2022-08-15T13:02:56-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 030306549 Helen Porter Nursing Home Inc HELE 8023884701 115 Porter Drive Middlebury VT 05753 Scott Comeau CFO 8023884701 2022-08-15 1 Scott Comeau 999009999 Joseph R Byrne P01289281 2077752387 2022-08-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Helen Porter Rehabilitation & Nursing Tom Thompson 115 Porter Drive Middlebury VT 05753 10077446 0 X www.portermedical.org X 1986 VT Operation of 98 bed skilled nursing home 17 15 187 23 0 0 707185 307180 10240786 9769809 3305 457 0 0 10951276 10077446 0 0 0 0 8286880 9387479 0 0 0 3409486 3213453 11696366 12600932 -745090 -2523486 4088031 4208955 6090588 6630651 -2002557 -2421696 The mission of Helen Porter Rehabilitation and Nursing is to improve the health of our community, one person at a time. 0 0 10183266 9769809 Operated long-term community oriented 98 bed skilled nursing home. The nursing home provided services to patients that totaled 28,860 resident days during the year ended 9/30/2021. 10183266 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 1 187 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Scott Comeau 8023884752 115 Porter Drive Middlebury VT 05753 Andrew Mahoney MD Medical Staff Vice President 1.00 41.00 X 0 300418 50943 Kristofer Anderson MD Director 1.00 41.00 X 0 301750 26361 Jennifer Bertrand Past CFO 1.00 41.00 X 0 228529 4630 Seleem Choudhury Former COO 0.00 0.00 X 0 213986 0 Mary Jane Nottonson Nursing Home Administrator 40.00 0.00 X 147035 0 37550 Tom Thompson President & COO 1.00 41.00 X 0 174992 0 Arlene Matthewson RN 40.00 0.00 X 139039 0 35483 Sarah Dugan LNA 40.00 0.00 X 131070 0 14751 Aida Nielsen RN 40.00 0.00 X 105982 0 35835 Roxanne Shaner RN 40.00 0.00 X 107868 0 4367 Linn Larson MD Director 1.00 2.00 X 0 1969 0 Sivan Cotel Chair 1.00 2.00 X X 0 0 0 Linda Schiffer Vice Chair 1.00 2.00 X X 0 0 0 Maureen McLaughlin Treasurer 1.00 2.00 X X 0 0 0 Matthew Curran Secretary 1.00 2.00 X X 0 0 0 Gretchen Ayer Director 1.00 2.00 X 0 0 0 Judson Bartlett Director 1.00 2.00 X 0 0 0 Anne Collins Director 1.00 2.00 X 0 0 0 Richard Foote Director 1.00 2.00 X 0 0 0 Amy Gregory MD Medical Staff President 1.00 2.00 X 0 0 0 Nicholas Lovejoy Director 1.00 2.00 X 0 0 0 Cheryl Mullins Director 1.00 2.00 X 0 0 0 Sarah Ray Director 1.00 2.00 X 0 0 0 Amey Ryan Director 1.00 2.00 X 0 0 0 Debra Stenner Director 1.00 2.00 X 0 0 0 Scott Comeau CFO 1.00 41.00 X 0 0 0 Judy Peek-Lee Interim CFO 1.00 41.00 X 0 0 0 630994 1221644 209920 8 1 1 0 Porter Medical Center Inc 115 Porter Drive Middlebury VT 05753 Management Services 616001 Porter Hospital 115 Porter Drive Middlebury VT 05753 Lab/Pharmacy/Radiology/Mgt. Svcs. 145807 2 245654 61526 307180 Patient Revenue 623000 10596334 10596334 Other Revenue 623000 6720 3878 2842 Contractual Allowances 623000 -833245 -833245 9769809 457 457 10077446 9766967 0 3299 7555710 6646010 909700 181759 163965 17794 1150463 1037582 112881 499547 450661 48886 650325 117733 532592 56144 56144 298428 92456 205972 87031 14131 72900 347159 15405 331754 6257 2987 3270 68808 56218 12590 246619 194829 51790 20570 20570 Medical Supplies 909715 892778 16937 Medicaid Provider Tax 482114 482114 Miscellaneous Expense 40283 16397 23886 12600932 10183266 2417666 0 X 17710 13150 1048437 1138986 997654 873068 16483 16483 7217 56930 8029170 5918832 1983676 2110338 16854 0 4088031 4208955 1455009 1357779 2470778 2335808 36459 64022 741973 741973 1386369 2131069 6090588 6630651 X -2695275 -3067203 692718 645507 -2002557 -2421696 4088031 4208955 X -2523486 2104347 X 0 1 X 1 0 X Form 990, Schedule A, Part I, Line 3: Reason for Public Charity Status: The Organization's exemption is based upon being classified as a hospital or cooperative hospital service organization described in 170(b)(1)(A)(iii). Since the Organization is not licensed in the state of Vermont as a hospital, but rather as a skilled nursing facility, Schedule H is not required. