2018-08-13T07:33:31-05:00 2017-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-10-01 030306549 Helen Porter Nursing Home Inc HELE 8023884701 115 Porter Drive Middlebury VT 05753 Jennifer Bertrand CFO 8023884701 2018-08-10 1 Barbara J McGuan CPA P00219457 2077752387 2018-08-10 2016 2022-09-23 18:48:47Z Helen Porter Healthcare & Rehabilitation Fred Kniffin 115 Porter Drive Middlebury VT 05753 9869718 0 X www.portermedical.org X 1986 VT Operation of 105 bed skilled nursing home 18 15 244 38 0 0 124213 6921 9460791 9862116 -23332 433 0 0 9561672 9869470 0 0 0 0 8235132 8362796 0 0 0 4101129 3919923 12336261 12282719 -2774589 -2413249 3007700 2931569 6185655 6660339 -3177955 -3728770 The mission of Helen Porter Nursing and Rehabilitation is to improve the health of our community, one patient at a time. 0 0 9929104 9862116 Operated long-term community oriented 105 bed skilled nursing home. The nursing home provided services to patients that totaled 33,631 resident days during the year ended 9/30/2017. 9929104 1 0 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 1 244 1 0 0 0 0 0 0 0 0 0 0 X 18 15 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 VT X Jennifer Bertrand 8023888878 115 Porter Drive Middlebury VT 05753 Kristofer Anderson MD Director 1.00 41.00 X 0 332115 18929 Jud Bartlett Past Vice-Chair 1.00 2.00 X X 0 0 0 John Brumsted MD CEO UVM Health Network 2.00 48.00 X 0 1887039 213152 Anne Collins Director 1.00 2.00 X 0 0 0 Sivan Cotel Vice-Chair 1.00 2.00 X X 0 0 0 Peter DeGraff Director 1.00 2.00 X 0 0 0 Kim Downs-Burns Director 1.00 2.00 X 0 0 0 Richard Foote Director 1.00 2.00 X 0 0 0 Lewis Holmes MD Director 1.00 41.00 X 0 148971 6527 James Keyes Treasurer 1.00 2.00 X X 0 0 0 Stephen Koller MD Director 1.00 2.00 X 0 0 0 Linn Larson MD Director 1.00 2.00 X 0 0 0 Kate McIntosh Director 1.00 2.00 X 0 0 0 Maureen Mclaughlin Chairperson 1.00 4.00 X X 0 0 0 Cheryl Mullins Director 1.00 2.00 X 0 0 0 Linda Schiffer Director 1.00 2.00 X 0 0 0 Steve Terry Director 1.00 2.00 X 0 0 0 Bill Townsend Director 1.00 2.00 X 0 0 0 Sherry Greifzu Past Director 1.00 2.00 X 0 0 0 Michael Kiernan MD Past Director 1.00 41.00 X 0 219073 33377 Robert Thorn Past Director 1.00 2.00 X 0 0 0 Fred Kniffin MD CEO 1.00 41.00 X 0 337076 31429 Jennifer Bertrand CFO 1.00 41.00 X 0 126234 11403 Michelle Wright Director of Nursing 40.00 0.00 X 101680 0 11508 James Daily Former President/CEO 0.00 0.00 X 0 385628 0 Lynn Boggs Former President/CEO 0.00 0.00 X 0 371901 4754 Steve Ciampa Former CFO 0.00 0.00 X 0 177601 12370 101680 3985638 343449 1 1 1 0 Porter Medical Center Inc 115 Porter Drive Middlebury VT 05753 Management Services 1169714 JK Mechanical & Fabrication LLC 4665 Ethan Allen Hwy New Haven VT 05472 Fabrication Services 128879 Porter Hospital 115 Porter Drive Middlebury VT 05753 Lab/Pharmacy/Radiology/Mgt. Svcs. 110309 TLC Nursing Associates LLC 56 W Twin Oaks Terrace Suite 1 S Burlington VT 05403 Nurse Staffing 108390 4 6921 6921 Patient Revenue 623000 12628221 12628221 Other Revenue 623000 16863 12541 4322 Provision for Bad Debt 623000 -19154 -19154 Contractual Allowances 623000 -2763814 -2763814 9862116 681 681 248 -248 -248 -248 9869470 9857794 0 4755 6305040 5623993 681047 170755 152311 18444 1427526 1273330 154196 459475 409844 49631 822941 822941 43122 43122 33914 33914 189599 189599 4994 4994 14297 14297 101982 101982 2252 2252 84771 84771 357430 357430 104022 104022 Medical Supplies 1595645 1595645 Medicaid Provider Tax 516551 516551 Miscellaneous Expense 42817 42817 Dues & Subscriptions 5586 5586 12282719 9929104 2353615 0 X 49820 46784 602237 382667 927381 1157613 13445 13536 9108 15798 6265283 5046737 1371866 1218546 33843 96625 3007700 2931569 1097513 1263457 2940920 2853081 25425 29946 35157 8095 741973 741973 1344667 1763787 6185655 6660339 X -3214316 -3766108 36361 37338 -3177955 -3728770 3007700 2931569 X -2413249 1862434 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2130 2130 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 0 1 X 4862768 4158603 704165 1153977 729632 424345 248538 158502 90036 1218546 Due to Affiliates 835029 Liability for Pension Benefits 805384 Estimated Third-Party Settlements 123374 1763787 Part IV, Line 2b: The Organization holds funds belonging to residents for their personal use. The funds are made available to the residents as requested or needed. 