2024-08-14T11:06:24-05:00 2023-09-30 920460586 PWC US TAX LLP 101 SEAPORT BLVD BOSTON MA 02210 990 2022-10-01 030181058 PORTER HOSPITAL INC PORT 8023884701 115 PORTER DRIVE MIDDLEBURY VT 05753 SCOTT COMEAU CFO 8023884752 2024-08-12 1 0 PAUL J TANIS P01441612 6175305000 2022 2024-08-08 14:25:15Z BOB ORTMYER 115 PORTER DRIVE MIDDLEBURY VT 05753 125536684 0 X WWW.PORTERMEDICAL.ORG X 1941 VT SEE SCHEDULE O 13 12 674 127 0 0 4426280 1897508 100695971 117603635 927280 93841 949809 752571 106999340 120347555 54369 192519 0 0 65429255 58110622 0 0 169665 36573454 52438505 102057078 110741646 4942262 9605909 76238721 88130330 22549146 20315142 53689575 67815188 X OPERATION OF A CRITICAL ACCESS HOSPITAL, IN LINE WITH OUR MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY, ONE PERSON AT A TIME. 0 0 90139159 192519 118093257 PORTER HOSPITAL, INC. ("PORTER") OPERATES A NOT-FOR PROFIT CRITICAL ACCESS HOSPITAL WITH PATIENT CARE SERVICES INCLUDING EMERGENCY ROOM, MATERNITY AND MEDICAL/SURGICAL INPATIENT AND OUTPATIENT CARE, AND ANCILLARY SERVICES INCLUDING REHABILITATION, LABORATORY TESTING, AND DIAGNOSTIC IMAGING SERVICES. AS A CRITICAL ACCESS HOSPITAL, PORTER STAFFS A TOTAL OF 25 BEDS INCLUDING THE BIRTHING UNIT. IN ADDITION, PORTER HAS AN EMERGENCY ROOM TO SERVE THE GREATER ADDISON COUNTY COMMUNITY NEEDS. PORTER RECORDED APPROXIMATELY 9,361 INPATIENT DAYS DURING THE YEAR. EMERGENCY ROOM VISITS TOTALED 13,349 FOR THE YEAR. SURGERIES FOR THE YEAR TOTALED 3,790. SUPPORT SERVICES FOR BOTH INPATIENTS AND OUTPATIENTS INCLUDE BUT ARE NOT LIMITED TO LABORATORY, DIAGNOSTIC IMAGING SERVICES, CARDIAC SERVICES, AND REHABILITATION FACILITIES. IMAGING INCLUDES RADIOLOGY, NUCLEAR MEDICINE, MRI, ULTRASOUND, AND CT SCAN. PORTER PROVIDES FREE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. PORTER PROVIDES A NUMBER OF COMMUNITY HEALTH OUTREACH PROGRAMS TO THE GENERAL PUBLIC FOR FREE. THE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO DIABETES EDUCATION, BREAST CANCER SCREENING, PRENATAL CLASSES, BREASTFEEDING CLASSES, AND CPR COURSES. PORTER PROVIDES CLINICAL OFFICE SPACE TO THE OPEN DOOR CLINIC, WHICH PROVIDES ACCESS TO FREE QUALITY HEALTHCARE SERVICES TO THOSE WHO ARE UNINSURED OR UNDERINSURED UNTIL A PERMANENT HEALTH CARE PROVIDER CAN BE ESTABLISHED. FINALLY, PORTER HAS PARTNERED WITH LOCAL CAREER CENTERS, AS WELL AS COLLEGES TO PROVIDED CLINICAL EXPOSURE TO THEIR STUDENTS WITH GOALS OF DEVELOPING FUTURE HEALTHCARE WORKERS FOR THE COMMUNITY. 90139159 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 95 0 1 674 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SCOTT COMEAU CFO 8023884752 115 PORTER DRIVE MIDDLEBURY VT 05753 ALICIA GRANGENT DIRECTOR (AS OF 1/2023) 2.00 3.00 X 0 0 0 DR KRISTOFER ANDERSON DIRECTOR 15.00 30.00 X 0 347740 33531 JUDSON BARTLETT VICE CHAIR 2.00 3.00 X X 0 0 0 MEGAN BRAKELY DIRECTOR (AS OF 1/2023) 2.00 5.00 X 0 0 0 ANNE COLLINS DIRECTOR 2.00 3.00 X 0 0 0 SIVAN COTEL DIRECTOR 2.00 5.00 X 0 0 0 BILL CUNNINGHAM DIRECTOR (AS OF 1/2023) 2.00 3.00 X 0 0 0 MATTHEW CURRAN TREASURER 2.00 3.00 X X 0 0 0 KIM FARNHAM DIRECTOR (AS OF 1/2023) 2.00 3.00 X 0 0 0 RICHARD FOOTE DIRECTOR 2.00 3.00 X 0 0 0 NICHOLAS LOVEJOY DIRECTOR/SECRETARY 2.00 3.00 X X 0 0 0 LINDA SCHIFFER CHAIR 2.00 3.00 X X 0 0 0 HELENA VAN VOORST DIRECTOR 2.00 3.00 X 0 0 0 DR LINN LARSON DIRECTOR (TIL 12/2022) 2.00 3.00 X 4677 0 0 SARAH RAY DIRECTOR (TIL 12/2022) 2.00 3.00 X 0 0 0 AMEY RYAN DIRECTOR (TIL 12/2022) 2.00 3.00 X 0 0 0 DEBRA STENNER DIRECTOR (TIL 12/2022) 2.00 3.00 X 0 0 0 CHERYL MULLINS DIRECTOR (TIL 7/2023) 2.00 3.00 X 0 0 0 TOM THOMPSON PRESIDENT & COO (TIL 9/2023) 15.00 35.00 X 0 504516 46297 SCOTT COMEAU CFO 15.00 35.00 X 0 237564 38498 BOB ORTMYER PRESIDENT & COO (AS OF 9/2023) 15.00 35.00 X 0 358016 30296 BRANDI BETCHER HELM AVP OPERATIONS (AS OF 7/2023) 45.00 0.00 X 169879 0 6029 LINDA HAVEY AVP OPERATIONS 15.00 35.00 X 0 232485 11111 MICHAEL LEYDEN AVP OPERATIONS (TIL 7/2023) 15.00 30.00 X 0 220005 34708 ERIC BERG CRNA 45.00 0.00 X 379043 0 46783 AMY BISHOP CRNA 45.00 0.00 X 314772 0 40402 WILLIAM HARRINGTON CRNA 45.00 0.00 X 288243 0 8834 TIFFANY LOVE AVP/CHIEF NURS OFF (TIL 7/2023) 45.00 0.00 X 231884 0 18974 ERIC SHUBERT PHARMACIST 45.00 0.00 X 183984 0 34503 JUDY PEEK-LEE FMR INTERIM CFO 0.00 50.00 X 0 409410 31192 1572482 2309736 381158 53 1 1 0 CROSS COUNTRY STAFFING INC PO BOX 404674 ATLANTA GA 303844674 TRAVELING NURSING SERVICES 8013930 MEDICAL SOLUTIONS 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 TRAVELING NURSING SERVICES 2724266 ALLIANCE HEALTHCARE SERVICES INC PO BOX 735714 DALLAS TX 753735714 RADIOLOGY SERVICES 837922 MARCAM ASSOCIATES PO BOX 60 ROCHESTER NH 038660060 COLLECTION AGENCY 593564 MAYO COLLABORATIVE SERVICES INC DBA PO BOX 4100 ROCHESTER MN 559034100 LABORATORY SERVICES 491607 19 1332129 565379 1897508 PATIENT SERVICE REVENUE 900099 93949677 93949677 FIXED PROSPECTIVE PAYMENTS 900099 22022831 22022831 PATIENT SERVICES - PHARMACY 456110 1183862 1183862 DSH REVENUE 900099 447265 447265 117603635 