2021-08-13T12:16:12-05:00 2020-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2019-10-01 030179423 COPLEY HOSPITAL INC % ANGELA LAMELL COPL 8028888888 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 JOSEPH WOODIN CEO 8028888888 2021-07-15 true Brian D Todd P00422601 4178658701 2019 2022-09-23 18:48:47Z JOSEPH WOODIN 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 74484356 false X WWW.COPLEYVT.ORG X 1934 VT COPLEY IS DEDICATED TO HELPING PEOPLE LIVE HEALTHIER LIVES; PROVIDING EXCEPTIONAL CARE, SUPERIOR SERVICE AND ASSURING PEOPLE HAVE ACCESS TO AFFORDABLE HEALTH CARE. 16 12 563 20 0 0 356332 1211832 68127051 73137260 50442 103713 0 7744 68533825 74460549 0 0 0 0 37974216 39885088 0 0 0 32325115 36884202 70299331 76769290 -1765506 -2308741 54544853 81994926 16683576 46310114 37861277 35684812 X TO HELP PEOPLE LIVE HEALTHIER LIVES BY PROVIDING EXCEPTIONAL CARE AND SUPERIOR SERVICE. false false 69138894 73137260 COPLEY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT IS CRITICAL TO THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 69138894 true true false true false false false false false true true true false false true false true true false false false false false false false false true true false false true false false false false false false true false false false false false false true false false false true 101 0 true 563 true false false false false false false false false false false false false X 16 12 false false false false true true false true true false false true true true true true true true true false X ANGELA LAMELL 8028888222 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 X BRIAN AROS ORTHOPEDIC SURGEON 40.0 0.0 X 813767 0 44098 JOHN MACY ORTHOPEDIC SURGEON 40.0 0.0 X 713640 0 36853 JOSEPH MCLAUGHLIN TRUSTEE BEG 02/20 39.8 0.2 X 632634 0 51671 NICHOLAS ANTELL ORTHOPEDIC SURGEON 40.0 0.0 X 590578 0 42707 BRYAN MONIER ORTHOPEDIC SURGEON 40.0 0.0 X 481913 0 32166 DONALD DUPUIS GENERAL SURGEON 40.0 0.0 X 439230 0 46337 VERA JONES COO 38.0 2.0 X 217178 0 16561 ARTHUR MATHISEN FORMER CEO 38.0 2.0 X 206010 0 8633 LORI PROFOTA CNO 38.0 2.0 X 180109 0 28284 DEBRALEE DORAIN CFO END 04/20 38.0 2.0 X 172919 0 7440 KEVIN DORAIN FORMER INTERIM CO-CFO 0.0 0.0 X 105610 0 30002 JOSEPH WOODIN CEO 38.0 2.0 X X 121497 0 633 CARL SZLACHETKA CHAIR/TREASURER BEGIN 01/20 3.8 0.2 X X 0 0 0 KATHY DEMARS VICE CHAIR/CHAIR BEGIN 01/20 1.8 0.2 X X 0 0 0 WALTER FRAME TREASURER/TRUSTEE BEGIN 01/20 1.8 0.2 X 0 0 0 SHARON GREEN SECRETARY 1.8 0.2 X X 0 0 0 HENRY BINDER MD TRUSTEE 1.8 0.2 X 0 0 0 DAVID BISBEE MD TRUSTEE END 01/20 1.8 0.2 X 0 0 0 BOB BLEIMEISTER TRUSTEE 1.8 0.2 X 0 0 0 IRA MARVIN TRUSTEE END 03/20 1.8 0.2 X 0 0 0 ELAINE NICHOLS TRUSTEE END 12/19 1.8 0.2 X 0 0 0 DAN NOYES TRUSTEE 1.8 0.2 X 0 0 0 NANCY PUTNAM TRUSTEE END 12/19 1.8 0.2 X 0 0 0 JAN ROY TRUSTEE 1.8 0.2 X 0 0 0 DAVID SILVERMAN TRUSTEE/VICE CHAIR BEGIN 01/20 1.8 0.2 X X 0 0 0 JAMEY VENTURA TRUSTEE 1.8 0.2 X 0 0 0 RICHARD WESTMAN TRUSTEE 1.8 0.2 X 0 0 0 ANNIE BONGIORNO TRUSTEE BEG 11/19 1.8 0.2 X 0 0 0 DEBORAH POMEROY TRUSTEE BEG 01/20 1.8 0.2 X 0 0 0 CHRIS TOWNE TRUSTEE BEG 01/20 1.8 0.2 X 0 0 0 JEFFREY HEBERT CFO BEGINNING 04/20 38.0 2.0 X 0 0 0 4675085 0 345385 55 true true false APOGEE MEDICAL MANAGEMENT INC 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 PHYSICIAN SERVICES 554540 CPSI PO BOX 850309 MOBILE AL 36685 SOFTWARE SUPPORT 310867 FLETCHER ALLEN HEALTH CARE 111 COLCHESTER AVENUE BURLINGTON VT 05401 LAB SERVICES 294176 UNIVERSITY OF VERMONT TSPIMF PO BOX 1389 WILLISTON VT 05495 BIOMED SERVICES 260815 HP CUMMINGS CONSTRUCTION CO PO BOX 269 WOODSVILLE NH 03785 CONSTRUCTION SERVICE 256227 18 359778 852054 1211832 PATIENT SERVICE REVENUE 621400 68394903 68394903 FIXED PROSPECTIVE REVENUE 621400 3666903 3666903 CAFETERIA 722514 331278 331278 MANAGEMENT FEE REVENUE 541610 74721 74721 EHR INCENTIVE REVENUE 624100 62270 62270 607185 607185 73137260 118720 118720 0 0 7744 7744 0 7744 7744 8800 23807 -15007 -15007 -15007 0 0 0 0 0 0 0 0 0 0 74460549 73137260 111457 0 0 0 0 1428926 892697 536229 466485 116230 350255 31229536 29385115 1844421 909541 852627 56914 3651201 3368556 282645 2199399 2011051 188348 29424 29424 24778 24778 53696 53696 30841 23310 7531 0 0 7175376 5423153 1752223 85724 64790 20934 1224906 528387 696519 0 0 1925806 844468 1081338 30403 21006 9397 0 126242 108711 17531 126029 126029 0 2789868 2576237 213631 1033833 854015 179818 MEDICAL SUPPLIES & DRUGS 14700952 14700952 PROVIDER TAX 3985329 3985329 BAD DEBT 2949724 2949724 LICENSES, DUES, SUBSCRIPTIONS 337654 110938 226716 253617 195569 58048 76769290 69138894 7630396 0 2650 2400 11498004 38877344 0 0 5439899 5013731 0 0 0 0 0 0 2997420 2484173 1534559 1862386 58108138 32973671 25814323 25134467 0 0 4868431 5000707 0 0 0 0 2389567 3619718 54544853 81994926 6144874 8484792 0 0 0 2896587 0 0 0 0 0 0 7910328 7454107 0 5037900 2628374 22436728 16683576 46310114 X 32992846 30684105 4868431 5000707 37861277 35684812 54544853 81994926 X -2308741 132276 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 30841 false true 10913 41754 false SCHEDULE C, PART II-B, LINE 1 OTHER LOBBYING ACTIVITIES: DIRECT CONTACT WITH LEGISLATORS: THE HOSPITAL ENGAGED A LAW FIRM FOR $30,841 FOR LOBBYING SERVICES. OTHER LOBBYING ACTIVITIES: THE ORGANIZATION ALSO PAYS DUES TO VARIOUS ORGANIZATIONS, A PORTION ($10,913) OF WHICH IS ATTRIBUTABLE TO LOBBYING EXPENSES. 