COPLEY HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COPLEY HOSPITAL INC (EIN 03-0179423)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-02-13
- IRS object ID
- 201920449349300017
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-02-13T08:43:50-06:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030179423 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COPL | BusinessNameControlTxt |
| Phone | 8028888888 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Arthur Mathisen | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 8028888888 | PhoneNum |
| Signature | 2019-02-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne CPA | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2019-02-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.49.157.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-02-12 | IPDt |
| IP Tm | 12:08:52 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E262D3C9A45A77A46A0A2832CF74466488750570 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | E262D3C9A45A77A46A0A2832CF74466488750570 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Arthur Mathisen | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $68,243,149 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.copleyvt.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1934 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 551 | TotalEmployeeCnt |
| Total Volunteers | 128 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,983,083 | PYContributionsGrantsAmt |
| CY Contributions Grants | $518,568 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $66,547,154 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $67,528,425 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$93,708 | PYInvestmentIncomeAmt |
| CY Investment Income | -$15,668 | CYInvestmentIncomeAmt |
| PY Other Revenue | $19,946 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $69,456,475 | PYTotalRevenueAmt |
| CY Total Revenue | $68,031,325 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $36,041,404 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,894,570 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $30,738,959 | PYOtherExpensesAmt |
| CY Other Expenses | $32,789,086 | CYOtherExpensesAmt |
| PY Total Expenses | $66,780,363 | PYTotalExpensesAmt |
| CY Total Expenses | $69,683,656 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,676,112 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,652,331 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,010,352 | TotalAssetsBOYAmt |
| Total Assets EOY | $56,568,832 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,965,223 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,153,752 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $41,045,129 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $39,415,080 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To help people live healthier lives by providing exceptional care and superior service. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $63,827,194 | ExpenseAmt |
| Revenue | $67,528,425 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $63,827,194 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 107 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 551 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kevin Dorain | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8028888138 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Kathy Demars | ||||||||
| Vice Chair | 1.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Harry Miller | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Carl Szlachetka | ||||||||
| Chair | 1.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Walter Frame | ||||||||
| Treasurer | 1.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sharon Green | ||||||||
| Secretary | 1.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Elaine Nichols | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Nancy Putnam | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Richard Westman | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| David Yacovone | ||||||||
| Past Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Henry Binder MD | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Jan Roy | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Joseph Subasic MD | ||||||||
| Trustee/Med. Staff President | 41.80 | 0.20 | Yes (X) | $177,286 | $0 | $29,189 | ||
| David Silverman | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Jamey Ventura | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Bob Bleimeister | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Ira Marvin | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Dan Noyes | ||||||||
| Trustee | 1.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Arthur Mathisen | ||||||||
| President and CEO | 38.00 | 2.00 | Yes (X) | Yes (X) | $318,110 | $0 | $10,922 | |
| Rassoul Rangaviz | ||||||||
| CFO | 38.00 | 2.00 | Yes (X) | $241,310 | $0 | $11,004 | ||
| Vera Jones | ||||||||
| COO | 38.00 | 2.00 | Yes (X) | $157,360 | $0 | $11,211 | ||
| Lori Profota | ||||||||
| CNO | 38.00 | 2.00 | Yes (X) | $171,798 | $0 | $24,708 | ||
| Bryan Huber MD | ||||||||
| Physician | 40.00 | 0.00 | $716,990 | $0 | $46,620 | Yes (X) | ||
| Brian Aros MD | ||||||||
| Physician | 40.00 | 0.00 | $680,761 | $0 | $55,818 | Yes (X) | ||
| Saul Trevino MD | ||||||||
| Physician | 40.00 | 0.00 | $476,515 | $0 | $58,505 | Yes (X) | ||
| John Macy MD | ||||||||
| Physician | 40.00 | 0.00 | $655,969 | $0 | $50,201 | Yes (X) | ||
| Joseph McLaughlin MD | ||||||||
| Physician | 40.00 | 0.00 | $595,795 | $0 | $47,677 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,191,894 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $345,855 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 49 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ReArch Company Inc | |||||
| 55 Community Drive Suite 402 | South Burlington | VT | 05403 | Construction | $5,401,801 |
| Apogee Medical Management | |||||
| 15059 N Scottsdale Rd Ste 600 | Scottsdale | AZ | 852542685 | Physician Services | $533,553 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 366850309 | Software Support | $455,962 |
| University of Vermont | |||||