1105931 1105931 7866 0 7866 7866 7866 4177039 5189129 -1012090 -1012090 -1012090 OTHER MISC REVENUE 900099 489622 489622 CAFETERIA 900099 255083 255083 744705 120347555 118093257 0 356790 X 186884 186884 5635 5635 200561 200561 47325848 41258980 6066868 1261390 1163474 97916 6212150 5233068 979082 3110673 2617626 493047 105205 105205 18689 18689 10246 10246 17283 17283 26992798 17368894 9454529 169375 151543 142746 8797 11897950 11449478 448189 283 63897 37044 26853 2190660 754410 1436250 111614 43308 68306 257110 246189 10921 240648 195881 44767 2587285 2105982 481296 7 577214 466113 111101 MEDICARE PROVIDER TAX 5903493 5903493 LEASED EQUIPMENT 567937 491824 76113 BOOKS, DUES & SUBSCRIPT 203006 42384 160622 FREIGHT 198902 193589 5313 343025 232157 110868 110741646 90139159 20432822 169665 19595 4316 7666579 7658237 17034121 15079859 2435609 2651388 1362795 2095657 22690938 10551890 13914036 12139048 27790928 24260367 4793323 4717075 1221735 19524383 76238721 88130330 10139416 9438527 65642 3447 13456 8965927 8383243 3440356 2414274 22549146 20315142 X 47932940 62131631 5756635 5683557 53689575 67815188 76238721 88130330 X 9605909 3369220 1150484 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10246 10246 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING EXPENSES. 4911005 382965 459213 4834757 5111060 215550 415605 4911005 3965823 1546430 401193 5111060 3834593 518448 387218 3965823 3801633 416015 383055 3834593 0.00000 1.00000 0.00000 1 0 11107386 3108027 7999359 10618742 7187713 3431029 964810 256150 708660 12139048 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 4717075 F 4717075 OPERATING LEASE RIGHT OF USE ASSETS 639531 DUE FROM RELATED PARTIES 18884852 19524383 ESTIMATED THIRD PARTY SETTLEMENTS 1688697 OPERATING LEASE OBLIGATION 649351 CONTRACT LIABILITIES 13886 PENDING CLAIMS 62340 2414274 X PART V, LINE 4: INCOME FROM ENDOWMENTS HELD AND ADMINISTERED BY MIDDLEBURY COLLEGE SUPPORTS THE ORGANIZATION'S MISSION BY PROVIDING FUNDS FOR CHARITY CARE AND ADDITIONALLY OFFSETS A PORTION OF THE ORGANIZATION'S OPERATING EXPENSES. PART X, LINE 2: PORTER HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVM HEALTH NETWORK"). PAGES 17 AND 18 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE INDICATING THAT NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED. 1 1 X 1 X 1 X 360.000000000000 1 1 1 0 1 1 769508 769508 0.00690 12959398 3427721 9531677 0.08610 13728906 3427721 10301185 0.09300 248957 248957 0.00220 48443 48443 0.00040 12181109 9889061 2292048 0.02070 28376 28376 0.00030 12506885 9889061 2617824 0.02360 26235791 13316782 12919009 0.11660 1 1216691 57307 13506418 20694339 -7187921 X 1 1 1 1 PORTER HOSPITAL INC 115 PORTER DRIVE MIDDLEBURY VT 05753 WWW.PORTERMEDICAL.ORG 899 X X X X PORTER HOSPITAL INC 1 0 0 1 X X X X X X X X X X 20 1 0 1 1 X SEE PART V, SECTION C X 1 21 1 SEE PART V, SECTION C 0 1 X 200.000000000000 360.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B, LINES 7A, 10A, AND 16A-16C: HOSPITAL FACILITY'S WEBSITE CHNA AND IMPLEMENTATION STRATEGY:WWW.PORTERMEDICAL.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/FINANCIAL ASSISTANCE POLICY, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY: WWW.PORTERMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/ PART V, SECTION B, LINE 3J: THE CHNA CONDUCTED IN FY 2021 / TY 2020 CONTAINS INFORMATION AND ANALYSIS THAT EXTENDS BEYOND THE SUBJECTS DESCRIBED IN PART V, LINE 3, INCLUDING BUT NOT LIMITED TO: SECONDARY DATA SOURCES, MORTALITY STATISTICS, KEY HEALTH AND WELLBEING INDICATORS AND THEIR SOURCES, AND A DISCUSSION OF THE IMPACT OF COVID-19 ON THE COMMUNITY. PART V, SECTION B, LINE 5: THE CHNA DATA COLLECTION PROCESS CONSISTED OF A CHNA SURVEY COMPLETED BY 761 RESPONDENTS, FIVE SEPARATE FOCUS GROUP SESSIONS IN WHICH 14 PERSONS PARTICIPATED, AND STAKEHOLDER INTERVIEWS WITH 33 REPRESENTATIVES FROM 23 COMMUNITY ORGANIZATIONS. THE SURVEYS WERE CONDUCTED IN FEBRUARY AND MARCH 2021 AND WERE PRIMARILY COLLECTED ONLINE. THE SURVEY WAS MADE AVAILABLE IN ENGLISH AND IN SPANISH. THE SURVEYS WERE PUBLICIZED THROUGH ELECTRONIC MAILING LISTS, ONLINE COMMUNITY MESSAGE BOARDS, SOCIAL MEDIA, AND THE PORTER HOSPITAL WEBSITE. HOWEVER, PAPER SURVEYS WERE MADE AVAILABLE BY REQUEST AND DISTRIBUTED LOCALLY AT OPEN DOOR CLINIC AND MIDDLEBURY LAUNDROMAT. PAPER SURVEYS WERE ALSO OFFERED TO INDIVIDUALS WHO RECEIVED HOME-BOUND COVID-19 VACCINATIONS.FOCUS GROUPS WERE HELD IN MAY 2021. PARTICIPANTS WERE RECRUITED VIA FLYERS SENT TO COMMUNITY PARTNERS, THROUGH COMMUNITY MEMBERS IDENTIFIED BY COMMUNITY PARTNERS, AND VIA ONLINE MESSAGE BOARDS. FOCUS GROUP DISCUSSIONS WERE GUIDED BY AN IN-DEPTH QUESTIONNAIRE, A COPY OF WHICH IS INCLUDED AS AN APPENDIX TO THE CHNA. CROSS-SECTOR STAKEHOLDERS WERE INTERVIEWED AT EXISTING MEETINGS SUCH AS THAT OF THE COMMUNITY HEALTH ACTION TEAM, BUILDING BRIGHT FUTURES GROUP, SUBSTANCE USE TREATMENT AND RECOVERY COMMITTEE, OR WERE CONDUCTED SEPARATELY TO INTERESTED INDIVIDUALS. STAKEHOLDER ORGANIZATIONS REPRESENTED