4644722 3000 117857 4765579 4495575 12098 137049 4644722 4362185 2352 131038 4495575 4252651 414 109120 4362185 4147113 696 104842 4252651 1.00000 false true true 1096205 1096205 31400644 13799878 17600766 723596 454332 269264 23886289 18145432 5740857 1001404 574029 427375 25134467 INTEREST IN CHSI 5000707 F 5000707 0 DUE TO THIRD PARTY PAYORS 1790000 ESTIMATED SELF INSURANCE 911741 PROVIDER RELIEF FUNDS 5862305 CONTRACT LIABILITIES 13872682 22436728 71510825 -2949724 -2949724 74460549 74460549 73819566 73819566 2949724 2949724 76769290 SCHEDULE D, PART V, LINE 4 INTENDED USES OF THE ENDOWMENT FUNDS: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO HELP SERVE THE LONG-TERM VIABILITY OF COPLEY HOSPITAL, INC. THESE ENDOWMENT FUNDS ARE HELD BY COPLEY HEALTH SYSTEM, INC. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990 PART VIII, LINE 12: $ (2,949,724) BAD DEBT EXPENSE SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1: $ 2,949,724 BAD DEBT EXPENSE true true true X 300. true X false true true false true true 508483 508483 0.00690 13485702 2783736 10701966 0.14500 13994185 2783736 11210449 0.15190 128752 88325 40428 0.00050 128752 88325 40428 0.00050 14122937 2872061 11250877 0.15240 false 2949724 268425 17181822 18722531 -1540709 X true true 1 1 COPLEY HOSPITAL INC 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 WWW.COPLEYVT.ORG 891 X X X X COPLEY HOSPITAL INC 1 false false true X X X X X X X X X 17 true false true true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 300. 400. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: THE HOSPITAL'S "LOCAL EXPERTS" COME FROM AN ADVISORY GROUP OF AT LEAST 15 LOCAL RESIDENTS, INCLUSIVE OF AT LEAST ONE MEMBER SELF-IDENTIFYING WITH EACH OF THE FIVE QUORUM WRITTEN COMMENT SOLICITATION CLASSIFICATIONS, WITH WHOM THE HOSPITAL SOLICITED TO PARTICIPATE IN THE QUORUM/HOSPITAL CHNA PROCESS. THE HOSPITAL ASKED ALL PARTICIPATING IN THE WRITTEN COMMENT SOLICITATION PROCESS TO SELF-IDENTIFY THEMSELVES INTO ANY OF THE FOLLOWING REPRESENTATIVE CLASSIFICATIONS, WHICH IS DETAILED IN AN APPENDIX TO THE CHNA REPORT. WRITTEN COMMENT PARTICIPANTS SELF-IDENTIFIED INTO THE FOLLOWING CLASSIFICATIONS: 1. PUBLIC HEALTH - PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH 2. DEPARTMENTS AND AGENCIES - FEDERAL, TRIBAL, REGIONAL, STATE, OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES, WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY 3. PRIORITY POPULATIONS - LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. ALSO, IN OTHER FEDERAL REGULATIONS THE TERM PRIORITY POPULATIONS, WHICH INCLUDE RURAL RESIDENTS AND LGBT INTERESTS, IS EMPLOYED AND FOR CONSISTENCY IS INCLUDED IN THIS DEFINITION 4. CHRONIC DISEASE GROUPS - REPRESENTATIVE OF OR MEMBER OF CHRONIC DISEASE GROUP OR ORGANIZATION, INCLUDING MENTAL AND ORAL HEALTH 5. BROAD INTEREST OF THE COMMUNITY - INDIVIDUALS, VOLUNTEERS, CIVIC LEADERS, MEDICAL PERSONNEL, AND OTHERS TO FULFILL THE SPIRIT OF BROAD INPUT REQUIRED BY THE FEDERAL REGULATIONS THE METHODOLOGY ALSO TOOK A COMPREHENSIVE APPROACH TO ASSESS COMMUNITY HEALTH NEEDS BY PERFORMING SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA, AUGMENTING THIS WITH LOCAL EXPERT ADVISOR OPINIONS, AND RESOLVING ANY DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINED OPINIONS FORMED FROM LOCAL EXPERTS. THE METHODOLOGY RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES AND PROPRIETARY DATA. DATA SOURCES INCLUDED: WWW. COUNTYHEALTHRANKINGS.ORG; IBM WATSON HEALTH (FORMERLY KNOWN AS TRUVEN HEALTH ANALYTICS); WWW.HEALTHVERMONT.GOV; AND WWW. WORLDLIFEEXPECTANCY.COM/USA-HEALTH-RANKINGS. COPLEY HOSPITAL DEPLOYED A CHNA ROUND 1 SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITALS DESIRE TO REPRESENT THE REGIONS GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. THE HOSPITAL RECEIVED COMMUNITY INPUT FROM 78 LOCAL EXPERT ADVISORS. SURVEY RESPONSES STARTED FEBRUARY 19, 2018 AND ENDED WITH THE LAST RESPONSE ON MARCH 12, 2018. A COMMUNITY SURVEY WAS ALSO COMPLETED IN THE SAME TIME PERIOD AS THE LOCAL EXPERT SURVEYS AND RECEIVED 172 RESPONSES. INFORMATION GAINED FROM THE COMMUNITY SURVEY CAN BE FOUND IN APPENDIX A OF THE