2020-07-30T10:09:54-05:00 2019-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-10-01 030306549 Helen Porter Nursing Home Inc HELE 8023884701 115 Porter Drive Middlebury VT 05753 Jennifer Bertrand CFO 8023884701 2020-07-28 1 Joseph R Byrne P01289281 2077752387 2020-07-28 69.49.157.66 2020-07-28 19:23:00 ED P 8B04EC08AF02322EA9ED1307B74D8AF8BDCA5114 98B0765DE24833D2D2C68263306E27B9DACD599F 2018 2020-09-23 17:36:50Z Helen Porter Rehabilitation & Nursing Jennifer Bertrand 115 Porter Drive Middlebury VT 05753 10581999 0 X www.portermedical.org X 1986 VT Operation of 98 bed skilled nursing home 17 15 218 36 0 0 463960 695606 9698273 9879567 -68464 -6050 0 0 10093769 10569123 0 0 0 0 7971592 8872595 0 0 0 3700778 3453979 11672370 12326574 -1578601 -1757451 3944285 5046688 6602648 6330094 -2658363 -1283406 The mission of Helen Porter Rehabilitation and Nursing is to improve the health of our community, one person at a time. 0 0 10928188 9879567 Operated long-term community oriented 98 bed skilled nursing home. The nursing home provided services to patients that totaled 31,125 resident days during the year ended 9/30/2019. 10928188 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 1 0 0 0 0 1 0 0 0 1 21 0 1 218 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 VT X Jennifer Bertrand 8023888878 115 Porter Drive Middlebury VT 05753 Sivan Cotel Chairperson 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 Linn Larson MD Secretary 1.00 2.00 X X 0 0 0 Kristofer Anderson MD Director 1.00 41.00 X 0 454253 19009 Judson Bartlett Director 1.00 2.00 X 0 0 0 Anne Collins Director 1.00 2.00 X 0 0 0 Matthew Curran Director 1.00 2.00 X 0 0 0 Kim Downs-Burns Director 1.00 2.00 X 0 0 0 Richard Foote Director 1.00 2.00 X 0 0 0 Lewis Holmes MD Director 1.00 41.00 X 0 182481 6532 Stephen Koller MD Director 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 Alix O'Meara Director 1.00 2.00 X 0 0 0 Steve Terry Director 1.00 2.00 X 0 0 0 Bill Townsend Director 1.00 2.00 X 0 0 0 Fred Kniffin MD CEO 1.00 41.00 X 0 443518 18921 Jennifer Bertrand CFO 1.00 41.00 X 0 223808 8005 Seleem Choudhury Past President/COO 1.00 41.00 X 0 0 0 Mary Jane Nottonson Nursing Home Administrator 40.00 0.00 X 169314 0 14096 Arlene Mathewson Unit RN 40.00 0.00 X 115724 0 11012 Sarah Dugan Unit LNA 40.00 0.00 X 113795 0 8008 Michelle Wright Director of Nursing 40.00 0.00 X 100187 0 4643 James Daily Former President/CEO 0.00 0.00 X 0 369846 0 499020 1673906 90226 4 1 1 0 Porter Medical Center Inc 115 Porter Drive Middlebury VT 05753 Management Services 645992 Porter Hospital 115 Porter Drive Middlebury VT 05753 Lab/Pharmacy/Radiology/Mgt. Svcs. 111644 2 695606 675332 695606 Patient Revenue 623000 12151185 12151185 Other Revenue 623000 4040 533 3507 Provision for Bad Debts 623000 -109450 -109450 Contractual Allowances 623000 -2166208 -2166208 9879567 6826 6826 12876 -12876 -12876 -12876 10569123 9876060 0 -2543 6368574 6021857 346717 288164 270383 17781 1740918 1633496 107422 474939 445633 29306 716062 154543 561519 30528 30528 45682 45682 122024 102513 19511 14248 14248 21044 21044 108973 85885 23088 4952 2839 2113 2335 2335 77131 60499 16632 256858 230758 26100 29671 18302 11369 Medical Supplies 1497449 1410757 86692 Medicaid Provider Tax 490723 490723 Miscellaneous Expense 35099 35099 Dues & Subscriptions 1200 1200 12326574 10928188 1398386 0 X 157608 22458 573817 1263136 1078026 1565299 17654 16483 