MANY ASPECTS OF THE COMMUNITY AND INCLUDED: PARENT CHILD CENTER, BUILDING BRIGHT FUTURES, UNITED WAY OF ADDISON COUNTY, MARY HOGAN, MARY JOHNSON, ADDISON COUNTY SCHOOL DISTRICTS, END OF LIFE SERVICES, ADDISON COUNTY HOME HEALTH AND HOSPICE, COUNSELING SERVICES OF ADDISON COUNTY, FIELD SERVICES, PRIVATE PT PRACTICE, MOUNTAIN HEALTH CENTER, GIVING FRIDGE, TURNING POINT CENTER, DEPARTMENT FOR CHILDREN AND FAMILIES, VERMONT DEPARTMENT OF HEALTH, RESIDENCE AT OTTER CREEK, SAVIDA, BRISTOL FAMILY CENTER, PREGNANCY RESOURCE CENTER, NORTHERN LIGHTS AT CCV, AND MOUNT ABRAHAM UNIFIED SCHOOL DISTRICT. PART V, SECTION B, LINE 6B: THE TY 2020/FY 2021 CHNA WAS CONDUCTED WITH THE ASSISTANCE OF COMMUNITY ORGANIZATIONS SUCH AS UNITED WAY OF ADDISON COUNTY, THE DEPARTMENT OF HEALTH, MIDDLEBURY COLLEGE, BLUEPRINT FOR HEALTH, AND ADDISON COUNTY HOME HEALTH AND HOSPICE, ALL OF WHICH CONTRIBUTED MEMBERS TO THE CHNA STEERING COMMITTEE. ADDITIONALLY, MIDDLEBURY COLLEGE STUDENTS SERVED IMPORTANT ROLES IN THE AREAS OF DATA COLLECTION AND ANALYSIS. FINALLY, THE LOCAL ORGANIZATIONS LISTED IN THE PREVIOUS DISCLOSURE CONTRIBUTED TO THE STAKEHOLDER MEETINGS. PART V, SECTION B, LINE 11: PARTICIPANTS IN THE CHNA DATA COLLECTION PROCESSES DESCRIBED ABOVE IDENTIFIED CONCERNS AROUND THE FOLLOWING AREAS: SUBSTANCE ABUSE, INCLUDING CONCERNS ABOUT STIGMA SURROUNDING TREATMENT, AS WELL AS THE AVAILABILITY AND AFFORDABILITY OF TREATMENT;HEALTHY EATING, PRIMARILY CONCERNED AROUND AFFORDABILITY OF HEALTHY FOODS;MENTAL HEALTH, INCLUDING CONCERNS ABOUT AFFORDABILITY AND A NEED FOR MORE RESOURCES SUCH AS MENTAL HEALTH CLINICIANS;HEALTH CARE, INCLUDING CONCERNS ABOUT AFFORDABILITY, THE NEED FOR MORE PRIMARY CARE PROVIDERS, AND WELLNESS CENTERED CARE, AS WELL AS BARRIERS SUCH AS TRANSPORTATION AND LACK OF HEALTH INSURANCEENVIRONMENTAL ISSUES SUCH AS CLIMATE CHANGE AND STREET SAFETY; ANDHOUSING, INCLUDING LACK OF AFFORDABLE UNITS, SPACE TO RENT, SOBER HOUSING, AND HOUSING FOR ELDERS.A COMMUNITY MEETING WAS HELD TO PRESENT THE INFORMATION FROM THE CHNA SURVEY, FOCUS GROUPS, AND STAKEHOLDER MEETINGS WHERE 32 COMMUNITY LEADERS WERE PRESENT. ONCE THE INFORMATION WAS PRESENTED, LEADERS BROKE OUT INTO GROUPS TO IDENTIFY THE TOP THREE PRIORITIES TO BE ADDRESSED IN THE IMPLEMENTATION STRATEGY. THE TOP THREE PRIORITIES SELECTED WERE ACCESS TO MENTAL HEALTH SERVICES (72%), ACCESS TO HEALTHCARE SERVICES (60%), AND HOUSING (44%). THIS YEAR, PORTER HOSPITAL STRENGTHENED INTERNAL EFFORTS AND COLLABORATED WITH EXTERNAL COMMUNITY PARTNERS TO ADDRESS THESE NEEDS. HIGHLIGHTS INCLUDED:ENHANCING USE OF TECHNOLOGY AND ELECTRONIC HEALTH RECORDS TO IMPROVE ACCESS TO CARE: PORTER HOSPITAL SIMPLIFIED THE SCHEDULING PROCESS, ENABLING PATIENT SELF-SCHEDULING, AND ADDING TELE SITE CONSULTS FOR MENTAL AND BEHAVIORAL HEALTH;INCREASING ACCESS TO MENTAL HEALTH CARE THROUGH USE OF TECHNOLOGY AND PLACEMENT OF A CLINICIAL PSYCHOLOGIST SERVING PRIMARY CARE OFFICES;SCREENING FOR DISPLACEMENT AND HOMELESSNESS THROUGH STANDARDIZED QUESTIONS AT WELLNESS VISITS AND REFERRALS TO CARE MANAGEMENT;MONETARY AND IN-KIND SUPPORT FOR A NUMBER OF LOCAL ORGANIZATIONS PROMOTING COMMUNITY HEALTH INCLUDING COUNSELING SERVICE OF ADDISON COUNTY, AND THE OPEN DOOR CLINIC.A MORE COMPREHENSIVE DISCUSSION OF THESE AND SIMILAR EFFORTS CAN BE FOUND IN AN ANNUAL REPORT AVAILABLE AT HTTPS://WWW.PORTERMEDICAL.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/. PART V, SECTION B, LINE 13H: PATIENTS WHOSE FAMILY INCOME IS ABOVE 360% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE TO RECEIVE ASSISTANCE ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES AT THE DISCRETION OF PORTER HOSPITAL. PART V, SECTION B, LINE 15E: ELIGIBILITY VERIFICATION MAY INCLUDE WRITTEN DOCUMENTATION FROM THE OPEN DOOR CLINIC (A LOCAL, FREE HEALTH CLINIC FOR UNINSURED AND UNDER-INSURED ADULTS IN ADDISON COUNTY, VERMONT) OF FINANCIAL INFORMATION IN LIEU OF INCOME VERIFICATION. WHILE THE FINANCIAL ASSISTANCE POLICY DOES NOT PROVIDE A LIST OF "EXTERNAL" CONTACT INFORMATION FOR ORGANIZATIONS AGENCIES WHO MAY ASSIST PATIENTS IN THE APPLICATION PROCESS, APPLICATION COMPLETION AID IS WELL PUBLISHED WITH MULTIPLE INTERNAL, ORGANIZATIONAL AND PROVIDED BY STAFF MEMBERS AVAILABLE TO ASSIST OUR PATIENTS. IT IS ALSO IMPORTANT TO NOTE, WHENEVER POSSIBLE, PATIENTS ARE REVIEWED IN ADVANCE OF SERVICE FOR POTENTIAL HARDSHIP; THE UNINSURED AND UNDERINSURED PATIENTS WHO ARE IDENTIFIED ARE ACTIVELY COUNSELED WITH HELP FOR GOVERNMENT AND EXCHANGE PROGRAMS AS WELL AS ASSISTANCE UNDER THE FINANCIAL ASSISTANCE PROGRAM. PART V, SECTION B, LINE 16J: PORTER HOSPITAL MAKES ADDITIONAL EFFORTS TO ENGAGE PATIENTS IN FINANCIAL COUNSELING AND DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE AS FOLLOWS: - SIGNAGE HAS BEEN POSTED IN ALL WAITING AREAS OF THE ORGANIZATION REGARDING FINANCIAL ASSISTANCE BEING OFFERED. - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE HAS BEEN ADDED TO THE PATIENT PORTAL ALONG WITH A PHONE NUMBER FOR ASSISTANCE ALONG WITH OUR WEBSITE ADDRESS FOR APPLICATION. - OUTPATIENT PREREGISTRATION CALLS NOTIFY PATIENTS OF AVAILABILITY OF FINANCIAL ASSISTANCE. - REGISTRATION AREAS NOTIFY PATIENTS OF AVAILABILITY OF FINANCIAL ASSISTANCE AS WELL AS HAVING APPLICATIONS READILY AVAILABLE. - EVERY STATEMENT HAS THE NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE ALONG WITH A PHONE NUMBER TO CALL FOR ASSISTANCE AND A WEBSITE TO VISIT FOR AN APPLICATION. - THE UVMHN CUSTOMER SERVICE DEPARTMENT MAKES A REASONABLE EFFORT TO CALL PATIENTS FOR COLLECTIONS OF SELF-PAY BALANCES AND NOTIFICATION OF FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 20E: (ALSO APPLICABLE TO LINE 20A) PORTER HOSPITAL DOES NOT TAKE ANY EXTRAORDINARY COLLECTION ACTIONS. 