HOSPITALS CHNA. WHILE THE ROUND 1 SURVEY WAS OPEN TO THE LOCAL EXPERTS, A COMMUNITY SURVEY WAS SOLICITED TO THE COPLEY HOSPITALS SERVICE AREA RESIDENTS TO HELP UNDERSTAND THE OVERALL HEALTH NEEDS AND CHALLENGES FACING THE LOCAL POPULATION TO ENSURE THE APPROPRIATE HEALTH NEEDS WERE IDENTIFIED FOR THE 2018 CHNA. THE SURVEY WAS OPEN TO ANY AREA RESIDENT OVER 18 YEARS OF AGE. 172 SURVEYS WERE COMPLETED. THE TOP THREE PRIORITY POPULATIONS IN THE AREA ARE RESIDENTS OF RURAL AREAS, LOW-INCOME GROUPS, AND CHILDREN. WHEN THE ROUND 1 SURVEY AND DATA ANALYSIS WAS COMPLETE, THE HOSPITAL PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL EXPERT ADVISORS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL COMMENTS OF NEED. CONSULTATION WITH LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET-BASED SURVEY BEGINNING MARCH 26, 2018 AND ENDING APRIL 9, 2018. 58 OF THE ORIGINAL 78 LOCAL EXPERT ADVISORS RESPONDED TO THE ROUND 2 SURVEY. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A WISDOM OF CROWDS METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. THROUGH THE "WISDOM OF CROWDS" PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. A SUMMARY OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA SETS WAS DEVELOPED. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE POTENTIAL SIGNIFICANT NEED CANDIDATES, INCLUDING THE OPPORTUNITY TO AGAIN PRESENT ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. A RANK ORDER OF PRIORITIES EMERGED, WITH SOME NEEDS RECEIVING NONE OR VIRTUALLY NO SUPPORT, AND OTHER NEEDS RECEIVING IDENTICAL POINT ALLOCATIONS. THE RANKED NEED WERE DIVIDED INTO TWO GROUPS: SIGNIFICANT AND OTHER IDENTIFIED NEEDS. OUR CRITERIA FOR IDENTIFYING AND PRIORITIZING SIGNIFICANT NEEDS WAS BASED ON A DESCENDING FREQUENCY RANK ORDER OF THE NEEDS BASED ON TOTAL POINTS CAST BY THE LOCAL EXPERTS, FURTHER RANKED BY A DESCENDING FREQUENCY COUNT OF THE NUMBER OF LOCAL EXPERTS CASTING ANY POINTS FOR THE NEED. BY OUR DEFINITION, A SIGNIFICANT NEED HAD TO INCLUDE ALL RANK ORDERED NEEDS UNTIL AT LEAST FIFTY PERCENT (50%) OF ALL POINTS WERE INCLUDED AND TO THE EXTENT POSSIBLE, REPRESENTED POINTS ALLOCATED BY A MAJORITY OF VOTING LOCAL EXPERTS. THE DETERMINATION OF THE BREAK POINT - SIGNIFICANT AS OPPOSED TO OTHER - WAS A QUALITATIVE INTERPRETATION WHERE A REASONABLE BREAK POINT IN RANK ORDER OCCURRED. SCHEDULE H, PART V, SECTION B, LINE 6B CHNA CONDUCTED WITH OTHER ORGANIZATIONS: THE HOSPITAL COLLABORATED AND OBTAINED ASSISTANCE IN CONDUCTING THIS CHNA FROM QUORUM HEALTH RESOURCES. OUR STEERING COMMITTEE INCLUDED THE VERMONT DEPARTMENT OF HEALTH FIELD DIRECTOR FOR THE MORRISVILLE, VT AREA AND THE MORRISVILLE AREA FACILITATOR FOR THE VERMONT STATE BLUEPRINT FOR HEALTH. LOCAL AREA EXPERTS CAME FROM THE UNIFIED COMMUNITY COLLABORATIVE (UCC) WHICH INCLUDES REPRESENTATIVES FROM COMMUNITY, REGIONAL AND STATE ORGANIZATIONS AND AGENCIES INVOLVED IN THE SOCIAL DETERMINANTS OF HEALTH. SCHEDULE H, PART V, SECTION B, LINE 7A CHNA URL: HTTPS://WWW.COPLEYVT.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY URL: HTTPS://WWW.COPLEYVT.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: 1. PREVENTATIVE CARE COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - SCREENING AVAILABILITY AT COPLEY HOSPITALS WOMEN CENTER [NOTE: SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, ADVERSE CHILDHOOD EVENTS, SMOKING, FOOD INSECURITY, HOUSING, BP AND BMI. NOTE: ADVERSE CHILDHOOD EVENTS SCREENING IS PERFORMED BY THE PROVIDER, WITH REFERRALS MADE TO THE SOCIAL WORKER AT TWC]. - PREVENTION EDUCATION/AWARENESS PROMOTED THROUGH HOSPITALS SOCIAL MEDIA THROUGH COLLABORATIVE COMMUNITY BLOG LIVEWELLLAMOILLE.COM. - PREVENTION/EDUCATION AWARENESS PROGRAM THROUGH THE LAUNCH OF RISE VT - SOCIAL WORKER WORKING WITH INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS TO SCREEN AND PROVIDE REFERRALS. [NOTE: SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, SMOKING, FOOD INSECURITY AND HOUSING]. - REFERRAL AND RESOURCE SPECIALIST IN EMERGENCY DEPARTMENT; CONTINUE FOCUS ON SUPER-UTILIZERS IN EMERGENCY DEPARTMENT AND INPATIENT POPULATION. - STANDARDIZED FALL RISK SCREENING TOOL FOR TARGETED POPULATIONS 65+ WITH IMPLEMENTATION SCHEDULED IN FY2020-FY2021. - 100% OF TARGETED PATIENT POPULATION IN THE EMERGENCY DEPARTMENT WILL BE SCREENED FOR CHRONIC HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOHS) [NOTE: SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, ADVERSE CHILDHOOD EVENTS, SMOKING, FOOD INSECURITY, HOUSING, AND BP]. ADDITIONALLY, COPLEY HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - EVALUATE OPTIONS TO INCREASE TRANSPORTATION ASSISTANCE TO IMPROVE ACCESS TO CARE. - THE WOMENS CENTER PROVIDES DENTAL HEALTH REFERRAL OPTIONS AS PART OF PRE-NATAL CARE. - 100% OF TARGETED PATIENT POPULATION IN OUTPATIENT CLINICS WILL ROUTINELY RECEIVE BLOOD PRESSURE SCREENING. 