflict of interest exists. I. Should there become known, at any time, a conflict of interest between any member of the Governing Body, medical staff, hospital personnel or other healthcare providers and the hospital or any of its agents, the individual(s) may excuse himself/herself from discussions and/or determinations with the identified healthcare provider(s). J. All members of the Governing Body, medical staff and hospital personnel have the responsibility and obligation, if there is such a time as it is discovered; that due to a fiduciary relationship, care of any patient may be compromised or may not be delivered within the known standard of care; to notify the Chief Executive Officer of the Brattleboro Retreat immediately upon identification of this issue. Form 990, Part VI, Section B, line 15 The Board Compensation Committee reviews comparative data for the CEO. The CEO does review benchmarking/comparative data for VPs and other key employees. Form 990, Part VI, Section C, line 19 All governing documents, conflict of interest policy, and audited financial statements are available upon request. Form 990, Part IX, line 11g Clinical Services: Program service expenses 215,693. Management and general expenses 49,676. Fundraising expenses 0. Total expenses 265,369. Contract Services: Program service expenses 16,869,134. Management and general expenses 3,885,107. Fundraising expenses 0. Total expenses 20,754,241. Consulting Fees: Program service expenses 37,154. Management and general expenses 488,619. Fundraising expenses 0. Total expenses 525,773. Collection Fees: Program service expenses 634. Management and general expenses 146. Fundraising expenses 0. Total expenses 780. Form 990, Part X, Line 10; Land, Building, and Equipment Section 1.263(a)-3(n) Election: Brattleboro Retreat 1 Anna Marsh Lane Brattleboro, VT 05302 EIN 03-0107360 Brattleboro Retreat is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part VI, Line 16: Brattleboro Retreat invested in the Vermont Collaborative Care, LLC with Catamount Insurance Services, Inc. which is a wholly-owned subsidiary of Blue Cross and Blue Shield of Vermont, a non-for-profit organization. Vermont Collaborative Care LLC PO Box 186 Montpelier VT 056010186 462187169 Care Management Services VT Brattleboro Retreat Related -79693 540481 0 1 0.50000 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0