2021-08-16T13:07:54-05:00 2020-09-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041041100 990 2019-10-01 030179437 Springfield Hospital Inc SPRI 8028852151 PO Box 2003 Springfield VT 05156 Kayda Wescott Interim CFO 8028852151 2021-08-16 1 Joseph R Byrne P01289281 2077752387 2021-08-16 2019 2022-09-23 18:48:47Z Robert Adcock PO Box 2003 Springfield VT 05156 47705943 0 X www.springfieldhospital.org X 1914 VT 25-Bed Critical Access Hospital 8 6 540 23 0 0 243556 7265313 49631544 40414089 316363 13996 3724 5042 50195187 47698440 6030293 4000 0 0 31429574 26212787 0 0 0 26615272 26141038 64075139 52357825 -13879952 -4659385 23192779 28092094 30240995 40577074 -7048216 -12484980 X Our mission is to excel at providing personalized, quality care; where people come first. Our vision is to be the provider of choice by creating a professional environment where patients want to receive care, clinicians want to practice medicine, and employees want to work. Our plan is to accomplish this by:1. Empowering our caregivers with education, technology, and opportunities for personal and professional development;2. Creating an environment which builds collaborative relationships among clinicians, staff, and patients;3. Providing our communities with the educational resources and support to make informed decisions emphasizing prevention and wellness; and4. Offering safe, personalized, high quality care. 0 0 42401018 4000 40414089 Springfield Hospital (SH) is a 25-bed critical access hospital located in Springfield, VT. SH also operates The Windham Center, a 10-bed comprehensive inpatient mental health program in Bellows Falls, VT; off-site physical therapy services, five hospital-owned specialty clinics (ENT, general surgery, orthopaedics, gynecology and urology, and an adult day care center in Springfield, VT. Our mission is to excel at providing personalized, quality care; where people come first. Our vision is to be the provider of choice by creating a professional environment where patients want to receive care, clinicians want to practice medicine, and employees want to work. Our plan is to accomplish this by:- Empowering our caregivers with education, technology, and opportunities for personal and professional development;- Creating an environment, which builds collaborative relationships among clinicians, staff, and patients;- Providing our communities with the educational resources and support to make informed decisions emphasizing prevention and wellness; and,- Offering safe, personalized, high-quality care.SH provides health services to residents throughout its catchment area. Many of the services benefit the elderly, the poor, the indigent, the underinsured and the uninsured. SH receives minimal reimbursement from these programs, with 40% of Springfield Hospital net revenue coming from Medicare and Medicaid funding.Springfield Hospital has a charity care policy under which patients who meet certain criteria will receive care without charge, or at amounts less than established rates. Patients qualify for 100% charity care at up to 200% of the federal poverty guideline (FPG) and 50% assistance up to 300% of the FPG. The Hospital does not bill patients nor pursue collection of amounts determined to qualify as charity care. For FY20, charges foregone for charity care, based on established rates, amounted to $889K.Springfield Hospital operates a number of specialty practices to provide needed specialty care to health center patients. These clinics include Connecticut Valley ENT, Surgical Associates, Connecticut Valley Orthopaedics, Springfield Gynecology and Springfield Urology. In addition, SH provides an outpatient clinic serving patients needing treatment and minimizing their need to travel great distances for medical oncology or infusion services. Cardiology services are also offered on-site 6 days each month at the specialty clinic. Charitable support, in the form of gas cards and/or medication cards, is provided to patients who do not have needed funds. This charitable support program is available through donations and grant funding. Other community benefit programs include the following:Job Training and Shadowing Programs: These programs, in cooperation with Vocational Rehab and training programs through the State of Vermont, provide opportunities to gain on-the-job experience in the healthcare field. We also work with area high school students to provide opportunities for career education and summer employment. Healthcare Scholarships: Springfield Hospital raises funds that are then donated to individuals to further their educational pursuits in healthcare careers. In FY 