| PO Box 1902 | Burlington | VT | 054021902 | Lab Services | $362,445 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Physician Services | $361,787 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 26 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $518,568 | RelatedOrganizationsAmt |
| Total Contributions | $518,568 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Gross Patient Revenue | 621400 | $107,028,309 | $107,028,309 | |
| Miscellaneous Revenue | 621400 | $951,666 | $951,666 | |
| Cafeteria Revenue | 900099 | $350,310 | $350,310 | |
| Provision for Bad Debt | 621400 | -$1,877,839 | -$1,877,839 | |
| Contractual/Char. Adj. | 621400 | -$38,924,021 | -$38,924,021 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $67,528,425 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,536 | TotalRevenueColumnAmt |
| Exclusion | $51,536 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $144,620 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $211,824 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$67,204 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$67,204 | TotalRevenueColumnAmt |
| Exclusion | -$67,204 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,031,325 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $66,226,449 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,286,308 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,152,897 | TotalAmt |
| Program Services | $206,475 | ProgramServicesAmt |
| Management And General | $946,422 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,001,763 | TotalAmt |
| Program Services | $28,175,905 | ProgramServicesAmt |
| Management And General | $1,825,858 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $727,834 | TotalAmt |
| Program Services | $678,004 | ProgramServicesAmt |
| Management And General | $49,830 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,084,304 | TotalAmt |
| Program Services | $2,851,300 | ProgramServicesAmt |
| Management And General | $233,004 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,927,772 | TotalAmt |
| Program Services | $1,759,339 | ProgramServicesAmt |
| Management And General | $168,433 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,888 | TotalAmt |
| Management And General | $70,888 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,886 | TotalAmt |
| Management And General | $48,886 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,440 | TotalAmt |
| Management And General | $45,440 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,118,467 | TotalAmt |
| Program Services | $7,130,308 | ProgramServicesAmt |
| Management And General | $988,159 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,938 | TotalAmt |
| Management And General | $164,938 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,197,205 | TotalAmt |
| Program Services | $859,617 | ProgramServicesAmt |
| Management And General | $337,588 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,842,137 | TotalAmt |
| Program Services | $1,461,400 | ProgramServicesAmt |
| Management And General | $380,737 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,756 | TotalAmt |
| Program Services | $48,091 | ProgramServicesAmt |
| Management And General | $14,665 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,927 | TotalAmt |
| Program Services | $117,927 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,911,044 | TotalAmt |
| Program Services | $2,662,642 | ProgramServicesAmt |
| Management And General | $248,402 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,071,167 | TotalAmt |
| Program Services | $974,517 | ProgramServicesAmt |
| Management And General | $96,650 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $12,821,002 | $12,787,170 | $33,832 |
| Service Provider Tax | $3,852,435 | $3,852,435 | |
| Dues & Subscriptions | $314,961 | $123,926 | $191,035 |
| Education | $149,833 | $138,138 | $11,695 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,683,656 | TotalAmt |
| Program Services | $63,827,194 | ProgramServicesAmt |
| Management And General | $5,856,462 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,650 | BOYAmt |
| EOY | $2,650 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,885,293 | BOYAmt |
| EOY | $11,696,982 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,151,040 | BOYAmt |
| EOY | $5,711,480 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,337,286 | BOYAmt |
| EOY | $3,360,814 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,578,154 | BOYAmt |
| EOY | $1,468,842 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $55,506,154 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $28,396,701 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,145,738 | BOYAmt |
| EOY | $27,109,453 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,634,446 | BOYAmt |
| EOY | $4,656,728 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,275,745 | BOYAmt |
| EOY | $2,561,883 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,010,352 | BOYAmt |
| EOY | $56,568,832 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,587,840 | BOYAmt |
| EOY | $6,011,506 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,250 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,922,371 | BOYAmt |
| EOY | $8,398,785 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,448,762 | BOYAmt |
| EOY | $2,743,461 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,965,223 | BOYAmt |
| EOY | $17,153,752 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,410,683 | BOYAmt |
| EOY | $34,758,352 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,261 | BOYAmt |
| EOY | $140,171 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,362,185 | BOYAmt |
| EOY | $4,516,557 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,045,129 | BOYAmt |
| EOY | $39,415,080 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,010,352 | BOYAmt |
| EOY | $56,568,832 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,652,331 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $22,282 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $31,939 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $13,501 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $45,440 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to various organizations, a portion (13,501) of which is attributable to lobbying expenses. The Hospital also engaged a law firm for 31,939 for lobbying services. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,052,157 | OtherCostOrOtherBasisAmt |