2. MENTAL HEALTH - LOCAL EXPERT CONCERN COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - SCREENING AVAILABILITY AT COPLEY HOSPITALS WOMEN CENTER [NOTE: SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, ADVERSE CHILDHOOD EVENTS, SMOKING, FOOD INSECURITY, HOUSING, BP AND BMI. NOTE: ADVERSE CHILDHOOD EVENTS SCREENING IS PERFORMED BY THE PROVIDER, WITH REFERRALS MADE TO THE SOCIAL WORKER AT TWC]. - COPLEY HOSPITAL PARTNERS WITH THE MOBILE CRISIS TEAM (LAMOILLE COUNTY MENTAL HEALTH) TO ASSIST WITH PEOPLE PRESENTING IN THE ER WITH A MENTAL HEALTH CRISIS. THE MOBILE CRISIS TEAM OFFERS EMERGENCY AND CRISIS SERVICES TO ANYONE WHO LIVES IN LAMOILLE COUNTY, 24 HOURS A DAY, 7 DAYS A WEEK. THEY ALSO SERVE CHILDREN IN THE SURROUNDING TOWNS INCLUDING: HARDWICK, CRAFTSBURY, GREENSBORO, STANNARD, AND WOODBURY. - TRAINED HOSPITAL STAFF AS PATIENT SITTERS AND ESTABLISHMENT OF SITTER PROGRAM. - DEVELOPED MENTAL HEALTH SAFE ROOM IN EMERGENCY DEPARTMENT. - REFERRAL AND RESOURCE SPECIALIST IN EMERGENCY DEPARTMENT FULL-TIME. - PARTNERED WITH LAMOILLE COUNTY MENTAL HEALTH ON THE ZERO SUICIDE PROGRAM (SCREENING, INTERVENTION, SAFE TRANSITION OF CARE). - PROVIDES MENTAL HEALTH AWARENESS EDUCATION FOR TARGETED STAFF. ADDITIONALLY, COPLEY HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - EVALUATE OPTIONS FOR INCREASING TRANSPORTATION PROGRAMS (RURAL COMMUNITY TRANSPORTATION, OTHERS) TO ASSIST WITH GETTING PATIENTS TO NEEDED MENTAL HEALTH AND BEHAVIORAL HEALTH APPOINTMENTS. - OFFER DE-ESCALATION TRAINING WITH COMMUNITY ORGANIZATIONS TO BUILD APPROPRIATE SKILLS IN THE COMMUNITY. - EVALUATE MENTAL HEALTH RESOURCES IN THE EMERGENCY DEPARTMENT. 3. CHRONIC HEALTH CONDITIONS COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - SCREENING AVAILABILITY AT COPLEY HOSPITALS WOMEN CENTER [NOTE: SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, ADVERSE CHILDHOOD EVENTS, SMOKING, FOOD INSECURITY, HOUSING, BP AND BMI. NOTE: ADVERSE CHILDHOOD EVENTS SCREENING IS PERFORMED BY THE PROVIDER, WITH REFERRALS MADE TO THE SOCIAL WORKER AT TWC]. - INCREASED SERVICES AVAILABLE VIA TELEMEDICINE, INCLUDING PULMONOLOGY AND NEPHROLOGY. - COLLABORATION WITH CENTRAL VERMONT MEDICAL CENTER FOR ONCOLOGY SERVICES AVAILABLE AT COPLEY HOSPITAL. - REFERRAL AND RESOURCE SPECIALIST IN EMERGENCY DEPARTMENT FULL TIME. - WORKFORCE WELLNESS PROGRAM AVAILABLE TO AREA BUSINESSES. - CARDIAC/PULMONARY REHABILITATION PROGRAM FOR PERSONS THAT EXPERIENCED AN EVENT OR HAS A QUALIFYING CONDITION. - PREVENTION/EDUCATION AND AWARENESS MESSAGING VIA SOCIAL MEDIA AND LIVEWELLLAMOILLE.COM BLOG. - INCREASE WORKFORCE WELLNESS SERVICE AREA TO OFFER TOBACCO CESSATION AND CHRONIC DISEASE PREVENTION/MANAGEMENT AT WORKSITES THROUGHOUT THE SERVICE AREA. - DISCHARGE PLANNING THAT INCLUDES SCHEDULING PRIMARY CARE FOLLOW-UP PRIOR TO DISCHARGE. ADDITIONALLY, COPLEY HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - EVALUATE OPTIONS FOR INCREASING TRANSPORTATION ASSISTANCE (RURAL COMMUNITY TRANSPORTATION, OTHERS). - 100% SCREENING OF TARGETED PATIENT POPULATIONS IN THE EMERGENCY DEPARTMENT [100% OF TARGETED PATIENT POPULATION IN THE EMERGENCY DEPARTMENT WILL BE SCREENED BY CHRONIC HEALTH CONDITIONS AND SOCIAL DETERMINANTS WITH HEALTH (SDOHS). SCREENING DEFINED AS SCREENING FOR SUBSTANCE ABUSE, MENTAL HEALTH, ADVERSE CHILDHOOD EVENTS, SMOKING, FOOD INSECURITY, HOUSING, AND BLOOD PRESSURE (BP)]. - 100% OF TARGETED PATIENT POPULATION IN OUTPATIENT CLINICS WILL ROUTINELY RECEIVE BLOOD PRESSURE SCREENING. - 100% OF IDENTIFIED INPATIENT POPULATION WILL BE EVALUATED USING READMISSION RISK ASSESSMENT TOOL. 4. SUBSTANCE USE/ABUSE COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - PROVIDES SBIRT/ACES SCREENINGS AT THE COPLEY HOSPITAL WOMENS HEALTH CENTER. - REFERRALS TO MEDICATION ASSISTANCE TREATMENT (MAT) PROGRAM. - COPLEY HOSPITAL PARTNERS WITH THE MOBILE CRISIS TEAM (LAMOILLE COUNTY MENTAL HEALTH) TO ASSIST THE PEOPLE PRESENTING IN THE ER WITH A MENTAL HEALTH CRISIS. THE MOBILE CRISIS TEAM OFFERS EMERGENCY AND CRISIS SERVICES TO ANYONE WHO LIVES IN LAMOILLE COUNTY, 24 HOURS A DAY, 7 DAYS A WEEK. THEY ALSO SERVE CHILDREN IN THE SURROUNDING TOWNS INCLUDING: HARDWICK, CRAFTSBURY, GREENSBORO, STANNARD, AND WOODBURY. - PLACED REFERRAL AND RESOURCE SPECIALIST IN EMERGENCY DEPARTMENT. - MENTAL HEALTH AWARENESS EDUCATION FOR HOSPITAL STAFF. - EVALUATED ABILITY TO PRESCRIBE AND/OR DISTRIBUTE NALOXONE THROUGH THE EMERGENCY DEPARTMENT. - INSTALLED A PRESCRIPTION DRUG DROP-BOX FOR PEOPLE TO SAFELY DISPOSE OF UNUSED AND/OR EXPIRED PRESCRIPTION DRUGS. - IMPLEMENTED COLLABORATION WITH NORTH CENTRAL VERMONT RECOVERY CENTER COACHES PROGRAM FOR TARGETED PATIENT POPULATION IN THE EMERGENCY DEPARTMENT. ADDITIONALLY, COPLEY HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - EVALUATE OPTIONS FOR INCREASING TRANSPORTATION PROGRAMS (RURAL COMMUNITY TRANSPORTATION, OTHERS). 