10 1 - UVMHN-PMC ORTHOPEDICS 2436 EXCHANGE STREET MIDDLEBURY VT 05753 PHYSICIAN CLINIC 2 - UVMHN-PMC PRIMARY CARE-MIDDLEBURY 82 CATAMOUNT PARK MIDDLEBURY VT 05753 FAMILY PHYSICIAN CLINIC 3 - UVMHN-PMC PRIMARY CARE-VERGENNES 10 NORTH STREET VERGENNES VT 05491 FAMILY PHYSICIAN CLINIC 4 - UVMHN-PMC PEDIATRIC PRIMARY CARE 1330 EXCHANGE STREET 201 MIDDLEBURY VT 05753 PHYSICIAN CLINIC 5 - UVMHN-PMC PRIMARY CARE-BRANDON 61 COURT DRIVE BRANDON VT 05733 FAMILY PHYSICIAN CLINIC 6 - UVMHN-PMC EAR NOSE & THROAT 1330 EXCHANGE STREET 202 MIDDLEBURY VT 05753 PHYSICIAN CLINIC 7 - UVMHN-PMC PRIMARY CARE-BRISTOL 61 PINE STREET BRISTOL VT 05443 PHYSICIAN CLINIC 8 - UVMHN-PMC CARDIOLOGY 115 PORTER DRIVE MIDDLEBURY VT 05753 PHYSICIAN CLINIC 9 - UVMHN-PMC PODIATRY 76 COURT STREET MIDDLEBURY VT 05753 PHYSICIAN CLINIC 10 - UVMHN-PMC WOMEN'S HEALTH 116 PORTER DRIVE MIDDLEBURY VT 05753 PHYSICIAN CLINIC PART I, LINE 3C: ALL UNINSURED PATIENTS AND PATIENTS HAVING A BALANCE AFTER INSURANCE ARE ELIGIBLE TO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. IN ADDITION TO THE INCOME TEST BASED ON FEDERAL POVERTY GUIDELINES DESCRIBED IN SCHEDULE H, PART I, ELIGIBILITY IS PREDICATED UPON AN ASSET LEVEL WITHIN THE LIMITATIONS SET FORTH BY THE CMS MEDICARE LOW INCOME BENEFICIARY LIMITS. ADDITIONALLY, CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE TO THE MEDICALLY INDIGENT. FINALLY, PATIENTS WHOSE FAMILY INCOME IS ABOVE 360% OF THE FEDERAL POVERTY GUIDELINES, OR WHO OTHERWISE DO NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE TESTS DESCRIBED ABOVE, WERE ELIGIBLE TO RECEIVE ASSISTANCE ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES AT THE THE DISCRETION OF PORTER HOSPITAL. PART I, LINE 7: THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR THE PURPOSES OF CALCULATING AMOUNTS ON LINES 7A AND 7B. AN ACTUAL COSTING METHOD WAS USED TO CALCULATE AMOUNTS ON LINES 7E, 7F, 7G AND 7I. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES PROVIDED DESPITE A LOSS TO THE ORGANIZATION INCLUDED SERVICES PROVIDED TO PUBLIC AGENCIES SERVING POPULATIONS SUCH AS VETERANS, DISABLED PERSONS, AND CRIME VICTIMS, AND ALSO INCLUDED HOSPITAL DEPARTMENTS MEETING NEEDS THAT ARE NOT OTHERWISE AVAILABLE IN THE COMMUNITY SUCH AS DELIVERY, NEWBORN AND POSTPARTUM SERVICES, AND SERVICES RELATED TO MENTAL HEALTH. PART I, LN 7 COL(F): THE PROVISION FOR BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE AMOUNT REPORTED ON LINE 7(F) IS $0. BAD DEBT IS DEDUCTED FROM PATIENT SERVICE REVENUE REPORTED ON FORM 990, PART VIII. PART III, LINE 2: THE ORGANIZATION USED THE UNCOMPENSATED AND INDIGENT CARE COST-TO-CHARGE RATIO FROM ITS MEDICAID COST REPORT AS ITS COSTING METHODOLOGY TO CALCULATE BAD DEBT EXPENSE AT COST. PART III, LINE 3: DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE NETTED AGAINST THE TOTAL GROSS CHARGES WHEN DETERMINING BAD DEBT EXPENSE. THE $57,307 REFLECTS THE ADJUSTED BAD DEBT EXPENSE FOR ALL PATIENTS WHO SUBMITTED AN INITIAL APPLICATION, BUT UPON FOLLOW-UP, DID NOT RESPOND TO REQUESTS FOR ADDITIONAL INFORMATION OR SUPPORTING DOCUMENTATION. PORTER HOSPITAL HAS A DATABASE WHICH TRACKS ALL APPLICATIONS AND THEIR STATUS; A QUERY EXTRACTED ALL INCOMPLETE/NON RESPONSIVE ARCHIVED APPLICATIONS PROVIDING A LIST OF PATIENTS & DEPENDENTS. SUBSEQUENTLY, A QUERY OF ASSOCIATED PATIENT SERVICES FROM 10/1/22-9/30/23 FOR "SELF-PAY AND COLLECTION ACCOUNTS WAS EXTRACTED FROM THE BILLING SYSTEM. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE IS ADDRESSED ON PAGE 27 IN FOOTNOTE 4 OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE AMOUNT REPORTED IN PART III, LINE 6, MEDICARE ALLOWABLE COSTS OF CARE, IS DERIVED FROM PORTER HOSPITAL'S FYE 9/30/23 MEDICARE COST REPORT, WORKSHEETS E-1 THROUGH E-3. WHILE PORTER HOSPITAL HAS FOLLOWED THE CATHOLIC HOSPITAL ASSOCIATION'S GUIDANCE AND HAS NOT CONSIDERED ANY MEDICARE SHORTFALL (REPORTED IN PART III, LINE 7) AS A COMMUNITY BENEFIT, IT IS LIKELY THAT SOME PORTION OF MEDICARE PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE UNDER OUR POLICIES IN THE ABSENCE OF MEDICARE COVERAGE, SUCH THAT SHORTFALLS ASSOCIATED WITH THOSE PATIENTS WOULD OTHERWISE HAVE BEEN INCLUDED IN OUR COMMUNITY BENEFITS. PART III, LINE 9B: THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY PROVIDES THAT PATIENTS INDICATING AN