| Book Value | $1,052,157 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,984,843 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,538,510 | DepreciationAmt |
| Book Value | $19,446,333 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $680,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $311,224 | DepreciationAmt |
| Book Value | $368,928 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,849,241 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,092,208 | DepreciationAmt |
| Book Value | $5,757,033 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $939,761 | OtherCostOrOtherBasisAmt |
| Depreciation | $454,759 | DepreciationAmt |
| Book Value | $485,002 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,109,453 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial Interest in Net Assets of Copley Health Systems, Inc. | Desc |
| Book Value | $4,656,728 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,656,728 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $2,543,461 |
| Estimated Third Party Payor Settlements | $200,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,743,461 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $68,053,607 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $22,282 | OtherRevenueAmt |
| Revenue Not Reported | $22,282 | RevenueNotReportedAmt |
| Revenue Subtotal | $68,031,325 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $68,031,325 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $69,683,656 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $69,683,656 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $69,683,656 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part XI, Line 2d - Other Adjustments: | FormAndLineReferenceDesc |
| Explanation | Change in Beneficial Interest in Net Assets of Copley Health Systems, Inc. 22,282. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $372,729 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $372,729 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,997,270 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,374,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,622,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,369,999 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,374,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,995,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,558 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $126,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,558 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $126,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,540,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,419,379 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,121,203 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10210 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,129,439 | BadDebtExpenseAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.copleyvt.org | WebsiteAddressTxt |
| State License | 827 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.copleyvt.org/about-us/community-health-needs-assessment/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.copleyvt.org/about-us/community-health-needs-assessment/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.copleyvt.org/for-patients-and-visitors/billing-and-insurance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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.- 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].Additionally, Copley Hospital plans to take the following steps to address this need:- Prevention/education awareness program - through the launch of RISE VT-Lamoille due FY2019.- Evaluate options to increase transportation assistance to improve access to care.- Place Referral and Resource Specialist in emergency department; continue focus on "super-utilizers" in emergency department and Inpatient population.- Develop a standardized Fall Risk Screening tool in FY2019 for targeted populations 65+ Implementation with targeted population 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].- 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.- Training of hospital staff as patient sitters and establishment of sitter program.- Developed mental health safe room in 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) to assist with getting patients to needed mental health and behavioral health appointments.- Place referral and resource specialist in emergency department full time.- Partner with Lamoille County Mental Health on the Zero Suicide Program (screening, intervention, safe transition of care).- Provide mental health awareness education for targeted staff.- 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].- Increasing services available via telemedicine, including Pulmonology and Nephrology as of Fall 2018. Collaboration with Central Vermont Medical Center for oncology services available at Copley Hospital.- 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.- 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).- Place referral and resource specialist in emergency department full time.- 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.- Provide prevention/education awareness program through the launch of RISE VT-Lamoille due FY 2019.- Increase Workforce Wellness service area to offer tobacco cessation and chronic disease prevention/management at worksites throughout the service area. 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.Additionally, Copley Hospital plans to take the following steps to address this need:- Evaluate options for increasing transportation programs (Rural Community Transportation, others).- Place Referral and Resource Specialist in emergency department.- Mental health awareness education for hospital staff.- Evaluate ability to prescribe and/or distribute Naloxone through the emergency department.- Install a prescription drug drop-box" for people to safely dispose of unused and/or expired prescription drugs.- Implement collaboration with North Central Vermont Recovery Center Coaches program for targeted patient population in the emergency department.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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 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% of the population; Routine Cholesterol Screening = 9.8% below average, impacting 40.0%; Cancer Screen: Pap/Cerv Test 2 yr = 9.1% below average, impacting 43.8%; and OB/Gyn 1+ Visit = 11.5% below average, impacting 34.0%. |