5. REDUCING COST OF HEALTHCARE COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - FINANCIAL ASSISTANCE PROGRAM OFFERED AT COPLEY HOSPITAL. - RESOURCES TO ASSIST PATIENTS WITH ENROLLING FOR INSURANCE THROUGH VERMONT HEALTH CONNECT. - CONTINUED FOCUS ON CONNECTING SUPER UTILIZERS OF THE EMERGENCY DEPARTMENT TO NEEDED SOCIAL SERVICES. - CONTINUED COLLABORATION WITH COMMUNITY CARE MANAGEMENT TEAM TO REFER COMPLEX PATIENTS TO APPROPRIATE SERVICES. - ONGOING IMPLEMENTATION OF INPATIENT READMISSION RISK ASSESSMENT TOOL TO HELP REDUCE 30 DAY ALL CAUSE READMISSIONS. COPLEY HOSPITAL DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION STRATEGY FOR THIS SIGNIFICANT NEED. DUE TO A RELATIVE LACK OF IDENTIFIED EFFECTIVE INTERVENTIONS AT THE HOSPITAL LEVEL OTHER THAN ADDRESSING CHRONIC CONDITIONS, PREVENTATIVE CARE AND IDENTIFYING PEOPLE AT RISK TO ADDRESS THE NEED, WE ARE CHOOSING NOT TO DEVELOP AN IMPLEMENTATION STRATEGY AT THIS TIME. WE FEEL WE CAN HAVE A GREATER IMPACT BY PUTTING ATTENTION AND RESOURCES TOWARD OTHER SIGNIFICANT NEEDS AS OUTLINED. 6.HOUSING INSECURITY - LOCAL EXPERT CONCERN COPLEY HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: - PROVIDE LAUNDRY SERVICE FOR WARMING SHELTER. - PROVIDE SCREENING FOR HOUSING INSECURITY AT THE WOMENS CENTER AND WITH TARGETED POPULATION IN THE EMERGENCY DEPARTMENT. COPLEY HOSPITAL DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION STRATEGY FOR THIS SIGNIFICANT NEED DUE TO A LACK OF IDENTIFIED EFFECTIVE INTERVENTIONS TO ADDRESS THE NEED, AND THE AVAILABILITY OF OTHER ORGANIZATIONS TO ADDRESS THIS NEED, WE ARE CHOOSING NOT TO DEVELOP AN IMPLEMENTATION STRATEGY AT THIS TIME. WE FEEL WE CAN HAVE A GREATER IMPACT BY PUTTING ATTENTION AND RESOURCES TOWARD OTHER SIGNIFICANT NEEDS FOR WHICH WE ARE BETTER QUALIFIED TO SERVE. SCHEDULE H, PART V, SECTION B, LINES 16A-C FAP, APPLICATION, AND PLS URL: WWW.COPLEYVT.ORG/FOR-PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/ 2 MANSFIELD ORTHOPAEDICS 555 WASHINGTON HIGHWAY MORRISVILLE VT 05661 OUTPATIENT ORTHOPAEDIC, REHAB AND RADIOLOGY SERVICES MANSFIELD ORTHOPAEDICS 6 NORTH MAIN STREET WATERBURY VT 05676 OUTPATIENT ORTHOPAEDIC, RADIOLOGY SERVICES SCHEDULE H, PART I, LINE 3C: ELIGIBILITY FOR FREE CARE: IN ADDITION TO INCOME, COPLEY USES OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE, INCLUDING RESIDENCY STATUS FOR NON-EMERGENT SERVICES AND AN ASSET THRESHOLD. SCHEDULE H, PART I, LINE 7: COSTING METHODOLOGY: THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION ON IRS WORKSHEETS 1 AND 3. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: COPLEY HOSPITAL, INC ESTIMATES THAT APPROXIMATELY 9.1% OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING 9.1% OF THE AMOUNT REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS UNDER NOTE 1, SUBTITLED "PATIENT ACCOUNTS RECEIVABLE." SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: FINANCIAL ASSISTANCE IS AVAILABLE TO GUARANTORS WHO MEET THE ELIGIBILITY REQUIREMENTS. INCOME LEVEL, HOUSEHOLD SIZE, RESIDENCY STATUS, ETC, DETERMINE ELIGIBILITY. FEDERAL POVERTY LEVEL GUIDELINES ARE UTILIZED TO DETERMINE THE AMOUNT OF ASSISTANCE A HOUSEHOLD MAY BE ELIGIBLE FOR. FOR THE PATIENTS CONVENIENCE, ALL STATEMENTS HAVE AN ABBREVIATED VERSION OF THE FINANCIAL ASSISTANCE APPLICATION ON THE BACK. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: COPLEY GATHERS AND ANALYZES INFORMATION ABOUT THE GREATER LAMOILLE VALLEY COMMUNITY AND ITS HEALTHCARE NEEDS THROUGH VARIOUS MEANS, INCLUDING: ANALYZING AND RESPONDING TO HEALTH TRENDS IN OUR PATIENTS; THROUGH AGGREGATE DATA FROM OUR QUALITY AND WELLNESS INITIATIVES, THE ONECARE VERMONT ACCOUNTABLE CARE ORGANIZATION, THE VERMONT STATE BLUEPRINT FOR HEALTH AND FROM THE UNIFIED COMMUNITY COLLABORATIVE (UCC) WHICH INCLUDES REPRESENTATIVES FROM COMMUNITY, REGIONAL AND STATE ORGANIZATIONS AND AGENCIES INVOLVED IN THE SOCIAL DETERMINANTS OF HEALTH. WE ALSO REVIEW RELEVANT DATA FROM THE VERMONT DEPARTMENT OF HEALTH, CENTERS FOR MEDICARE AND MEDICAID SERVICES, AND THE FEDERAL CENTERS FOR DISEASE CONTROL. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INFORMATION ABOUT COPLEYS CHARITABLE CARE POLICY, WHICH INCLUDES HELPING PATIENTS APPLY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS, IS POSTED BY EACH REGISTRATION DESK (MAIN LOBBY AND EMERGENCY DEPARTMENT). IT IS ALSO AVAILABLE, ALONG WITH THE APPLICATION FORM, ONLINE ON THE HOSPITALS WEBSITE IN ADDITION TO THE "HOSPITAL REPORT CARD" WEBSITE OF THE GREEN MOUNTAIN CARE BOARD. DETAILS ARE ALSO INCLUDED IN THE PATIENT GUIDE FOR INPATIENTS, FAMILIES AND VISITORS. COPLEYS CHARITABLE CARE PROGRAM IS ALSO PROMOTED IN OUR PHILANTHROPY EFFORTS AS MANY DONORS GIVE TO THE PROGRAM. ALL CARE PROVIDERS MAY REFER PATIENTS TO THE HOSPITALS PATIENT FINANCIAL SERVICES COUNSELORS OR TO PATIENT AND FAMILY SERVICES TO CONNECT THEM TO ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: COPLEY HOSPITAL, DEFINES ITS SERVICE AREA AS LAMOILLE, AND PARTS OF ORLEANS AND CALEDONIA COUNTIES IN VERMONT, WHICH INCLUDES THE TOWNS OF BELVEDIRE, CAMBRIDGE, JEFFERSONVILLE, WATERVILLE, EDEN, EDEN MILLS, HYDE PARK, JOHNSON, ELMORE, MORRISTOWN, MOSCOW, NORTH HYDE PARK, STOWE, WOLCOTT, CRAFTSBURY, GREENSBORO, HARDWICK AND STANNARD. COPLEY SERVES A POPULATION OF 30,387 PEOPLE. LAMOILLE COUNTY IS ONE OF THE FEW COUNTIES SEEING POPULATION GROWN IN VERMONT, WITH AN ESTIMATED POPULATION OF 30,849 BY 2022. THE COMMUNITY IS PREDOMINANTLY WHITE, NON-HISPANIC, WITH A MEDIAN AGE OF 47.3 AND A MEDIAN HOUSEHOLD INCOME OF $53,086 COMPARED TO THE VERMONT MEDIAN HOUSEHOLD INCOME OF $59,175. THE AREA HAS POCKETS OF GREAT WEALTH AND GREAT POVERTY. THE TOP THREE PRIORITY POPULATIONS ARE RESIDENTS OF RURAL AREAS, LOW-INCOME GROUPS, AND CHILDREN. NEARLY 17% OF THE HOSPITALS SERVICE AREA IS GREATER THAN 65 YEARS OF AGE, WITH 18.5% WOMEN OF CHILD-BEARING AGE. NEARLY 31% OF ADULTS 25 YEARS OF AGE OR OLDER IN THE AREA HOLD A HIGH SCHOOL DEGREE, WITH 29% HAVING SOME COLLEGE EXPERIENCE OR AN ASSOCIATES DEGREE AND 34% HOLDING A BACHELORS DEGREE OR HIGHER. THE MAJOR INDUSTRY IS ACCOMMODATIONS AND FOOD SERVICE, FOLLOWED BY HEALTH AND SOCIAL ASSISTANCE. RECENT STUDIES INDICATE LAMOILLE COUNTY HAS THE HIGHEST RATE OF SUICIDE IN THE STATE. THE LEADING CAUSES OF DEATH ARE FROM CANCER, HEART DISEASE, AND LUNG DISEASE. ADVERSE METRICS IMPACTING MORE THAN 30% OF THE POPULATION AND STATISTICALLY SIGNIFICANTLY DIFFERENT FROM THE NATIONAL AVERAGE INCLUDE: - BMI IN MORBID/OBESE RANGE AT 10% ABOVE AVERAGE, IMPACTING 33.7% - ROUTINE CHOLESTEROL SCREENING = 9.8% BELOW AVERAGE, IMPACTING 40.0% - CANCER SCREEN: PAP/CERV TEST 2 YR = 9.1% BELOW AVERAGE, IMPACTING 43.8% - OB/GYN 1+ VISIT = 11.5% BELOW AVERAGE, IMPACTING 34.0%. BENEFICIAL METRICS IMPACTING MORE THAN 30% OF THE POPULATION AND STATISTICALLY SIGNIFICANTLY DIFFERENT FROM THE NATIONAL AVERAGE INCLUDE: - CONSUMED ALCOHOL IN THE PAST 30 DAYS = 18.3% BELOW AVERAGE, IMPACTING 43.9% - NP/PA VISIT IN THE LAST 6 MONTHS = 10.7% ABOVE AVERAGE, IMPACTING 45.9% RECENT STUDIES INDICATE LAMOILLE COUNTY HAS THE HIGHEST RATE OF SUICIDE IN THE STATE. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL IS GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES MADE UP OF LOCAL CITIZENS REPRESENTING A CROSS SECTION OF THE COMMUNITY SERVED. THE BOARD HOLDS A PUBLIC ANNUAL MEETING IN JANUARY AND ITS ETHICS COMMITTEE HOSTS AN ANNUAL PUBLIC FORUM ON A TOPIC PERTINENT TO POPULATION HEALTH. COPLEY CONTINUES TO WORK COLLABORATIVELY WITH OTHER ORGANIZATIONS TO IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS. OUR COLLABORATIONS INCLUDE BUT ARE NOT LIMITED TO THE UNIFIED COMMUNITY COLLABORATIVE (UCC) WHICH INCLUDES REPRESENTATIVES FROM COMMUNITY, REGIONAL AND STATE ORGANIZATIONS AND AGENCIES INVOLVED IN THE SOCIAL DETERMINANTS OF HEALTH; PRIMARY CARE PRACTICES; LAMOILLE HORNE HEALTH AND HOSPICE; LONG-TERM RESIDENTIAL CARE FACILITIES THE MANOR AND THE GREENSBORO NURSING HORNE; LAMOILLE COUNTY MENTAL HEALTH; COMMUNITY HEALTH SERVICES OF LAMOILLE VALLEY BEHAVIORAL HEALTH & WELLNESS; HEALTHY LAMOILLE VALLEY; PEOPLE IN PARTNERSHIP; THE MORRISVILLE DISTRICT OFFICE OF THE VERMONT DEPARTMENT OF HEALTH; THE LAMOILLE COMMUNITY HOUSE (WARMING SHELTER); UNITED WAY; CLARINA HOWARD NICHOLS CENTER; THE NORTH CENTRAL VERMONT RECOVERY CENTER; AND OTHERS. COPLEY HOSPITAL PROVIDES NEEDED MEDICAL SERVICES, REGARDLESS OF ABILITY TO PAY. SERVICES INCLUDES 24 HOURS/7 DAYS A WEEK EMERGENCY SERVICES, WOMENS AND CHILDRENS SERVICES, GENERAL SURGERY, LABORATORY SERVICES, DIAGNOSTIC IMAGING, ORTHOPAEDICS, AND REHABILITATION. COPLEY CONTINUES ITS PARTNERSHIP WITH DARTMOUTH HITCHCOCK CONNECTED CARE TO DELIVER NEEDED SERVICES IN THE AREA WITH TELEMEDICINE; INCLUDING RHEUMATOLOGY, NEPHROLOGY AND PULMONOLOGY. IN CONJUNCTION WITH COMMUNITY HEALTH SERVICES OF LAMOILLE VALLEY, COPLEY HAS PLACED A RESOURCE REFERRAL SPECIALIST IN THE ER. THIS SPECIALIST WORKS CLOSELY WITH OUR SOCIAL WORKER AND OUR UTILIZATION REVIEW NURSE TO SCREEN AND CONNECT PATIENTS TO NEEDED SERVICES AND COMMUNITY RESOURCES TO ADDRESS A VARIETY OF ISSUES INCLUDING QUIT SMOKING, FUEL INSECURITY, FOOD INSECURITY, HOMELESSNESS OR INADEQUATE HOUSING, SUBSTANCE ABUSE, MENTAL HEALTH AND/OR LONG TERM MANAGEMENT OF COMPLEX CONDITIONS. AN ONGOING INITIATIVE FOCUSES ON IDENTIFYING PATIENTS WITH COMPLEX HEALTH ISSUES THAT ARE HIGH UTILIZERS OF EMERGENCY SERVICES AND CONNECTING THEM WITH A DEDICATED