INABILITY TO MEET THEIR FINANCIAL OBLIGATIONS ARE TO BE REFERRED TO THE PATIENT FINANCIAL ADVOCATE. THE POLICY PROVIDES FURTHER THAT PATIENTS WHO APPLY UNDER THE FINANCIAL ASSISTANCE POLICY ARE NOT CHARGED MORE THAN AMOUNTS GENERALLY BILLED AND QUALIFY FOR A SLIDING SCALE DISCOUNT. THE BILLING AND COLLECTIONS PROCESS IS EXTENDED FOR UP TO THE LATTER OF 240 DAYS OR SIX WEEKS AFTER A PATIENT HAS REQUESTED A FINANCIAL ASSISTANCE APPLICATION FOR PATIENTS REQUESTING A FINANCIAL ASSISTANCE APPLICATION. ONCE A PATIENT IS DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL PAYMENTS MADE IN EXCESS OF THE FAP-ELIGIBLE AMOUNT ARE FUNDED AND THE FAP-ELIGIBLE AMOUNT IS NOT PURSUED. PART VI, LINE 2: PORTER HOSPITAL PARTNERS WITH A NUMBER OF COMMUNITY HEALTH RESOURCE GROUPS INCLUDING MY HEALTHY VERMONT, THE VERMONT PUBLIC HEALTH INSTITUTE, COUNSELING SERVICE OF ADDISON COUNTY AND THE VERMONT DEPARTMENT OF HEALTH DISTRICT OFFICES TO ADDRESS THE NEEDS OF ADDISON COUNTY, VERMONT AND SURROUNDING AREAS. RECENT COLLABORATIONS HAVE INCLUDED PARTNERSHIP WITH THE VERMONT AHS TO ADMINISTER WORKFORCE GRANT INITIATIVES; WORK WITH THE HANNAFORD CARERRER CENTER TO EXPAND ACCESS TO HEALTH PROFESSIONS EDUCATION; COLLABORATIVE MEEINGS WITH COUNSELING SERVICES OF ADDISON COUNTY TO IMPROVE OPERATIONAL AND OPERATIONAL WORKFLOWS; AND PARTNERSHIP WITH THE VERMONT FOOD BANK TO HOST A MOBILE FOOD PANTRY. ADDITIONALLY, PORTER HOSPITAL OFFERS FREE TO THE COMMUNITY A WIDE RANGE OF HEALTH, PREVENTION AND WELLNESS PROGRAMS DESIGNED TO ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITY AND LIMIT THE NEED FOR MORE EXPENSIVE ACUTE CARE.. FINALLY, PORTER HOSPITAL HAS A COMMUNITY DEVELOPMENT COUNCIL THAT CONSISTS OF COMMUNITY MEMBERS AND PORTER STAFF WORKING TOGETHER TO DRIVE COMMUNITY ENGAGEMENT AND CREATE OPPORTUNITIES TO SUPPORT PORTER AND EXPAND PATIENT ACCESS. PART VI, LINE 3: PORTER HOSPITAL ("PORTER") UTILIZES A VARIETY OF METHODS TO INFORM, EDUCATE, AND ASSIST PAYMENTS IN IDENTIFYING PAYMENT SOURCES, INCLUDING STATE / FEDERAL PROGRAMS AND ITS FINANCIAL ASSISTANCE POLICY. PORTER WIDELY PUBLICIZES ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE, WHICH INCLUDES THE POLICY, THE APPLICATION, AND PLAIN LANGUAGE SUMMARY IN BOTH ENGLISH AND SPANISH. PAPER COPIES ARE AVAILABLE WITHOUT CHARGE AT LOCATIONS THROUGHOUT THE HOSPITAL INCLUDING BUT NOT LIMITED TO REGISTRATIONS DESKS IN THE ER AS WELL AS OFFSITE LOCATIONS. INDIVIDUALS ARE NOTIFIED ABOUT THE FAP WITH BILLING NOTICES AND OTHER BROCHURES PLACED THROUGHOUT PORTER FACILITIES.PORTER MAINTAINS ITS OWN HEALTH ASSISTANCE PROGRAM TO HELP ELIGIBLE LOW AND MIDDLE INCOME FAMILIES OBTAIN PRESCRIPTION MEDICATIONS, EYEGLASSES, AND MEDICAL EQUIPMENT AT NO COST. THE HEALTH ASSISTANCE PROGRAM ALSO PROVIDES ASSISTANCE WITH ENROLLMENT IN STATE AND FEDERAL PROGRAMS, INCLUDING OBTAINING INSURANCE THROUGH THE VERMONT HEALTH CONNECT EXCHANGE, AND PROVIDES ADVOCACY AND SUPPORT WITH OBTAINING OTHER HEALTH CARE RELATED RESOURCES.ADDITIONALLY, PORTER'S OFFICE OF PATIENT AND FAMILY ADVOCACY IS AVAILABLE TO HELP WITH CONCERNS ABOUT DELIVERY OF CARE, INCLUDING BUT NOT LIMITED TO COSTS. PART VI, LINE 4: ADDISON COUNTY IS LOCATED IN THE LOWER CHAMPLAIN VALLEY OF VERMONT WITH LAKE CHAMPLAIN AND THE ADIRONDACKS TO THE WEST AND THE GREEN MOUNTAINS TO THE EAST. THE UNIQUE LANDSCAPE OF ADDISON COUNTY, THE FARMLANDS OF THE CHAMPLAIN VALLEY, AND THE PREDOMINATELY WOODED SETTINGS NEAR THE GREEN MOUNTAINS PROMOTE A BLEND OF LIGHT INDUSTRY AND FARMING. THE MAJOR EMPLOYERS IN THE COUNTY INCLUDE MIDDLEBURY COLLEGE, PORTER MEDICAL CENTER (AND ITS AFFILIATES INCLUDING PORTER HOSPITAL), AND COLLINS AEROSPACE.PORTER HOSPITAL SERVES 37,400 RESIDENTS LOCATED IN ADDISON COUNTY, VERMONT, WHICH COMPRISES APPROXIMATELY 6% OF THE STATE'S TOTAL POPULATION. AS OF 2022, A VAST MAJORITY (94.4%) OF ADDISON COUNTY RESIDENTS WERE WHITE, NON-HISPANIC. HISPANIC OR LATINO RESIDENTS ARE ADDISON COUNTY'S MORE PREVALENT MINORITY POPULATION AT 1.8%. THE US CENSUS BUREAU ESTIMATES THAT 4.7% OF ADDISON COUNTY RESIDENTS UNDER THE AGE OF 65 WERE UNINSURED IN 2019. 93.5% OF THE POPULATION HAS A HIGH SCHOOL DIPLOMA OR HIGHER, 39.6% OF THE POPULATION HAS A BACHELOR'S DEGREE OR HIGHER, AND 7.9% OF THE POPULATION IS UNDER THE FEDERAL POVERTY LEVEL. THE MEDIAN HOUSEHOLD INCOME AS OF 2019 WAS $68,825. PART VI, LINE 5: IN ADDITION TO THE COLLABORATIONS AND PARTNERSHIPS DESCRIBED PREVIOUSLY:PORTER HOSPITAL ("PORTER") PROVIDES RENT-FREE CLINIC SPACE AND VOUCHERS FOR NO-COST ANCILLARY SERVICES TO THE LOCAL OPEN DOOR CLINIC IN ITS ROLE AS A CATALYST IN THE DELIVERY OF HEALTH CARE SERVICES TO ITS ENTIRE COMMUNITY. PORTER OFFERS FREE AND LOW COST COMMUNITY EDUCATION PROGRAMS ON HEALTH CARE TOPICS INCLUDING MEMORY LOSS, DEMENTIA, BREAST CANCER SCREENING, BASIC DIABETES, CPR, SMOKING CESSATION, NUTRITION, PHYSICAL FITNESS, PARENTING, PRENATAL EXERCISE AND BREASTFEEDING. A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN ITS SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF PORTER NOR FAMILY MEMBERS THEREOF. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL DEPARTMENTS AND/OR SPECIALTIES.SURPLUS FUNDS ARE INVESTED IN TECHNOLOGY, FACILITIES AND PROGRAMS. PART VI, LINE 6: ON APRIL 1, 2017, THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVMHN") BECAME THE SOLE MEMBER OF PORTER MEDICAL CENTER, INC., THE PARENT ORGANIZATION FOR BOTH PORTER HOSPITAL AND HELEN PORTER NURSING HOME, INC. WITH SIX HOSPITALS ACROSS VERMONT AND NORTHERN NEW YORK, AS WELL AS A MEDICAL GROUP, AND AFFILIATED CLINICS, NURSING HOMES, AND NON-HOSPITAL FACILITIES, UVMHN COMPRISES AN INTEGRATED SYSTEM OF CARE SERVING ITS COMMUNITIES. UVMHN CARRIES OUT CENTRALIZED ACTIVITIES FOR THE BENEFIT OF PATIENTS OF ALL PARTNER ORGANIZATIONS, INCLUDING IMPROVING ACCESS TO LOCAL CARE, COST SAVINGS THROUGH GREATER JOINT PURCHASING POWER, ENHANCING INFORMATION TECHNOLOGY, INCREASING ACADEMIC OPPORTUNITIES FOR PHYSICIANS, ENGAGING IN REGIONAL STRATEGIC PLANNING, AND PARTICIPATING IN JOINT QUALITY AND CLINICAL INITIATIVES, AND COLLABORATIVE EFFORTS. PORTER HOSPITAL REGULARLY PARTNERS WITH OTHER ORGANIZATIONS AND PROVIDERS TO HELP MEET THE NEEDS OF ITS COMMUNITY. THIS INCLUDES WORKING WITH OTHER ORGANIZED SYSTEMS OF CARE (LIKE HOME HEALTH AGENCIES AND PHYSICIAN PRACTICES), AS WELL AS COMMUNITY-BASED ORGANIZATIONS WHOSE MISSIONS ARE SIMILAR. FOR EXAMPLE, PORTER HOSPITAL COLLABORATES WITH COMMUNITY PARTNERS TO REGULARLY ASSESS COMMUNITY AND HEALTH CARE NEEDS, WHICH HELPS GUIDE THE ORGANIZATION'S PRIORITIES. 1 ADDISON ALLIES NETWORK INC PO BOX 1012 MIDDLEBURY VT 05753 831559952 501(C)(3) 13948 0 COMMUNITY HEALTH IMPROVEMENT ADDISON CENTRAL TEENS AND FRIENDS PO BOX 1115 MIDDLEBURY VT 05753 841968545 501(C)(3) 15320 0 COMMUNITY HEALTH IMPROVEMENT EARLY CARE AND LEARNING PARTNERSHIP INC 164 MITCHELL DRIVE VERGENNES VT 05491 833569812 501(C)(3) 15000 0 COMMUNITY HEALTH IMPROVEMENT ELDERLY SERVICES INC PO BOX 581 MIDDLEBURY VT 05753 030280968 501(C)(3) 30000 0 COMMUNITY HEALTH IMPROVEMENT GIVING FRIDGE LLC 66 MERCHANTS ROW MIDDLEBURY VT 05753 923585871 501(C)(3) 30000 0 COMMUNITY HEALTH IMPROVEMENT MIDDLEBURY EYE ASSOCIATES 91 MAIN ST MIDDLEBURY VT 05753 030341864 7637 0 COMMUNITY HEALTH IMPROVEMENT PATRICIA A HANNAFORD REGIONAL 51 CHARLES AVENUE MIDDLEBURY VT 05753 201189236 115(1) (VERMONT) 7132 0 COMMUNITY HEALTH IMPROVEMENT 6 1 COMMUNITY HEALTH EQUITY PARTNERSHIP GRANT 1 5635 0 PART I, LINE 2: RECORDS PERTAINING TO GRANTS AND ASSISTANCE ARE MAINTAINED IN THE ORGANIZATION'S ACCOUNTING SYSTEM, AND, IN THE CASE OF GRANTS FOR COMMUNITY BENEFIT, BY COMMUNITY BENEFIT STAFF. THE ORGANIZATION HAS ALSO IMPLEMENTED SOFTWARE FOR THE PURPOSES OF MONITORING GRANTS AND THE USE OF GRANT FUNDS. GRANT RECIPIENTS ARE LOCAL ORGANIZATIONS SERVING THE HEALTH NEEDS OF THE COMMUNITY SERVED BY PORTER HOSPITAL, AND ARE SELECTED BY STAFF MEMBERS INCLUDING COMMUNITY HEALTH STAFF MEMBERS WHO ARE ADVISED BY OTHER LOCAL ORGANIZATIONS REGARDING POTENTIAL RECIPIENTS AND APPLICATION PROCESSES. 0 1 0 0 0 0 0 1 1 0 TOM THOMPSON PRESIDENT & COO (TIL 9/2023) 0 369384 0 72839 0 62293 0 45944 0 353 0 550813 0 0 JUDY PEEK-LEE FMR INTERIM CFO 0 349587 0 37030 0 22793 0 14754 0 16438 0 440602 0 0 ERIC BERG CRNA 337555 0 0 0 41488 0 15492 0 31291 0 425826 0 0 0 BOB ORTMYER PRESIDENT & COO (AS OF 9/2023) 0 296556 0 50753 0 10707 0 18618 0 11678 0 388312 0 0 DR KRISTOFER ANDERSON DIRECTOR 0 346574 0 0 0 1166 0 18300 0 15231 0 381271 0 0 AMY BISHOP CRNA 296675 0 0 0 18097 0 9729 0 30673 0 355174 0 0 0 WILLIAM HARRINGTON CRNA 272030 0 0 0 16213 0 8639 0 195 0 297077 0 0 0 SCOTT COMEAU CFO 0 199220 0 15444 0 22900 0 7382 0 31116 0 276062 0 0 MICHAEL LEYDEN AVP OPERATIONS (TIL 7/2023) 0 207210 0 12541 0 254 0 6803 0 27905 0 254713 0 0 TIFFANY LOVE AVP/CHIEF NURS OFF (TIL 7/2023) 203614 0 27870 0 400 0 7023 0 11951 0 250858 0 0 0 LINDA HAVEY AVP OPERATIONS 0 216632 0 12541 0 3312 0 7021 0 4090 0 243596 0 0 ERIC SHUBERT PHARMACIST 179766 0 0 0 4218 0 7036 0 27467 0 218487 0 0 0 BRANDI BETCHER HELM AVP OPERATIONS (AS OF 7/2023) 159556 0 10230 0 93 0 5077 0 952 0 175908 0 0 0 PART I, LINE 3 PORTER HOSPITAL CENTER RELIED ON THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVM HEALTH NETWORK"), PARENT OF PORTER HOSPITAL'S PARENT ORGANIZATION, PORTER MEDICAL CENTER, TO ESTABLISH SENIOR EXECUTIVE COMPENSATION. UVM HEALTH NETWORK UTILIZED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B SUPPLEMENTAL RETIREMENT PLAN PORTER MEDICAL CENTER, PARENT ORGANIZATION OF PORTER HOSPITAL, MAINTAINS A SUPPLEMENTAL RETIREMENT BENEFIT PLAN (SRP) UNDER CONTRACTUAL ARRANGEMENT WITH PRESIDENT AND COO THOMAS THOMPSON. PURSUANT TO THE TERMS OF THE SRP, PORTER MEDICAL CENTER MAKES ANNUAL CREDITS EQUAL TO 8.68% OF BASE SALARY. AMOUNTS DEFERRED DURING CALENDAR YEAR 2022 ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. AMOUNTS DEFERRED REMAIN SUBJECT TO FORFEITURE IF CERTAIN CONDITIONS ARE NOT MET. PART I, LINE 7 PORTER HOSPITAL PAID AWARDS TO CERTAIN MEMBERS OF UPPER MANAGEMENT (OFFICERS, VICE