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3869 3869 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 0 1 X 216666 216666 5986783 4595807 1390976 1528943 1139984 388959 296778 183041 113737 2110338 Due to Affiliates 1792854 Liability for Pension Benefits 338031 Estimated Third-Party Settlements 184 2131069 Part IV, Line 2b: The Organization holds funds belonging to residents for their personal use. The funds are made available to the residents as requested or needed. 1 0 0 0 0 0 0 1 0 Andrew Mahoney MD Medical Staff Vice President 0 298483 0 0 0 1935 0 18810 0 32133 0 351361 0 0 Kristofer Anderson MD Director 0 296501 0 0 0 5249 0 12455 0 13906 0 328111 0 0 Jennifer Bertrand Past CFO 0 224282 0 0 0 4247 0 4417 0 213 0 233159 0 0 Seleem Choudhury Former COO 0 96479 0 0 0 117507 0 0 0 0 0 213986 0 0 Mary Jane Nottonson Nursing Home Administrator 146508 0 0 0 527 0 3056 0 34494 0 184585 0 0 0 Tom Thompson President & COO 0 74038 0 50000 0 50954 0 0 0 0 0 174992 0 0 Arlene Matthewson RN 135354 0 0 0 3685 0 4291 0 31192 0 174522 0 0 0 Part I, Line 3 Porter Medical Center (PMC), a related organization, establishes the compensation for the Organization's CEO. Porter Medical Center uses a variety of resources to establish compensation as follows: 1. Independent compensation consultant 2. Written employment contract 3. Approval by the PMC Board Part I, Line 4a During 2020, Seleem Choudhury, Former COO, received severance pay of $114,540 from Porter Medical Center, a related organization. Seleem received the severance pay as a result of leaving her position as COO. Dr. Choudhury remained an employee of Porter Medical Center as a Physician. Part I, Line 7 Employees of Helen Porter Nursing Home were eligible to receive discretionary bonuses for taking on extra responsibilities. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-08-01 3100000 Refunding 2000 Series A Bonds 0 0 0 A 764192 3100000 34525 3065475 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Form 990, Part VI, Section A, line 6 As of April 1, 2017, the University of Vermont Health Network became the sole member of Porter Medical Center. Form 990, Part VI, Section A, line 7a The University of Vermont Health Network, as Porter Medical Center's sole member, has reserve powers that allow the University of Vermont Health Network to refuse the acceptance of new board members appointed by the Porter Medical Center Board of Directors if The University of Vermont Health Network does not agree with the choice of appointments. As a result, the process of appointing members to the governing body is a collaboration of the Porter Medical Center Board of Directors and the University of Vermont Health Network. Form 990, Part VI, Section A, line 7b The University of Vermont Health Network has certain reserve powers that require it to approve certain decisions made by the Porter Medical Center Board of Directors. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by management and the Finance committee before filing. The Form 990 is also made available electronically to the Board of Directors before filing. Form 990, Part VI, Section B, line 12c The Organization's CFO and Controller are responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. When bids are solicited to include the business of a Board member, those bids are reviewed by the Board of Directors to assure adherence to the Organization's lowest bid policy. When an issue comes up to a vote and it is connected, in any way, to the business of a Board member, the member must recuse him/herself from the vote. Form 990, Part VI, Section B, line 15a The Compensation Committee reviews the data prepared by the UVMHN Total Rewards team and audited external consultants. Based on the data provided, the Compensation Committee reviews the CEO's salary for appropriateness and votes to approve the salary of the CEO. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Helen Porter Nursing Home, Inc. 115 Porter Drive Middlebury, VT 05753 EIN 03-0306549 Helen Porter Nursing Home, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Net Assets to Recognize Funded Status of Pension Plan 386,091. Other Component of Pension Expense -31,744. Transfer from Affiliate 1,750,000. Form 990, Schedule A, Part I, Line 3: Reason for Public Charity Status: The Organization's exemption is based upon being classified as a hospital or cooperative hospital service organization described in 170(b)(1)(A)(iii). Since the Organization is not licensed in the state of Vermont as a hospital, but rather as a skilled nursing facility, Schedule H is not required. Porter Hospital Inc 37 Porter Drive Middlebury VT 05753 030181058 Critical Access Hospital VT 501(c)(3) Line 3 Porter Medical Center Inc 0 Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 12b, II N/A 0 Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 12b, II Porter Medical Center Inc 0 Univ of Vermont Health Network Inc 111 Colchester Ave Burlington VT 05401 452880726 Parent Organization VT 501(c)(3) Line 12a, I N/A 0 UVM Health Network Medical Group Inc 111 Colchester Ave Burlington VT 05401 030225105 Physician Services VT 501(c)(3) Line 12a, I UVMHN 0 UVM Medical Group-New York PLLC 183 Park Street Malone NY 12953 203905216 Physician Services NY 501(c)(3) Line 3 UVMHNMG 0 The University of Vermont Med Ctr Fdn Inc 111 Colchester Ave Burlington VT 05401 263159849 Fundraising VT 501(c)(3) Line 12a, I UVMMC 0 The University of Vermont Medical Center 111 Colchester Ave Burlington VT 05401 030219309 Hospital VT 501(c)(3) Line 3 UVMHN 0 Central Vermont Medical Center 130 Fisher Road Berlin VT 05602 222547186 Hospital VT 501(c)(3) Line 3 UVMHN 0 Community Providers Inc 75 Beekman Street Plattsburgh NY 12901 222544844 Health Service Coordinator NY 501(c)(3) Line 12a, I UVMHN 0 Champlain Valley Physicians Hospital 75 Beekman Street Plattsburgh NY 12901 141338471 Hospital NY 501(c)(3) Line 3 UVMHN 0 Elizabethtown Community Hospital 75 Park Street Elizabethtown NY 12932 141364513 Hospital NY 501(c)(3) Line 3 UVMHN 0 Emergency Medical Transport of CVPH Inc 75 Beekman Street Plattsburgh NY 12901 061718419 Ambulance Service NY 501(c)(3) Line 12b, II CPI 0 CVPH Medical Center Foundation 75 Beekman Street Plattsburgh NY 12901 141727048 Health Service Support NY 501(c)(3) Line 12b, II CVPH 0 University Health Center 111 Colchester Ave Burlington VT 05401 030229931 Hospital VT 501(c)(3) Line 12c, III-FI UVMHNMG 0 University Medical Education Associates 89 Beaumont Avenue Burlington VT 05401 237107832 Educational VT 501(c)(3) Line 10 UVMHNMG 0 Alice Hyde Medical Center 133 Park Street Malone NY 12953 150346515 Hospital NY 501(c)(3) Line 3 UVMHN 0 UVM Medical Center Auxiliary Inc 111 Colchester Ave Burlington VT 05401 208022004 Service VT 501(c)(3) Line 12c, III-FI N/A 0 UVMHN Home Healthcare & Hospice 1110 Prim Road Colchester VT 05446 030179603 Home Healthcare VT 501(c)(3) Line 3 UVMHN 0 Lake Champlain Physicians Services PC 75 Beekman Street Plattsburgh NY 12901 273785445 Physician Services NY 501(c)(3) Line 12a, I CVPH 0 VMC Indemnity Company Inc 95 St Paul St Burlington VT 05401 831102018 Insurance VT 501(c)(3) Line 12a, I UVMHN 0 Onecare Vermont ACO LLC 111 Colcester Ave Burlington VT 05401 455399218 Accountable Care VT N/A 0 0 Adirondack ACO LLC 75 Beekman Street Plattsburgh NY 12901 462840926 Accountable Care NY N/A 0 0 UVMHN Health Ventures Inc 111 Colchester Ave Burlington VT 05401 043380045 Holding Company VT N/A C 0 VMC Indemnity Company LTD PO Box HM 3103 25 Church Street Hamilton HM FX BD Captive Insurance BD N/A C 0 UVMHN Credentialing & Enrollment 111 Colchester Ave Burlington VT 05401 030333056 Admin Services VT N/A C 0 Charitable Remainder Trust (5) Support VT UVMMCCVMC 0 Perpetual Trust (4) Support VT UVMMC 0 Charitable Irrevocable Trust (7) Support VT UVMMCCVMC 0 Champlain Valley Health Network 75 Beekman Street Plattsburgh NY 12901 161586102 Admin Service 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 Perpetual Trust (2) Support VT Porter Hospital Inc 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1