CASE WORKER TO DEVELOP A COORDINATED CARE PLAN. THIS EFFORT HAS RESULTED IN A SIGNIFICANT REDUCTION IN AVOIDABLE USE OF THE EMERGENCY ROOM, CREATING A POTENTIAL - SAVINGS FOR THE AREAS HEALTHCARE SYSTEM. TO HELP ADDRESS HOMELESSNESS IN THE AREA, COPLEY PROVIDES LAUNDRY SERVICES TO A GRASSROOTS WARMING SHELTER THAT OPENED IN THE AREA. ALL OF THESE EFFORTS IMPROVE TRANSITIONS IN CARE AND OUTCOMES, WITH THE GOAL BEING THE IMPROVEMENT OF THE HEALTH OF OUR COMMUNITY. AS ONE OF THE LARGEST EMPLOYERS IN THE AREA, THE HOSPITAL IS INVESTING IN EDUCATION AND TRAINING IN SUPPORT OF RECRUITMENT AND RETENTION. COPLEY PARTNERS WITH VERMONT TECHNICAL COLLEGE, NORTHERN VERMONT UNIVERSITY & LAMOILLES WORKFORCE DEVELOPMENT GROUP TO OFFER AN ASSOCIATE DEGREE IN NURSING PROGRAM HERE IN LAMOILLE COUNTY. THE HOSPITAL WORKS WITH MANY EDUCATIONAL INSTITUTIONS, OFFERING ONSITE CLINICAL ROTATIONS ALONG WITH 8 GRADUATE PROGRAMS IN NURSING, MEDICINE AND HEALTHCARE ADMINISTRATION. THE HOSPITAL CONTINUES TO BE A KEY PARTNER IN THE LAMOILLE COUNTY CHAPTER OF RISE VERMONT, A STATE-WIDE INITIATIVE WITH THE STATES ACCOUNTABLE CARE ORGANIZATION. RISEVT SUPPORTS AND INSPIRES RESIDENTS TO HAVE FUN, PLAY MORE, EAT WELL AND FEEL GOOD BY AMPLIFYING AND SUPPORTING EFFORTS UNDERWAY IN THE COMMUNITY. THE RISEVT PROGRAM MANAGER IS EMPLOYED BY THE HOSPITAL. RISEVT OPERATED WELLNESS PROGRAMMING IN THE TOWNS OF MORRISVILLE AND JOHNSON, AND ATTENDS MULTIPLE HEALTH AND WELLNESS EVENTS ACROSS OUR SERVICE AREA THROUGHOUT THE YEAR. THE HOSPITAL REGULARLY PROMOTES HEALTHY LIFESTYLE CHOICES AND PREVENTATIVE INFORMATION VIA SOCIAL MEDIA OUTLETS, INCLUDING AN AWARD-WINNING COLLABORATIVE COMMUNITY BLOG (LIVEWELLLAMOILLE.COM), COMMUNITY NEWSLETTERS, INFORMATION DISTRIBUTED ON THE HOSPITAL CAMPUS, AND A YEAR-LONG SERIES OF INFORMATIONAL SEMINARS THAT COVER A RANGE OF TIMELY HEALTH AND WELLNESS TOPICS. WE PROMOTE AND SUPPORT HEALTHY, FAMILY-FRIENDLY ACTIVITIES AND EVENTS TO ENCOURAGE HEALTHY LIFESTYLE CHOICES. X X X X X X false false false true false false false true false JOSEPH MCLAUGHLIN TRUSTEE BEG 02/20 561702 0 32594 0 38338 0 10800 0 40871 0 684305 0 0 0 VERA JONES COO 206638 0 0 0 10540 0 7960 0 8601 0 233739 0 0 0 ARTHUR MATHISEN FORMER CEO 136895 0 26667 0 42448 0 5572 0 3061 0 214643 0 0 0 LORI PROFOTA CNO 179404 0 0 0 705 0 7452 0 20832 0 208393 0 0 0 DEBRALEE DORAIN CFO END 04/20 172777 0 0 0 142 0 6707 0 733 0 180359 0 0 0 BRIAN AROS ORTHOPEDIC SURGEON 605326 0 180067 0 28374 0 10800 0 33298 0 857865 0 0 0 JOHN MACY ORTHOPEDIC SURGEON 604989 0 50000 0 58651 0 10800 0 26053 0 750493 0 0 0 NICHOLAS ANTELL ORTHOPEDIC SURGEON 483176 0 50000 0 57402 0 10800 0 31907 0 633285 0 0 0 BRYAN MONIER ORTHOPEDIC SURGEON 449955 0 0 0 31958 0 2308 0 29858 0 514079 0 0 0 DONALD DUPUIS GENERAL SURGEON 408415 0 0 0 30815 0 10800 0 35537 0 485567 0 0 0 KEVIN DORAIN FORMER INTERIM CO-CFO 105443 0 0 0 167 0 4410 0 25592 0 135612 0 0 0 SCHEDULE J, PART I, LINE 5A COMPENSATION CONTINGENT ON REVENUES: INCENTIVE BONUSES ARE PAID TO OUR ORTHOPEDIC SURGEONS BASED UPON GROSS REVENUE PRODUCED INDIVIDUALLY FOR THE HOSPITAL. THE BONUS IS 20% OF THE EXCESS REVENUE PRODUCED OVER THAT LEVEL. SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: DURING CALENDAR YEAR 2019, ARTHUR MATHISEN, PRESIDENT & CEO, RECEIVED A BONUS OF $26,667. MR. MATHISEN IS ELIGIBLE FOR A QUARTERLY BONUS OF UP TO $10,000 PER QUARTER BASED ON HIS CONTRACT. QUARTERLY INCENTIVES ARE REVIEWED AND EVALUATED BY THE COMPENSATION COMMITTEE AND ARE SUBJECT TO FINAL APPROVAL BY THE BOARD. DAVID VINICK SEE PART V 116230 EMPLOYMENT false DIANE SZLACHETKA SEE PART V 27769 INDEPENDENT CONTRACTOR false SCHEDULE L, PART IV, COLUMN (B) RELATIONSHIP BETWEEN INTERESTED PERSON: 1) DAVID VINICK IS A FAMILY MEMBER OF SHARON GREENE, BOARD SECRETARY 2) DIANE SZLACHETKA IS A FAMILY MEMBER OF CARL SZLACHETKA, BOARD TREASURER 3) KATHERINE MARVIN IS A FAMILY MEMBER OF IRA MARVIN, BOARD TRUSTEE TREASURER FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: FURTHER, OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT, PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY. THE HOSPITAL OFFERS FREE CARE AND OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AND ARE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. COPLEY HOSPITAL SERVES AS A VITAL RESOURCE FOR RURAL NORTH CENTRAL VERMONT. A CRITICAL ACCESS HOSPITAL, COPLEY PROVIDES A 25-BED ACUTE CARE INPATIENT UNIT INCLUDING A BIRTHING CENTER, A WIDE RANGE OF OUTPATIENT SERVICES AND 24/7 EMERGENCY SERVICES IN ADDITION TO LABORATORY SERVICES, DIAGNOSTIC IMAGING AND REHABILITATION SERVICES. SERVICES INCLUDE CARDIOLOGY, GENERAL SURGERY, OBSTETRICS/GYNECOLOGY, ONCOLOGY, ORTHOPEDICS, NEUROLOGY AND TELE-MEDICINE (RHEUMATOLOGY,NEPHROLOGY AND PULMONOLOGY). OUR REHABILITATION