PRESIDENTS, PHYSICIAN CHAIRS AND SENIOR EXECUTIVES) THROUGH ITS ANNUAL VARIABLE PAY PLAN AS THE PLAN'S PERFORMANCE MEASURES WERE MET. THE MEASURES WERE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THESE MEASURES INCLUDED FINANCIAL, POPULATION HEALTH & QUALITY, AND OPERATIONAL RELATED METRICS. ADDITIONALLY, CERTAIN EMPLOYEES OF THE ORGANIZATION WERE ELIGIBLE TO RECEIVE DISCRETIONARY BONUSES FOR RETENTION AND TAKING ON EXTRA RESPONSIBILITIES. PART I, LINE 8 SALARIES AND OTHER FIXED AMOUNTS PAYABLE TO EXECUTIVES SUCH AS OFFICERS AND CERTAIN KEY EMPLOYEES ARE SET BY CONTRACTS THAT ARE NEGOTIATED AND ENTERED INTO PRIOR TO THE COMMENCEMENT OF EACH EXECUTIVES' EMPLOYMENT. THE TERMS OF SUCH CONTRACTS ARE APPROVED IN ADVANCE BY THE APPROPRIATE COMPENSATION COMMITTEE OR OTHER BOARD-AUTHORIZED BODY, WHICH OBTAINS AND RELIES ON APPROPRIATE DATA AS TO COMPARABILITY PRIOR TO MAKING SUCH OFFER, AND CONCURRENTLY DOCUMENTS ITS BASIS FOR DETERMINATION. A VERMONT EDUCATIONAL HEALTH BUILDINGS AND FINANCING AGENCY 237154467 NONEAVAIL 2015-08-06 12650000 REFUND 2006 SERIES A BONDS 0 0 0 A 4266757 12650000 138787 12511213 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, COL (C) CUSIP # BECAUSE THE BONDS ARE HELD BY A PRIVATE FINANCIAL INSTITUTION AND WERE NEVER OFFERED TO THE PUBLIC, A CUSIP NUMBER WAS NOT ASSIGNED. FORM 990, PART 1, LINE 1: OPERATION OF A CRITICAL ACCESS HOSPITAL, IN LINE WITH OUR MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY, ONE PERSON AT A TIME. FORM 990, PART VI, SECTION A, LINE 2 THE GOVERNING BODY FOR PORTER HOSPITAL, INC. IS IDENTICAL TO THAT OF HELEN PORTER NURSING HOME, INC. AS WELL AS THEIR PARENT ORGANIZATION, PORTER MEDICAL CENTER. TOM THOMPSON, SCOTT COMEAU, MICHAEL LEYDEN, AND LINDA HAVEY HAD EMPLOYMENT RELATIONSHIPS WITH PORTER MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 PORTER MEDICAL CENTER, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY OF PORTER HOSPITAL, INC. IS IDENTICAL TO THAT OF ITS PARENT ORGANIZATION, PORTER MEDICAL CENTER, INC. THE UNIVERSITY OF VERMONT HEALTH NETWORK, AS SOLE MEMBER OF PORTER MEDICAL CENTER, INC., HAS POWERS TO ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B UVM HEALTH NETWORK HAS THE POWER TO APPROVE SIGNIFICANT CORPORATE ACTIONS, INCLUDING ANNUAL OPERATING AND CAPITAL BUDGETS, STRATEGIC PLANS, THE APPOINTMENT OF THE CEO, THE INCURRENCE OF LONG-TERM INDEBTEDNESS, AMENDMENTS TO THE ORGANIZATION'S BYLAWS AND ARTICLES OF ORGANIZATION, AND APPROVAL OF MAJOR FINANCIAL DECISIONS INCLUDING MERGERS, BANKRUPTCIES, AND THE DEVELOPMENT OR TERMINATION OF PROGRAM SERVICES. UVM HEALTH NETWORK IS A VERMONT NON-PROFIT CORPORATION WHICH HAS BEEN RECOGNIZED BY THE IRS AS A 501(C)(3) ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 FOR PORTER HOSPITAL, INC. IS PREPARED BY UVM MEDICAL CENTER STAFF AND REVIEWED BY PWC US TAX LLP. FOLLOWING OR CONCURRENT WITH PWC'S REVIEW, A DRAFT RETURN IS PRESENTED TO THE UVM HEALTH NETWORK AUDIT COMMITTEE AND MANAGEMENT FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE FORM BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH ANNUAL QUESTIONNAIRES AND CERTIFICATIONS REQUIRED OF ALL TRUSTEES, OFFICERS, AND OTHER INDIVIDUALS IN A POSITION TO EXERCISE INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION, THROUGH ONGOING DUTIES TO DISCLOSE TRANSACTIONS IN WHICH SUCH PERSONS HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST, AND THROUGH ONGOING MONITORING EFFORTS BY THE ORGANIZATION'S CFO AND CONTROLLER. WHEN A POTENTIAL CONFLICT IS DISCLOSED OR OTHERWISE IDENTIFIED, THE BOARD OR AFFECTED BOARD COMMITTEE IS CHARGED WITH DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS, WITH THE INTERESTED PERSON BEING DISQUALIFIED FROM VOTING, PARTICIPATION, AND ATTENDANCE. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST DOES IN FACT EXIST, THEN SUCH PERSON IS RESTRICTED FROM PARTICIPATION IN ALL DELIBERATIONS PERTAINING TO THE PROPOSED TRANSACTION OR ARRANGEMENT AT ISSUE. THE REMAINING BOARD OR COMMITTEE MEMBERS MAY, AT THEIR DISCRETION, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD OR AFFECTED COMMITTEE SHALL CONTAIN THE NAME OF THE INTERESTED PERSON, THE NATURE OF THE INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT WAS PRESENT, AND THE DECISION AS TO WHETHER A CONFLICT EXISTED. VIOLATIONS OF THE CONFLICT OF INTEREST POLICY ARE SUBJECT TO DISCIPLINARY AND CORRECTIVE ACTION INCLUDING BUT NOT LIMITED TO TERMINATION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DELEGATES THE SETTING OF EXECUTIVE COMPENSATION TO THE UVM HEALTH NETWORK COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE, UNDER PRINCIPLES DESCRIBED IN ITS CHARTER. THE UVM HEALTH NETWORK HAS ADOPTED A COMPENSATION PHILOSOPHY WHICH PROVIDES A FRAMEWORK FOR SETTING COMPENSATION FOR THE EXECUTIVES OF UVM HEALTH NETWORK AND ITS AFFILIATED MEMBER ORGANIZATIONS. THE PARAMETERS OF THIS PHILOSOPHY INCLUDE UTILIZING APPROPRIATE NATIONAL AND REGIONAL PEER GROUPS. SALARIES ARE TARGETED AT THE 50TH PERCENTILE OF THE NATIONAL