2020, we donated four scholarships of $1,000 each.BeSeatSmart Program: This program helps residents comply with Vermont's child passenger restraint law, while ensuring the safety of our smallest patients. During FY 2020, 13 child safety seats were provided to families in need, and a total of 20 child safety seats were installed and/or inspected by the Child Passenger Safety Technician, on site at Springfield Hospital. The safety seat checks are offered as a free community service. We estimate the value of this program to be $1,000 based on staff time to educate parents on the proper use and installation of the child safety seats and administrative assistant costs.Employee Donations For Community Causes: Throughout the year, the Hospital encourages employees to participate in and donate to fundraising events in support of various associations that address community needs, for example Hearts of Hope and the Santa Claus Club. In addition, Springfield Hospital partners with the Vermont Food Bank in offering Veggie VanGo that provides free fresh fruits and vegetables to families in need on a monthly basis. The Springfield Hospital Veggie VanGo site serves approximately 300-400 families each month.EMS Preceptor Programs: Through Springfield Hospital's Emergency Department, area EMS continue their education by participating in a preceptor program, allowing personnel to observe patient care.Hospital Based Support Groups: Springfield Hospital routinely provides education and support groups on a variety of topics such as Alzheimers' Caregivers. Group meetings meet monthly and are free to participants, educational in nature, and offer an opportunity for group discussion. During FY 2020, these groups were suspended for public safety precautions related to COVID-19.Meeting Rooms: Free meeting room space is offered to community groups when space is available. Groups that offer information on health or wellness are given a priority; such as Alcoholics Anonymous, Vermont Department of Health, the community health team and the community collaborative. During FY 2020, these groups were suspended for public safety precautions related to COVID-19.Training Site Partnerships: Springfield Hospital is a training site for Vermont Technical College for their Licensed Practical Nurses and several other schools for their Registered Nurses. Generally, the following participating schools have students doing practicums: University of New Hampshire, University of Vermont, Norwich University, University of Massachusetts, Smith College, Antioch New England Graduate School, River Valley College, VTC, St Joseph's College of Maine, Castleton State College. The program utilization generally requires an estimated 1,500 to 1,700 hours for clinical work, although we had lower activity in 2020 due to COVID-19.Community Education: Springfield Hospital promotes health education programs, open to the public, which include American Heart Association CPR and First Aid classes. The Hospital also collaborates with the Springfield Medical Care Systems' community health team in offering community health and wellness education programs throughout the year emphasizing preventive programming around diet, exercise and nutrition.Springfield Community: Springfield Hospital encourages employees to become an active volunteer to help improve the communities we call home. Employees donate their time in a variety of areas ranging from serving as Board Members for local groups, participation in fundraising activities, including the Springfield Hospital Annual Golf Tournament and Apple Blossom Cotillion fundraising events. Volunteer Service: Volunteer Services provide a variety of services to patients and visitors. The donation of time and fundraising activities support programs that include Clerical Services, Activities Assistant at Adult Day Services, Materials Management Support, Inpatient Discharge Phone Calling Support and Special Services in the Emergency Department. Volunteer numbers and time were drastically reduced I 2020 due to COVID-19. In 2020, prior to early March, Springfield Hospital had 28 volunteers. These individuals volunteered approximately 650 hours.The Windham Center: The Windham Center is a 10-bed inpatient mental health unit that provides mental health services to residents of Windham and Windsor counties and other communities. Programs provide treatment for men and women who are 18 years of age and older. Multidisciplinary teams include psychiatrists, social workers, clinicians, drug and alcohol counselors, and nurses. The Windham Center serves the general population and financial assistance is available, based on