SERVICES INCLUDE PHYSICAL, OCCUPATIONAL, SPEECH & LANGUAGE, CARDIAC, PULMONARY, AND WORK CONDITIONING. OUR HOSPITAL SERVICE AREA HAS A POPULATION OF JUST OVER 30,000 PEOPLE, ACROSS MORE THAN 459 SQUARE MILES. COPLEY COLLABORATES WITH OTHER HEALTHCARE PROVIDERS, SOCIAL SERVICE AGENCIES, NOT-FOR-PROFIT ORGANIZATIONS AND BUSINESSES TO FULFILL OURISSION OF HELPING PEOPLE LIVE HEALTHIER LIVES. THE CLOSEST HOSPITAL IS 45 MINUTES TO ONE HOUR AWAY. IN FISCAL YEAR 2020, COPLEY HAD NEARLY 75,500 OUTPATIENT VISITS AND MORE THAN 1,800 INPATIENT ADMISSIONS TOTALING 5,483 PATIENT DAYS. WE PERFORMED 2,145 SURGERIES AND 1,523 PROCEDURES AND HAD 11,278 EMERGENCY ROOM VISITS. OUR CHARITABLE CARE PROGRAM IS AVAILABLE TO PATIENTS WHO ARE UNINSURED, UNDERINSURED, OR HAVE OTHERWISE DEMONSTRATED THEY DO NOT HAVE FINANCIAL RESOURCES TO FULLY PAY FOR THEIR HOSPITAL CARE. FORM 990, PART V, LINE 2A W-2'S FILED: COPLEY HOSPITAL, INC ALSO FILES W-2'S FOR ITS RELATED ORGANIZATIONS. THE TOTAL NUMBER OF W-2'S FILED ON THE W-3 INCLUDES THESE W-2'S. THE COMPENSATION, EMPLOYEE BENEFITS AND PAYROLL TAXES AMOUNTS ARE THEN ALLOCATED TO THE ORGANIZATION FOR THE AMOUNT THAT REPRESENTS WORK PERFORMED FOR THE ORGANIZATION. THE AMOUNT INCLUDED ON LINE 2A INCLUDES ONLY EMPLOYEES ALLOCATED TO COPLEY HOSPITAL. THE AMOUNT REPORTED ON PART IX INCLUDES ONLY THOSE AMOUNTS ALLOCATED TO WORK PERFORMED DIRECTLY FOR COPLEY HOSPITAL, INC. THE HIGHEST PAID EMPLOYEES ARE DETERMINED BY THE WORK PERFORMED FOR EACH ORGANIZATION. THEREFORE, THE FIVE HIGHEST PAID EMPLOYEES LISTED ON PART VII AND SCHEDULE J ARE THOSE EMPLOYEES WHO WORK DIRECTLY FOR COPLEY HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B MEMBERS/STOCKHOLDERS: COPLEY HOSPITAL, INC. IS A MEMBER ORGANIZATION WHOSE SOLE CORPORATE MEMBER IS COPLEY HEALTH SYSTEMS, INC. COPLEY HEALTH SYSTEMS, INC. AND THE HOSPITAL SHARE THE SAME BOARD OF TRUSTEES. EACH YEAR, THE MEMBERS OF COPLEY HEALTH SYSTEMS, INC. WILL HOLD AN ANNUAL MEETING. THE PURPOSES OF THE ANNUAL MEETING SHALL INCLUDE THE ELECTION OF MEMBERS TO THE CORPORATION, THE ELECTION OF TRUSTEES TO THE CORPORATIONS BOARD OF TRUSTEES, THE ELECTION OF THE COMMUNITY MEMBER AT LARGE OF THE GOVERNANCE AND BYLAWS COMMITTEE, AND THE TRANSACTION OF SUCH OTHER BUSINESS AS MAY PROPERLY COME BEFORE THE MEMBERSHIP. THE BOARD SHALL CONSIST OF UP TO TWENTY-ONE ELECTED MEMBERS, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND THE PRESIDENT OF THE MEDICAL STAFF OF COPLEY HOSPITAL, INC., ALL AS VOTING MEMBERS. ALL TRUSTEES MUST BE MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A TENTATIVE DRAFT OF THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS. A COMPLETE COPY OF THE FORM IS MADE AVAILABLE TO ALL MEMBERS OF THE GOVERNING BODY THROUGH THE FINANCE OFFICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE GOVERNANCE COMMITTEE REVIEWS THE STATEMENTS AND SURVEYS COMPLETED BY INTERESTED PERSONS AND MAINTAINS A LIST OF INDIVIDUALS WHO MAY BE CONSIDERED DISQUALIFIED PERSONS UNDER IRS REGULATIONS. THE GOVERNANCE COMMITTEE REPORTS THE RESULTS OF ITS REVIEWS ANNUALLY TO THE BOARD. THE INTERNAL COMPLIANCE COMMITTEE OF THE CORPORATION REVIEWS ANY POTENTIAL CONFLICT OF INTEREST WHICH INVOLVES AN INTERESTED PERSON WHO IS NOT A TRUSTEE OR OFFICER OF THE CORPORATION. THE INTERNAL COMPLIANCE COMMITTEE REPORTS THE RESULTS OF ITS REVIEWS ANNUALLY TO THE BOARD. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: THE ORGANIZATION'S CEO IS PAID BY COPLEY HOSPITAL, A RELATED ORGANIZATION. THE CEO'S PAY IS DETERMINED BY USING MARKET SURVEY COMPENSATION DATA FROM THE NNE HEALTHCARE COMP SURVEY. THE CEO'S COMPENSATION IS ALSO APPROVED BY THE BOARD. SENIOR LEADERSHIP AND OTHER HIGHLY COMPENSATED INDIVIDUALS HAVE THEIR PAY RANGES DETERMINED THROUGHT MARKET DATA FROM THE NNE HEALTHCARE COMPENSATION SURVEY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY AND MATRIX ARE AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE SUMMARIZED IN AN ANNUAL REPORT THAT IS AVAILABLE TO THE PUBLIC. THE HOSPITAL ALSO SUBMITS BOTH THEIR BUDGET AND ACTUAL FINANCIAL INFORMATION TO THE STATE OF VERMONTS DEPARTMENT OF FINANCIAL REGULATION. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $132,276 CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF COPLEY HEALTH SYSTEMS, INC. LAMOILLE HOUSING CORPORATION 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 030270255 HUD HOUSING VT 501(C)(3) 10 CHSI false COPLEY HEALTH SYSTEMS INC 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 030301457 SUPPORT VT 501(C)(3) 12B II NA false HEALTH CENTER BUILDING INC 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661 030220357 BUILDING RENTAL VT CHSI C CORP false false false true false false false false false false true true true false false true false true false false