2020-08-07T11:13:04-05:00 2019-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-10-01 030179423 Copley Hospital Inc COPL 8028888888 528 Washington Highway Morrisville VT 05661 Joseph Woodin CEO 8028888888 2020-08-03 1 Joseph R Byrne P01289281 2077752387 2020-08-03 69.49.157.66 2020-08-03 13:11:24 ED P BFB386403C9EAE7FF660C386334FC3E1098CE7FC 00743ACC225E8BFC471CDFB8B0D482A24F37EDEF 2018 2020-11-06 18:47:13Z Joseph Woodin 528 Washington Highway Morrisville VT 05661 68634684 0 X www.copleyvt.org X 1934 VT Critical Access Hospital 16 13 551 114 0 0 518568 356332 67528425 68127051 -15668 50442 0 0 68031325 68533825 0 0 0 0 36894570 37974216 0 0 0 32789086 32325115 69683656 70299331 -1652331 -1765506 56568832 54544853 17153752 16683576 39415080 37861277 X To help people live healthier lives by providing exceptional care and superior service. 0 0 64479032 68127051 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. Further, our mission is to serve the community with respect to 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. These activities include a variety of services in the form of seminars, workshops, clinics, and screenings at minimal or no charge. 64479032 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 96 0 1 551 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 13 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Angela Lamell 8028888222 528 Washington Highway Morrisville VT 05661 Carl Szlachetka Chair 3.80 0.20 X X 0 0 0 Kathy Demars Vice Chair 1.80 0.20 X X 0 0 0 Walter Frame Treasurer 1.80 0.20 X X 0 0 0 Sharon Green Secretary 1.80 0.20 X X 0 0 0 Henry Binder MD Trustee 1.80 0.20 X 0 0 0 David Bisbee MD Trustee/Med. Staff President 1.80 0.20 X 0 0 0 Bob Bleimeister Trustee 1.80 0.20 X 0 0 0 Ira Marvin Trustee 1.80 0.20 X 0 0 0 Elaine Nichols Trustee 1.80 0.20 X 0 0 0 Dan Noyes Trustee 1.80 0.20 X 0 0 0 Nancy Putnam Trustee 1.80 0.20 X 0 0 0 Jan Roy Trustee 1.80 0.20 X 0 0 0 David Silverman Trustee 1.80 0.20 X 0 0 0 Jamey Ventura Trustee 1.80 0.20 X 0 0 0 Richard Westman Trustee 1.80 0.20 X 0 0 0 Harry Miller Past Trustee 1.80 0.20 X 0 0 0 Joseph Subasic MD Past Trustee/Med. Staff President 41.80 0.20 X 258936 0 31034 Arthur Mathisen Past President and CEO 38.00 2.00 X X 347745 0 17755 Jeff White Interim CEO 23.00 1.00 X X 0 0 0 Rassoul Rangaviz Past CFO 38.00 2.00 X 266426 0 10585 Vera Jones COO 38.00 2.00 X 185632 0 17347 Lori Profota CNO 38.00 2.00 X 176451 0 28575 Debralee Dorain Interim CFO 38.00 2.00 X 122654 0 5809 Kevin Dorain Interim Co-CFO 38.00 2.00 X 102042 0 30462 Nicholas Antell Physician 40.00 0.00 X 491944 0 40821 Bryan Huber Physician 40.00 0.00 X 641790 0 44810 John Macy Physician 40.00 0.00 X 697658 0 47528 Brian Aros Physician 40.00 0.00 X 761289 0 41623 Joseph McLaughlin Physician 40.00 0.00 X 572023 0 41080 4624590 0 357429 51 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Physician Services 587800 Apogee Medical Management 15059 N Scottsdale Rd Ste 600 Scottsdale AZ 852542685 Physician Services 552539 CPSI PO Box 850309 Mobile AL 366850309 Software support 478055 University of Vermont PO Box 1902 Burlington VT 054021902 Lab Services 335236 Amnesia Anesthesia PLLC PO Box 4461 St Johnsbury VT 05819 Anesthesia Services 315835 21 356332 356332 Gross Patient Revenue 621400 113757897 113757897 Miscellaneous Revenue 621400 780954 780954 Cafeteria Revenue 900099 352285 352285 Provision for Bad Debt 621400 -1809559 -1809559 Contractual/Char. Adj. 621400 -44954526 -44954526 68127051 59853 59853 91448 100859 -9411 -9411 -9411 68533825 66993812 0 1183681 X 1601455 289971 1311484 29974794 28458254 1516540 730354 703206 27148 3704610 3446656 257954 1963003 1793304 169699 27350 27350 50872 50872 45001 45001 7188506 6037865 1150641 159739 159739 1092878 828196 264682 1897493 1568217 329276 52925 40255 12670 111344 111344 2711502 2555012 156490 993248 894342 98906 Medical Supplies 13629311 13594573 34738 Service Provider Tax 3899906 3899906 Dues & Subscriptions 322548 125947 196601 Education 142492 131984 10508 70299331 64479032 5820299 0 X 2650 2650 11696982 11498004 5711480 5439899 3360814 2997420 1468842 1534559 56093751 30279428 27109453 25814323 4656728 4868431 2561883 2389567 56568832 54544853 6011506 6144874 8398785 7910328 2743461 2628374 17153752 16683576 X 34758352 32992846 140171 204259 4516557 4664172 39415080 37861277 56568832 54544853 X -1765506 211703 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 32122 0 1 12879 45001 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion (12,879) of which is attributable to lobbying expenses. The Hospital also engaged a law firm for 32,122 for lobbying services. 1096205 1096205 31212794 12588430 18624364 686072 382458 303614 22108026 16793013 5315013 990654 515527 475127 25814323 Beneficial Interest in Net Assets of Copley Health Systems, Inc. 4868431 F 4868431 Deferred Compensation 2378374 Estimated Third Party Payor Settlements 250000 2628374 68745528 211703 211703 68533825 0 68533825 70299331 0 70299331 0 70299331 Part XI, Line 2d - Other Adjustments: Change in Beneficial Interest in Net Assets of Copley Health Systems, Inc. 211,703. 