| 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 Home Health and Hospice; long-term residential care facilities The Manor and the Greensboro Nursing Home; 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. In 2018, Copley partnered with Dartmouth Hitchcock Connected Care to return needed services to 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 provided laundry services and a dozen pillows to a grassroots warming shelter that opened in the area. All of these efforts improve transitions in care and outcomes, with a goal of improving 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 partnered with Vermont Technical College, Northern Vermont University & Lamoille's Workforce Development Group to offer an Associate Degree in Nursing program here in Lamoille County. Altogether, the hospital is working with 14 educational institutions, offering onsite clinical rotations along with 8 graduate programs in nursing, medicine and healthcare administration. The Hospital helped launch the Lamoille County Chapter of Rise Vermont, a state-wide initiative with the state's Accountable Care Organization. RiseVT is a state-wide program that supports and inspires residents to have fun, play more, eat well and feel good by amplifying and supporting efforts underway in the community. The hospital hired a coordinator that created the Lamoille Valley Stakeholders Group. In its initial year, the chapter has focused on increasing awareness of the organization in Morristown and Johnson. RiseVT-Lamoille tabled at the Music at the Oxbow events and donated snow shoes to the Johnson Town Library for residents' use, placed benches on the Lamoille Valley Rail Trail to encourage more use; and donated and fitted bike helmets for children in the area. The Chapter will announce several "Amplify Grants' for the area in FY19. The Hospital regularly promotes healthy lifestyle choices and preventative information via social media outlets, including a collaborative community blog (LiveWellLamoille.com), community newsletters, and information distributed on the hospital campus. We promote and support healthy, family-friendly activities and events to encourage healthy lifestyle choices. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Joseph Subasic MD | ||||||||||||||
| Trustee/Med. Staff President | $155,598 | $0 | $0 | $0 | $21,688 | $0 | $7,105 | $0 | $22,084 | $0 | $206,475 | $0 | $0 | $0 |
| Arthur Mathisen | ||||||||||||||
| President and CEO | $272,692 | $0 | $34,425 | $0 | $10,993 | $0 | $5,114 | $0 | $5,808 | $0 | $329,032 | $0 | $0 | $0 |
| Rassoul Rangaviz | ||||||||||||||
| CFO | $230,929 | $0 | $0 | $0 | $10,381 | $0 | $9,251 | $0 | $1,753 | $0 | $252,314 | $0 | $0 | $0 |
| Vera Jones | ||||||||||||||
| COO | $148,880 | $0 | $0 | $0 | $8,480 | $0 | $0 | $0 | $11,211 | $0 | $168,571 | $0 | $0 | $0 |
| Lori Profota | ||||||||||||||
| CNO | $171,440 | $0 | $0 | $0 | $358 | $0 | $1,395 | $0 | $23,313 | $0 | $196,506 | $0 | $0 | $0 |
| Bryan Huber MD | ||||||||||||||
| Physician | $577,256 | $0 | $39,540 | $0 | $100,194 | $0 | $10,800 | $0 | $35,820 | $0 | $763,610 | $0 | $0 | $0 |
| Brian Aros MD | ||||||||||||||
| Physician | $572,654 | $0 | $50,000 | $0 | $58,107 | $0 | $10,800 | $0 | $45,018 | $0 | $736,579 | $0 | $0 | $0 |
| Saul Trevino MD | ||||||||||||||
| Physician | $389,529 | $0 | $0 | $0 | $86,986 | $0 | $10,800 | $0 | $47,705 | $0 | $535,020 | $0 | $0 | $0 |
| John Macy MD | ||||||||||||||
| Physician | $558,796 | $0 | $35,520 | $0 | $61,653 | $0 | $10,800 | $0 | $39,401 | $0 | $706,170 | $0 | $0 | $0 |
| Joseph McLaughlin MD | ||||||||||||||
| Physician | $533,684 | $0 | $0 | $0 | $62,111 | $0 | $10,800 | $0 | $36,877 | $0 | $643,472 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 5 | Bryan Huber, Brian Aros, and John Macy, highest compensated employees, received bonuses of $39,540, $50,000, & $35,520, respectively. The bonuses were based upon the gross revenue produced individually for the Hospital. The bonus is triggered when the individual produces a certain level of revenue. The bonus is 20% of the excess revenue produced over that level. There is a cap on the amount of bonus the individual can receive. |
| Part I, Line 7 | During calendar year 2017, Arthur Mathisen, President & CEO, received a bonus of $34,425. 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| David Vinick | |||
| Family Member of Sharon Greene, Board Secretary | $106,288 | Employment | 0 |
| Diane Szlachetka | |||
| Family Member of Carl Szlachetka, Board Chair | $22,650 | Independent Contractor Arrangement | 0 |
| Katherine Marvin | |||
| Family Member of Ira Marvin, Board Trustee | $11,750 | Independent Contractor Arrangement | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 finance committee 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 Green Mountain Care Board. |
| Form 990, Part IX, line 11g | Other Fees: Program service expenses 1,983,805. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,983,805. Contract Labor: Program service expenses 2,199,310. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,199,310. Purchased Services: Program service expenses 2,947,193. Management and general expenses 988,159. Fundraising expenses 0. Total expenses 3,935,352. |
| 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. 22,282. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Health Center Building Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1Txt |
| City | Morrisville | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030220357 | EIN |
| Primary Activities | Office Building Rental | PrimaryActivitiesTxt |
| Legal Domicile State | VT | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Health Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Health Center Building | ||
| K | $208,534 | FMV |
| Copley Health Systems Inc | ||
| C | $518,568 | FMV |