need. The Windham Center had 190 admissions in 2020, and incurred $29K in charity care expense and $487K in non-reimbursed Medicaid and Medicare costs for the same time period.Adult Day Care Service: Springfield Hospital operates an adult day care service, located in Springfield, VT. A cost-effective choice to long term nursing home health care, the Springfield Area Adult Day Service assists families with seniors or disabled adults, over the age of 18, who face the challenge of losing their independence. The structured program offers a safe and protective environment where nutritious meals, social activities, health care services, nursing oversight, and coordination of needed social and support services are provided. Transportation is available through an arrangement with the local bus service, Marble Valley Regional Transit. 42401018 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 95 0 1 540 1 0 0 0 0 0 1 0 0 0 0 0 0 0 X 8 6 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 VT X Kayda Wescott 8028857646 PO Box 2003 Springfield VT 05156 Jim Rumrill Chairperson 2.00 1.00 X X 0 0 0 Heather Presch Vice Chairperson 1.00 0.00 X X 0 0 0 Richard Dexter III Treasurer 2.00 2.00 X X 0 0 0 David Sandelman Director 1.00 0.00 X 0 0 0 Gabriel St Pierre Director 1.00 0.00 X 0 0 0 Lynn Raymond-Empey Director 1.00 0.00 X 0 0 0 Robert Cantu MD Director/Orthopaedic Surgeon 40.00 0.00 X 556530 0 9007 Eliot Hall MD Director 1.00 40.00 X 0 290562 15467 Stephen Lyon Past Secretary 2.00 2.00 X X 0 0 0 Gerald Drabyn MD Past Director 1.00 40.00 X 0 182023 14736 Jim Remy Past Director 1.00 0.00 X 0 0 0 Michael Halstead Interim CEO/President 40.00 0.00 X 254275 113862 0 Allan Scroggins Interim CFO 20.00 20.00 X 67478 28919 0 Cecil Beehler MD Past Chief Medical Officer 1.00 40.00 X 0 378327 9094 David Muller MD Orthopaedic Surgeon 40.00 0.00 X 607253 0 18031 Khalid Husain MD General Surgeon 40.00 0.00 X 468495 0 15965 Xiangtian Hu MD Anesthesiologist 40.00 0.00 X 384153 0 6369 Vitaliano Sicilia MD Hospitalist Physician 40.00 0.00 X 302384 0 1061 John Ciocchi MD General Surgeon 40.00 0.00 X 330381 0 5960 Wayne Scholz Former Interim CFO 0.00 0.00 X 72611 41023 0 Thomas Marshall Former Interim CFO 0.00 0.00 X 86818 37208 0 3130378 1071924 95690 25 1 1 1 Bluewater Emergency Partners 14 Maine Street Box 44 Brunswick ME 04011 Physicians 1689775 Clinical Colleagues Inc PO Box 824246 Philadelphia PA 191824246 Physicians 1022007 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Physicians 958168 Quorum Health Resources LLC 1573 Mallory Lane Suite 200 Brentwood TN 37027 Consulting Services 845536 Soliant Health PO Box 934411 Atlanta GA 311934411 Staffing Services 548371 17 8200 7123347 133766 7265313 Patient Service Revenue 622110 93130531 93130531 Miscellaneous Revenue 622110 6086768 5988164 98604 Adult Daycare Revenue 624120 617877 617877 Provision for Bad Debts 622110 -4117891 -4117891 Contractual Allowances 622110 -55303196 -55303196 40414089 13996 13996 12545 8200 7503 5042 5042 47698440 40315485 0 117642 X 4000 4000 887289 565536 321753 19198178 16457140 2741038 458368 393724 64644 4215627 3630488 585139 1453325 1251671 201654 96600 96600 126439 126439 37136 37136 10523851 8825583 1698268 67138 361 66777 198179 95556 102623 1449373 588396 860977 38702 35432 3270 438178 29393 408785 1595703 1429331 166372 741889 663455 78434 Medical Supplies 4326993 4092650 234343 Healthcare Provider Tax 3508015 3508015 Miscellaneous Expenses 2137871 830287 1307584 Reorganization Expenses 854971 854971 52357825 42401018 9956807 0 X 2203692 6299641 356526 359297 620514 7438526 8826704 57250 247471 230072 937715 801235 41268045 30313414 11951599 10954631 23192779 28092094 4481283 9580646 269284 994393 25759712 29732751 30240995 40577074 X -7931988 -13427178 883772 942198 -7048216 -12484980 23192779 28092094 X -4659385 -777379 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6298 6298 0 Part II-B, Line 1: The Organization paid dues to Vermont Association of Hospitals and Health Systems of which a percentage of the dues were used for lobbying. 87157 87157 14291064 8018610 6272454 948319 598951 349368 23264532 20156019 3108513 2676973 1539834 1137139 10954631 Other Current Liabilities 3776810 Pension Liability 5163028 Liabilities Subject to Compromise 19002998 Estimated Third-Party Payor Settlements 1732938 Due to Related Party 56977 29732751 46928564 7503 7503 46921061 777379 777379 47698440 52365328 7503 7503 52357825 0 52357825 Part XI, Line 2d - Other Adjustments: Fundraising Expenses 7,503. Part XI, Line 4b - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan 757,412. Transfer to Affilate 19,967. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 7,503. Golf Tournament 20745 8200 12545 2000 4175 511 817 20745 8200 12545 2000 4175 511 817 7503 5042 1 1 X 1 X 1 X 1 1 0 0 418710 418710 0.00800 11455603 6999837 4455766 0.08510 11874313 6999837 4874476 0.09310 11874313 6999837 4874476 0.09310 1 1877124 17117732 17398690 -280958 X 1 1 1 1 Springfield Hospital PO Box 2003 Springfield VT 05156 www.springfieldmed.org 902 X X X X Inpatient Psychiatric Unit Springfield Hospital Inc 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 1 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X 1 X 0 X 1 X 0 0 Springfield Hospital, Inc. Part V, Section B, Line 5: A steering committee was formed to conduct this assessment, review the data ad recommend priorities and strategies to Springfield Hospital's Board of Directors. Members included: Anna Smith, Chief of Marketing and Development, Springfield Medical Care Systems (SMCS); Laura Jensen, MPH, Program Coordinator, Lifestyle Medicine Department, SMCS; Becky Thomas, MA, MCHES, Vermont Department of Health; Steve Geller, Executive Director, Southeastern Vermont Community Action; Susan White, Health Professionals Resource Coordinator, Southern VT AHEC; Lynn Raymond-Empey, Executive Director, Valley Health Connections; Christian Craig, Executive Director, Edgar May Health & Recreation Center; Laura Schairbaum, MA, Director, Greater Falls Connections; Sue Graff, MS, Field Services Director, VT Agency of Human Services; Mark Boutwell, Director of Social Services, Senior Solutions; Sandra Knowlton Soho, MS, ACO Clinical Consultant, OneCare VT; Trisha Paradis, Executive Director, Neighborhood Connections; Cecil Beehler, MD, Chief Medical Officer, SMCS; Thomas Dougherty, MPH, Director Community Health Team; George Karabakakis, PhD, Chief Executive Officer, Healthcare & Rehabilitation Services; Stephanie Mahoney, President, Chester/Andover Family Center Board of Directors; Adam Ameele, PsyD, Director of Behavioral Health, SMCS. Springfield Hospital, Inc. Part V, Section B, Line 6b: Springfield Medical Care Systems, Inc. Springfield Hospital, Inc. Part V, Section B, Line 11: The process included focus groups in Springfield, Bellows Falls, Chester, Ludlow, Londonderry, VT and Charlestown, NH. A community survey was distributed and promoted through newspaper, email and social media. 551 surveys were received, 34 people participated in focus group discussions, and 43 key stakeholders provided information on patient care needs, barriers to access, and the impact of social determinants of health on health outcomes. A medical staff survey was also conducted. In person community stakeholder interviews and a review of population demographics and health status indicators were conducted. Secondary data from Community Commons and Robert Wood Johnson County Health Rankings are reported at the county level. Secondary data also includes a variety of state and national resources, including Vermont's Behavioral Risk Factor Surveillance System, the Vermont Blueprint Community Profiles, and national sources such as the National Institute of Mental Health and the Centers for Disease Control and Prevention (CDC) among others. Priority needs identified include 1) dental care/oral health; 2) Substance Use Disorder; 3) Mental Health; and, 4) Affordable Health Care. An implementation plan for each of these categories is included, along with an impact statement for our 2019 CHNA implementation strategy and progress report. Note For Public Input Info - Monthly Board meetings are open to the public for comments and questions.Please see attached Implementation Strategy and status updates through April 2021.The Hospital's CHNA & Implementation Plan can also be accessed via the Hospital's website - www.springfieldhospital.org/community-health-needs-assessment/ Springfield Hospital, Inc. Part V, Section B, Line 20e: A patient financial counselor meets with patient prior to discharge if medical condition allows. Part V, line 7a, Hospital facility's CHNA website: www.springfieldmed.org/community-needs-assessment-2/ Part V, line 10a, Hospital facility's Implementation Strategy website: www.springfieldmed.org/wp-content/uploads/2020/02/SPR-2019-CHNA-SH-Implementation.pdf Part V, line 16a, FAP website: www.springfieldhospital.org/wp-content/uploads/2021/04/FAPolicy4-7-21.pdf Part V, line 16b, FAP Application website: www.springfieldhospital.org/wp-content/uploads/2021/04/SMCS-SH-CombinedFAP-App2021v3final.pdf Part V, line 16c, FAP Plain Language Summary website: www.springfieldhospital.org/financial-assistance-from-springfield-hospital/ 9 1 - The Windham Center 1 Hospital Court 12 