1 1 1 X 300.000000000000 1 X 0 1 1 0 1 1 482203 482203 0.00690 12605205 6260935 6344270 0.09020 13087408 6260935 6826473 0.09710 156392 101681 54711 0.00080 156392 101681 54711 0.00080 13243800 6362616 6881184 0.09790 0 1036899 1 1 1 1 Copley Hospital Inc 528 Washington Highway Morrisville VT 05661 www.copleyvt.org 891 X X X X Copley Hospital Inc 1 0 0 1 X X X X X X X X X 17 1 0 1 1 X https://www.copleyvt.org/about-us/community-health-needs-assessment/ X 1 17 1 https://www.copleyvt.org/about-us/community-health-needs-assessment/ 0 1 X 300.000000000000 400.000000000000 X X 1 1 X X X 1 X www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ X www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ X www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ X X X X X 1 X 0 X X X X 1 X 0 1 Copley Hospital, Inc. Part V, Section B, Line 5: 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 health2. 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 facility3. 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 definition4. Chronic Disease Groups - Representative of or member of Chronic Disease Group or Organization, including mental and oral health5. Broad Interest of the Community - Individuals, volunteers, civic leaders, medical personnel, and others to fulfill the spirit of broad input required by the federal regulationsAnd Other 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 Analyics); 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 Hospital's desire to represent the region's 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 hospital's CHNA.While the Round 1 survey was open to the Local Experts, a Community Survey was solicited to the Copley Hospital's 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. Copley Hospital, Inc. Part V, Section B, Line 6b: 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. Copley Hospital, Inc. Part V, Section B, Line 11: 1. Preventative CareCopley Hospital services, programs, and resources available to respond to this need include: - Screening availability at Copley Hospital's 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 hospital's social media through collaborative community blog LiveWellLamoille.com.- Prevention/education awareness program - through the launch of RISE VT-Lamoille due FY2019.- 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 Women's 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 concernCopley Hospital services, programs, and resources available to respond to this need include:- Screening availability at Copley Hospital's 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. Copley Hospital, Inc. Part V, Section B, Line 24: Services that are not medically necessary are excluded from coverage under the FAP, but an uninsured discount is granted for these services. Continuation of Part V, Section B, Line 11: 3. Chronic Health Conditions Copley Hospital services, programs, and resources available to respond to this need include:- Screening availability at Copley Hospital's 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 Women's 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 concernCopley 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 Women's Center and with targeted population in the emergency department.Copley Hospital does not intend to develop an implementation strategy for this Significant NeedDue 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. 4 1 - Copley Hospital Inc 88 High Street Hardwick VT 05843 Outpatient Rehab Services 2 - Stoweflake Resort 1746 Mountain Road Stowe VT 05672 Outpatient Rehab Services 3 - Mansfield Orthopaedics 555 Washington Highway Morrisville VT 05661 Outpatient Orthopaedic, Rehab and Radiology Services 4 - Mansfield Orthopaedics 6 North Main Street Waterbury VT 05676 Outpatient Orthopaedic, Radiology Services Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. Part I, Line 3c 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. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances, and thus are reduced by an allowance for doubtful accounts. In evaluating collectibility of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provisions 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, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). 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 on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill 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 off against the allowance for doubtful accounts. The allowance for doubtful accounts decreased from $2,100,000 in 2018 to $2,015,000 in 2019 based on the aging of receivables.The Organization utilized a cost to charge ratio as the costing methodology used to determine the amount of bad debt expense at cost. Part III, Line 9b: 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 patient's convenience, all statements have an abbreviated version of the Financial Assistance Application on the back. Part VI, Line 2: 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. Part VI, Line 3: Information about Copley's 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 