13153 26223 7553451 5421179 2082122 2132272 21905 20817 3944285 5046688 1608342 1267719 2729207 2601831 23527 23435 2800 0 741973 741973 1496799 1695136 6602648 6330094 X -2798735 -1946530 140372 663124 -2658363 -1283406 3944285 5046688 X -1757451 3132408 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3047 3047 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 5923806 4315979 1607827 1418667 931883 486784 210978 173317 37661 2132272 Due to Affiliates 688806 Liability for Pension Benefits 881132 Estimated Third-Party Settlements 125198 1695136 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. 0 1 0 0 0 0 0 1 0 Kristofer Anderson MD Director 0 352264 0 8831 0 93158 0 11000 0 8009 0 473262 0 0 Lewis Holmes MD Director 0 159412 0 11392 0 11677 0 5456 0 1076 0 189013 0 0 Fred Kniffin MD CEO 0 366023 0 40083 0 37412 0 13750 0 5171 0 462439 0 0 Jennifer Bertrand CFO 0 201003 0 21356 0 1449 0 6671 0 1334 0 231813 0 0 Mary Jane Nottonson Nursing Home Administrator 142915 0 26103 0 296 0 5304 0 8792 0 183410 0 0 0 James Daily Former President/CEO 0 0 0 0 0 369846 0 0 0 0 0 369846 0 369846 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 4b James Daily, former President/CEO, received a payout of $369,846 from his 457(f) deferred compensation plan. Part I, Line 7 Kristofer Anderson, M.D. and Lewis Holmes, M.D. received bonuses which were based on their productivity and quality. A lump sum incentive award has been issued to members of senior leadership and the President of Porter Medical Center, Porter Hospital, and Helen Porter Nursing Home through its annual variable pay plan, as the organization performance measures were met. Threshold measures were reviewed by the Executive Committee of the Board of Directors. These measures included, financial, population health/quality, and operational related metrics. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-08-01 3100000 Refunding 2000 Series A Bonds 0 0 0 A 498169 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 X 1 675332 Stock Market Value 0 0 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 Organization's executive committee reviews comparative data prepared by a consultant prior to referral of compensation to the board of directors. The board of directors review the findings of the consultant and vote 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 -317,592. Equity Transfer from Affiliate 3,450,000. 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 Related 0 0 Adirondack ACO LLC 75 Beekman Street Plattsburgh NY 12901 462840926 Accountable Care NY N/A N/A 0 0 UVMHN Health Ventures Inc 111 Colchester Ave Burlington VT 05401 043380045 Holding Company VT UVMHN C 0 VMC Indemnity Company LTD PO Box HM 3103 25 Church Street Hamilton HM FX BD Captive Insurance BD UVMMC C 0 UVMHN Credentialing & Enrollment 111 Colchester Ave Burlington VT 05401 030333056 Admin Services VT UVMHN Ventures C 0 Charitable Remainder Trust (5) Support VT UVMMCCVMC T 0 Perpetual Trust (4) Support VT UVMMC T 0 Charitable Irrevocable Trust (7) Support VT UVMMCCVMC T 0 Champlain Valley Health Network 75 Beekman Street Plattsburgh NY 12901 161586102 Admin Service NY CPI C 0 Mediquest Inc PO Box 1656 Plattsburgh NY 12901 141663061 Med Office Lease NY CPI C 0 Yankee Medical Inc 276 North Avenue Burlington VT 05401 030225363 Home Medical Equipment VT UVMHN Ventures C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1