Bellows Falls VT 05101 Inpatient Psych Unit 2 - Connecticut Valley Orthopaedics and Spor 29 Ridgewood Rd Springfield VT 05156 Specialty Practice 3 - Surgical Associates 29 Ridgewood Rd Springfield VT 05156 Specialty Practice 4 - Springfield Hospital Rehabilitation Serv 100 River Street Springfield VT 05156 Physical Therapy 5 - Springfield Area Adult Day Services 266 River Street Springfield VT 05156 Adult Day Services 6 - Connecticut Valley ENT 29 Ridgewood Rd Springfield VT 05156 Specialty Practice 7 - Mountain View Physical Therapy 8 Main St Ludlow VT 05149 Physical Therapy 8 - Springfield Urology 25 Ridgewood Rd Springfield VT 05156 Specialty Practice 9 - Springfield Gynecology 25 Ridgewood Rd Springfield VT 05156 Specialty Practice Part I, Line 7g: Amount represents funding required by Springfield Medical Care Syetems in order to operate, conduct, and provide various medical services to the community served. Part III, Line 2: The Organization used the cost to charge ratio calculated on Worksheet 2 multiplied by bad debt expense per the Organization's audited financial statements. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision 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. 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 provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts 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 against the allowance for doubtful accounts. Part III, Line 8: Worksheet A from the Form 990 Instructions was used to determine the amount reported on Line 6. Part III, Line 9b: Financial assistance is written off from charges before any collection efforts are made. Part VI, Line 2: Our planning process is participative and incorporates ongoing public input regarding community health care, hospital services, and new opportunities. Conducted on an annual basis, planning includes information from various sources as outlined below: - Public Input is invited at any time through our website, e-mail, or regular mail. - Monthly Board of Directors' meetings are open to the public.1) A community needs assessment tool is available on our website's home page, www.springfieldmed.org, that provides ongoing opportunity for community feedback. 2) A Community Relations Line offers an invitation to provide feedback directly to the Quality & Systems Improvement Department via phone or email. This contact information can be found on the home page of our website, www.springfieldmed.org, by calling 802-885-7299, or by e-mailing communityrelations@springfieldmed.org. - Ongoing information is received throughout the year to help us with our quality improvement initiatives. Our patient satisfaction survey process is conducted in cooperation with N.R.C. Picker, and monitors quality and services on a monthly basis.- Outreach activity for planning and partnering with local boards, community services, and membership organizations is ongoing. This includes partnering with Vermont's Blueprint For Health, the VT Chronic Care Collaborative, the Edgar May Health & Recreation Center, emergency planning, career/education, and youth and elderly services agencies, to name a few, and provides ongoing community input. - A Community Health Team is fully operational, meeting monthly to collaborate and partner with area agencies to remove barriers and improve access and quality of care. The team now exceeds 100 participants. New members are welcomed at each meeting as word of the team spreads throughout the community. The quarterly Community Collaborative Group is an extension of this group and all members of the Community Health Team are invited to participate as often as they wish. - Our Board of Directors and Corporators provide ongoing participation through local representation. As a small community hospital, representatives interact regularly with community members and are available to answer questions or receive feedback. - Our volunteer network creates ongoing opportunities for patient interaction and community outreach activities. - Public meetings and events are held as needed throughout the year allowing our community to be directly involved in our work, and public comment and suggestions are invited. Part VI, Line 3: Enrollment counselors are available at physician practice offices, at Valley Health Connections on River Street in Springfield, VT, and at Springfield Hospital to meet privately to consult with patients about their eligibility for a variety of public programs and/or financial assistance. Information is provided through certified navigators and enrollment counselors, distributed to the community via our Community Health Team and area social