PEER GROUP, WITH PERFORMANCE BASED VARIABLE PAY OPPORTUNITIES TO ACHIEVE UP TO THE 65TH PERCENTILE, DEPENDING ON ORGANIZATION AND INDIVIDUAL RESULTS. COMPENSATION LEVELS ARE APPROVED BY THE NETWORK COMPENSATION COMMITTEE FOR THE UVM HEALTH NETWORK/DIRECT REPORTS AND THE AFFILIATED ORGANIZATIONS' CEOS. CALCULATIONS ARE PERFORMED USING THE SAME PHILOSOPHY FOR THE THIRD TIER OF LEADERSHIP, WITH THE EXCEPTION THAT THE LOCAL BOARDS APPROVE COMPENSATION FOR ALL NON-CEO POSITIONS. ALL ACTIONS TAKEN REGARDING EXECUTIVE COMPENSATION ARE CONTEMPORANEOUSLY DOCUMENTED BY THE APPROPRIATE ORGANIZATION. THIS REVIEW IS PERFORMED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G TEMP STAFFING: PROGRAM SERVICE EXPENSES 12,660,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,660,700. NTWK SHARED SERVICES AND AFFILIATED RECOVERY: PROGRAM SERVICE EXPENSES 402,776. MANAGEMENT AND GENERAL EXPENSES 7,154,190. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,556,966. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,157,181. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,157,181. COLLECTION AGENCY FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 486,994. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 486,994. CONSULTING: PROGRAM SERVICE EXPENSES 29,703. MANAGEMENT AND GENERAL EXPENSES 195,971. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 225,674. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,118,534. MANAGEMENT AND GENERAL EXPENSES 1,617,374. FUNDRAISING EXPENSES 169,375. TOTAL EXPENSES 3,905,283. FORM 990, PART XI, LINE 9: OTHER COMPONENTS OF CURRENT PERIOD PENSION EXPENSE -45,445. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -76,248. TEMPORARILY RESTRICTED CONTRIBUTIONS -222,748. OTHER CHANGES IN NET ASSETS 3,170. TRANSFER OF NET ASSETS 1,177,274. PENSION PLAN ADJUSTMENT 314,481. THE UNIVERSITY OF VERMONT MEDICAL CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 030219309 HOSPITAL VT 501(C)(3) 3 UVMHN 1 THE UNIVERSITY OF VERMONT MED CTR FDN INC 111 COLCHESTER AVE BURLINGTON VT 05401 263159849 FUNDRAISING VT 501(C)(3) 12A-I UVMMC 1 UNIVERSITY OF VERMONT HEALTH NETWORK INC 111 COLCHESTER AVE BURLINGTON VT 05401 452880726 HOLDING COMPANY VT 501(C)(3) 12A-I N/A 0 CENTRAL VERMONT MEDICAL CENTER 130 FISHCHER ROAD BERLIN VT 05602 222547186 HOSPITAL VT 501(C)(3) 3 UVMHN 1 UNIVERSITY HEALTH CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 030229931 HOSPITAL VT 501(C)(3) 12C-III-FI UVMHNMG 1 COMMUNITY PROVIDERS INC 75 BEEKMAN STREET PLATTSBURGH NY 01290 222544844 HEALTH SVC COOR NY 501(C)(3) 12A-I UVMHN 1 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL 75 BEEKMAN STREET PLATTSBURGH NY 12901 141338471 HOSPITAL NY 501(C)(3) 3 UVMHN 1 ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET ELIZABETHTOWN NY 12932 141364513 HOSPITAL NY 501(C)(3) 3 UVMHN 1 EMERGENCY MEDICAL TRANSPORT OF CVPH INC 75 BEEKMAN STREET PLATTSBURGH NY 12901 061718419 AMBULANCE SVC NY 501(C)(3) 12B-II CPI 1 CVPH MEDICAL CENTER FOUNDATION 75 BEEKMAN STREET PLATTSBURGH NY 12901 141727048 HEALTH SVC SUPPORT NY 501(C)(3) 12B-II CVPH 1 UNIVERSITY MEDICAL EDUCATION ASSOCIATES 89 BEAUMONT AVENUE BURLINGTON VT 05405 237107832 EDUCATIONAL VT 501(C)(3) 10 UVMHNMG 1 ALICE HYDE MEDICAL CENTER 133 PARK STREET MALONE NY 12953 150346515 HOSPITAL NY 501(C)(3) 3 UVMHN 1 PORTER MEDICAL CENTER INC 115 PORTER DRIVE MIDDLEBURY VT 05753 030310862 SUPPORTING ORG VT 501(C)(3) 12B-II UVMHN 0 HELEN PORTER NURSING HOME 37 PORTER DRIVE MIDDLEBURY VT 05753 030306549 NURSING HOME VT 501(C)(3) 3 PMC 1 AUXILIARY OF PORTER MEDICAL CENTER 37 PORTER DRIVE MIDDLEBURY VT 05753 237363227 SUPPORTING ORG VT 501(C)(3) 12B-II PMC 1 LAKE CHAMPLAIN PHYSICIAN SERVICES PC 75 BEEKMAN STREET PLATTSBURGH NY 12901 273785445 PHYSICIAN SVC NY 501(C)(3) 12A-I CVPH 1 THE UNIVERSITY OF VERMONT HEALTH NETWORK MEDICAL GROUP INC 111 COLCHESTER AVE BURLINGTON VT 05401 030225105 PHYSICIAN SVC VT 501(C)(3) 12A-I UVMHN 1 UVMHN HOME HEALTH & HOSPICE 1110 PRIM ROAD COLCHESTER VT 05446 030179603 HOME HEALTHCARE VT 501(C)(3) 10 UVMHN 1 VMC INDEMNITY COMPANY INC 95 ST PAUL ST BURLINGTON VT 05401 831102018 INSURANCE VT 501(C)(3) 10 UVMHN 1 UVMHN VENTURES INC 111 COLCHESTER AVENUE BURLINGTON VT 05401 043380045 HOLDING COMPANY VT N/A C 0 UVMHN CREDENTIALING & ENROLLMENT 111 COLCHESTER AVENUE BURLINGTON VT 05401 030333056 ADMIN SVC VT N/A C 0 CHARITABLE REMAINDER TRUSTS (6) SUPPORT VT N/A T 0 PERPETUAL TRUSTS (10) SUPPORT VT N/A T 0 CHARITABLE IRREVOCABLE TRUSTS (8) SUPPORT VT N/A T 0 CHAMPLAIN VALLEY HEALTH NETWORK 75 BEEKMAN STREET PLATTSBURGH NY 12901 161586102 ADMIN SVC NY N/A C 0 MEDIQUEST INC PO BOX 1656 PLATTSBURGH NY 12901 141663061 MED OFFICE LEASE NY N/A C 0 YANKEE MEDICAL INC 276 NORTH AVENUE BURLINGTON VT 05401 030225363 HOME MEDICAL EQUIPMENT VT N/A C 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 HELEN PORTER NURSING HOME INC I 221572 FMV HELEN PORTER NURSING HOME INC Q 11194375 FMV PORTER MEDICAL CENTER INC P 1177888 FMV PORTER MEDICAL CENTER INC K 84720 FMV