Hospital's 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.Copley's 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 Hospital's Patient Financial Services counselors or to Patient and Family Services to connect them to assistance. Part VI, Line 4: 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 Hospital's 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 Associate's degree and 34% holding a Bachelor's 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. Part VI, Line 5: 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, women's and children's 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 area's 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 & Lamoille's 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 state's 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. In 2019, the chapter awarded $26,059 in Amplify Grants to local organizations like: Craftsbury Outdoor Center, Lamoille Family Center, and Everyone Equals Morristown Community Center.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 0 0 0 1 0 0 0 1 0 Joseph Subasic MD Past Trustee/Med. Staff President 233159 0 0 0 25777 0 9960 0 21074 0 289970 0 0 0 Arthur Mathisen Past President and CEO 295188 0 40000 0 12557 0 10800 0 6955 0 365500 0 0 0 Rassoul Rangaviz Past CFO 226455 0 0 0 39971 0 9071 0 1514 0 277011 0 0 0 Vera Jones COO 176549 0 0 0 9083 0 3954 0 13393 0 202979 0 0 0 Lori Profota CNO 175762 0 0 0 689 0 7306 0 21269 0 205026 0 0 0 Nicholas Antell Physician 454010 0 0 0 37934 0 6154 0 34667 0 532765 0 0 0 Bryan Huber Physician 594286 0 25000 0 22504 0 10800 0 34010 0 686600 0 0 0 John Macy Physician 585659 0 50000 0 61999 0 10800 0 36728 0 745186 0 0 0 Brian Aros Physician 591769 0 107567 0 61953 0 10800 0 30823 0 802912 0 0 0 Joseph McLaughlin Physician 544517 0 5573 0 21933 0 10800 0 30280 0 613103 0 0 0 Part I, Line 5 Bryan Huber, Brian Aros, John Macy, and Joseph McLaughlin highest compensated employees, received bonuses of $25,000, $107,567, $50,000, & $5,573 respectively. The bonuses were based upon the gross revenue produced individually for the Hospital. The bonus is 20% of the excess revenue produced over that level. Part I, Line 7 During calendar year 2018, Arthur Mathisen, President & CEO, received a bonus of $40,000. Mr. Mathisen is eligible for a quarterly bonus of up to $10,000 per quarter. Quarterly incentive accruals are reviewed and evaluated by the Compensation and Evaluation Committee, and are subject to final approval by the full Board. David Vinick Family Member of Sharon Greene, Board Secretary 118058 Employment 0 Diane Szlachetka Family Member of Carl Szlachetka, Board Chair 29773 Independent Contractor Arrangement 0 Katherine Marvin Family Member of Ira Marvin, Board Trustee 12750 Independent Contractor Arrangement 0 Form 990, Part VI, Section A, line 2 Debralee Dorain and Kevin Dorain have a family relationship. Both were named Interim Co-CFOs after the previous CFO suddenly passed away in December of 2018. Form 990, Part VI, Section A, line 6 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. Form 990, Part VI, Section A, line 7a Copley Hospital, Inc. shares the same board as Copley Health Systems, Inc. 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 Corporation's 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 The board reviews the Form 990 prior to submission. 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 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, line 15 The CEO's pay is determined through the use of an outside compensation firm. Senior leadership and other highly compensated individuals have their pay ranges determined through market data from Astron Solutions. The compensation for the CEO is approved by the Board. Form 990, Part VI, Section C, line 19 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 Vermont's Department of Financial Regulation. Form 990, Part IX, line 11g Other Fees: Program service expenses 1,262,541. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,262,541. Contract Labor: Program service expenses 1,782,083. Management and general expenses 150,048. Fundraising expenses 0. Total expenses 1,932,131. Purchased Services: Program service expenses 2,993,241. Management and general expenses 1,000,593. Fundraising expenses 0. Total expenses 3,993,834. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Copley Hospital, Inc. 528 Washington Highway Morrisville, VT 05661 EIN: 03-0179423 Copley 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 Beneficial Interest in Net Assets of Copley Health Systems, Inc. 211,703. Lamoille Area Housing Corporation Copley Terrace Project 528 Washington Highway Morrisville VT 05661 030270255 Subsidized Elderly Housing VT 501(c)(3) Line 10 Copley Health Systems Inc 0 Copley Health Systems Inc 528 Washington Highway Morrisville VT 05661 030301457 Support of Copley Hospital VT 501(c)(3) Line 12b, II N/A 0 Health Center Building Inc 528 Washington Highway Morrisville VT 05661 030220357 Office Building Rental VT Copley Health Systems Inc C 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0