service agencies, and is included in every welcome packet to new patients. It is also available via our website. Part VI, Line 4: The Organization is a non-profit corporation directed by a dedicated Board of Directors comprised of patients and community members. The service area includes towns located in the Vermont counties of Windsor, Windham and Bennington; and New Hampshire counties of Sullivan (two towns) and Cheshire (one town). Springfield Medical Care Systems, the parent corporation, provides and coordinates care from nine health center locations in the towns of Springfield, Ludlow, Chester, Londonderry and Rockingham, VT, and Charlestown NH. Springfield Hospital is located in Springfield, VT. The service area is rural, primarily white, and has an older, lower income population. The community includes uninsured and Medicaid patients which represents 25% of the patient population. In NH, MUPs include Alstead, Acworth, Charlestown, Langdon and Walpole. In VT, MUPs include Rockingham, Athens, Grafton and Westminster in Windham County and Ludlow, Plymouth, Weston, and Reading in Windsor County. In addition to Springfield Hospital other area hospitals serving a portion of the service area include Brattleboro Memorial Hospital, Rutland Regional Medical Center, Mt. Ascutney Hospital, and Grace Cottage Hospital in Vermont and Valley Regional Hospital, Cheshire Medical Center, and Dartmouth-Hitchcock Medical Center in New Hampshire. Springfield Medical Care Systems maintains collaborative working relationships with each of these institutions.Median Population by Age (2010 Census source: USA.com)Windsor County: 45.8 Windham County: 44.9Vermont: 41.5 US: 37.2Cheshire County: 40.7 Sullivan County: 43.9 NH: 41.1 Median Household IncomeWindsor County: $50,893 Windham County: $46,714Vermont: $51,841US: $51,914Cheshire County: $48,030Sullivan County: $50,689NH: $63,277Population in PovertyWindsor County: 9.73%Windham County: 11.13%Vermont: 11.12%US: 13.82%Cheshire County: 11.8%Sullivan County: 10.04%NH: 8.29% Part VI, Line 5: The health of our area communities and access to quality health care is served through the community health center network of the organization's parent corporation, Springfield Medical Care Systems, which is the primary source of preventive and coordinated care in our service area. The organization is directed by a Board of Directors comprised of community members and patients. Free health screenings, education programs and support groups are offered throughout the year. Financial assistance is communicated broadly across the service area, available to all who qualify based on a sliding fee scale, and includes dental, vision and pharmacy assistance. Part VI, Line 6: Springfield Hospital is a subsidiary of Springfield Medical Care Systems (SMCS). SMCS is comprised of a network of primary care offices (federally-qualified health centers) that provide ongoing care and outreach to our local communities, employing a medical home model of care, and focusing on prevention and efficient care management in cooperation with the Chronic Care Collaborative and the Vermont Blueprint for Health. Need for specialty services is referred by SMCS' health center medical staff to Springfield Hospital and its outpatient specialty clinicians, other area hospitals, or to designated tertiary care facilities for the appropriate level of care as needed. 0 0 0 0 0 0 0 1 0 Robert Cantu MD Director/Orthopaedic Surgeon 555404 0 1000 0 126 0 7525 0 1482 0 565537 0 0 0 Eliot Hall MD Director 0 290562 0 0 0 0 0 762 0 14705 0 306029 0 0 Gerald Drabyn MD Past Director 0 182023 0 0 0 0 0 0 0 14736 0 196759 0 0 Michael Halstead Interim CEO/President 254275 113862 0 0 0 0 0 0 0 0 254275 113862 0 0 Cecil Beehler MD Past Chief Medical Officer 0 378327 0 0 0 0 0 4274 0 4820 0 387421 0 0 David Muller MD Orthopaedic Surgeon 539753 0 67500 0 0 0 5049 0 12982 0 625284 0 0 0 Khalid Husain MD General Surgeon 432495 0 0 0 36000 0 4910 0 11055 0 484460 0 0 0 Xiangtian Hu MD Anesthesiologist 384153 0 0 0 0 0 2886 0 3483 0 390522 0 0 0 Vitaliano Sicilia MD Hospitalist Physician 292420 0 9930 0 34 0 0 0 1061 0 303445 0 0 0 John Ciocchi MD General Surgeon 330381 0 0 0 0 0 0 0 5960 0 336341 0 0 0 Wayne Scholz Former Interim CFO 72611 41023 0 0 0 0 0 0 0 0 72611 41023 0 0 Thomas Marshall Former Interim CFO 86818 37208 0 0 0 0 0 0 0 0 86818 37208 0 0 Part I, Line 7 Robert Cantu and David Muller received bonus compensation in 2019 for their productivity. Vitaliano Sicilia's bonus is contingent in part on the following metrics: - Core Measures - Patient Experience - Meaningful Use - Completion of Medical Records Form 990, Part VII, line 5: Michael Halstead, Interim CEO, was compensated by a third party, Quorum Health Resources for services rendered to both Springfield Hospital, Inc. and Springfield Medical Care Systems, Inc., a related organization. Quorum Health Resources received the following amounts from the filing Organization and its related organization respectively for services rendered: Springfield Hospital, Inc.: $254,275 Springfield Medical Care Systems, Inc.: $113,862 Allan Scroggins, Interim CFO, was compensated by a third party, Quorum Health Resources for services rendered to both Springfield Hospital, Inc. and Springfield Medical Care Systems, Inc., a related organization. Quorum Health Resources received the following amounts from the filing Organization and its related organization respectively for services rendered: Springfield Hospital, Inc.: $67,478 Springfield Medical Care Systems, Inc.: $28,919 Wayne Scholz, Former Interim CFO, was compensated by a third party, Quorum Health Resources for services rendered to both Springfield Hospital, Inc. and Springfield Medical Care Systems, Inc., a related organization. Quorum Health Resources received the following amounts from the filing Organization and its related organization respectively for services rendered: Springfield Hospital, Inc.: $72,611 Springfield Medical Care Systems, Inc.: $41,023 Thomas Marshall, Former Interim CFO, was compensated by a third party, Quorum Health Resources for services rendered to both Springfield Hospital, Inc. and Springfield Medical Care Systems, Inc., a related organization. Quorum Health Resources received the following amounts from the filing Organization and its related organization respectively for services rendered: Springfield Hospital, Inc.: $86,818 Springfield Medical Care Systems, Inc.: $37,208 Neither Springfield Hospital, Inc. nor Springfield Medical Care Systems, Inc. are aware of the amounts of compensation paid to the individuals noted above by Quorum Health Resources. The amounts shown are the amounts paid to the unrelated third party for services rendered. Form 990, Part VI, Section A, line 4 Springfield Hospital, Inc. made the following changes to its bylaws during the tax year: 1. Eliminated all references to Springfield Medical Care Systems, Inc., who is no longer the parent of Springfield Hospital as of December 2020. 2. Combined Class A and Class B members into a single class of members. 3. Composition of the the Board changed from 9-17 board members to 10-14 board members. 4. Removed the residence requirement from the qualifications of the Board members. 5. Added "There should be efforts to include individuals on the Board of Directors with the following expertise: accounting, human resources, quality/performance improvement, medical, and legal." to the Board member qualifications. Form 990, Part VI, Section A, line 6 The Organization has a single class of members. Form 990, Part VI, Section A, line 7a The responsibilities of the Members are limited to election of Members and election of the Board of Directors of the Hospital. Form 990, Part VI, Section A, line 7b The Bylaws may be amended at an annual, regular or special meeting of the Members by a two-thirds vote of the Members. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the Organization's Chief Financial Officer upon completion. Form 990, Part VI, Section B, line 12c Conflicts of interest are reviewed by the Corporate Compliance Officer and Chief Executive Officer on an annual basis. Members must recuse themselves from voting on issues where a conflict is actual or implied. Form 990, Part VI, Section B, line 15 For FY20, the Hospital's CEO was compensated by a third party, Quorum Health Resources for services rendered to Springfield Hospital, Inc. The Hospital is not aware of the amount of compensation paid to the CEO by Quorum Health Resources. The amounts shown on Part VII & Schedule J are the amounts paid to the unrelated third party for services rendered. 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 Purchased Services: Program service expenses 8,825,583. Management and general expenses 1,698,268. Fundraising expenses 0. Total expenses 10,523,851. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Springfield Hospital, Inc. PO Box 2003 Springfield, VT 05156 EIN: 03-0179437 Springfield Hospital, 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 -757,412. Transfer to Affiliate -19,967. Springfield Medical Care Systems Inc PO Box 2003 Springfield VT 05156 030284813 Primary medical care, support and enabling VT 501(c)(3) Line 3 N/A 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 0 1 0