1 1 0 0 0 0 0 0 0 Kristofer Anderson MD Director 0 321400 0 10000 0 715 0 10600 0 8329 0 351044 0 0 John Brumsted MD CEO UVM Health Network 0 1024109 0 694095 0 168835 0 186083 0 27069 0 2100191 0 0 Lewis Holmes MD Director 0 148971 0 0 0 0 0 5959 0 568 0 155498 0 0 Michael Kiernan MD Past Director 0 218170 0 0 0 903 0 9022 0 24355 0 252450 0 0 Fred Kniffin MD CEO 0 272403 0 0 0 64673 0 13250 0 18179 0 368505 0 0 James Daily Former President/CEO 0 6312 0 0 0 379316 0 0 0 0 0 385628 0 359150 Lynn Boggs Former President/CEO 0 130582 0 0 0 241319 0 0 0 4754 0 376655 0 0 Steve Ciampa Former CFO 0 143510 0 10000 0 24091 0 5381 0 6989 0 189971 0 0 Part I, Line 3 Porter Medical Center (PMC), a related organization, establishes the compensation for the Organization's CEO. Porter Medical Center uses a variety of resources to establish compensation as follows: 1. Independent compensation consultant 2. Written employment contract 3. Approval by the PMC Board Part I, Lines 4a-b Lynn Boggs, Former CEO received serverance compensation of $230,243. James Daily, former President/CEO, received a payout of $359,150 from his 457(f) deferred compensation plan. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-08-01 3100000 Refunding 2000 Series A Bonds 0 0 0 A 246919 3100000 34525 3065475 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Form 990, Part VI, Section A, line 4 Porter Medical Center and its Subsidiaries (Porter Hospital and Helen Porter Nursing Home) entered into an active parent governance relationship with the University of Vermont Health Network as of April 1, 2017. As a result of the formal affiliation with the University of Vermont Health Network, Porter Medical Center updated its governing documents to reflect the new relationship with the University of Vermont Health Network including the University of Vermont Health Network's reserve powers with Porter Medical Center. The update to the governing documents also reflects the University of Vermont Health Network as the sole member of Porter Medical Center. Form 990, Part VI, Section A, line 6 Prior to April 1, 2017, Porter Medical Center did have members; however, with the affiliation the University of Vermont Health Network became the sole member of Porter Medical Center. Form 990, Part VI, Section A, line 7a The University of Vermont Health Network, as Porter Medical Center's sole member, has reserve powers that allow the University of Vermont Health Network to refuse the acceptance of new board members appointed by the Porter Medical Center Board of Directors if The University of Vermont Health Network does not agree with the choice of appointments. As a result, the process of appointing members to the governing body is a collaboration of the Porter Medical Center Board of Directors and the University of Vermont Health Network. Form 990, Part VI, Section A, line 7b The University of Vermont Health Network has certain reserve powers that require it to approve certain decisions made the Porter Medical Center Board of Directors. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by management and the Finance committee before filing. The form 990 is also made available electronically to the Board of Directors before filing. Form 990, Part VI, Section B, line 12c The Organization's CFO and Controller are responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. When bids are solicited to include the business of a Board member, those bids are reviewed by the Board of Directors to assure adherence to the Organization's lowest bid policy. When an issue comes up to a vote and it is connected, in any way, to the business of a Board member, the member must recuse him/herself from the vote. Form 990, Part VI, Section B, line 15a The Organization's executive committee reviews comparative data prepared by a consultant prior to referral of compensation to the board of directors. The board of directors review the findings of the consultant and vote to approve the salary of the CEO. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Helen Porter Nursing Home, Inc. 115 Porter Drive Middlebury, VT 05753 EIN 03-0306549 Helen Porter Nursing Home, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Net Assets to Recognize Funded Status of Pension Plan 212,434. Equity Transfer from Affiliate 1,650,000. Form 990, Schedule A, Part I, Line 3: Reason for Public Charity Status: The Organization's exemption is based upon being classified as a hospital or cooperative hospital service organization described in 170(b)(1)(A)(iii). Since the Organization is not licensed in the state of Vermont as a hospital, but rather as a skilled nursing facility, Schedule H is not required. Porter Hospital Inc 37 Porter Drive Middlebury VT 05753 030181058 Critical Access Hospital VT 501(c)(3) Line 3 Porter Medical Center Inc 0 Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 12b, II N/A 0 Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 12b, II Porter Medical Center Inc 0 Univ of Vermont Health Network Inc 111 Colchester Ave Burlington VT 05401 452880726 Parent Organization VT 501(c)(3) Line 12a, I NA 0 Univ of Vermont Medical Group 111 Colchester Ave Burlington VT 05401 030225105 Physician Services VT 501(c)(3) Line 12a, I UVM HLTH Net 0 Univ of Vermont Med Group-New York 183 Park Street Malone NY 12953 203905216 Physician Services NY 501(c)(3) Line 3 UVMMG 0 Univ of Vermont Med CTR FDN Inc 111 Colchester Ave Burlington VT 05401 263159849 Fundraising VT 501(c)(3) Line 12a, I UVMMC 0 Univ of Vermont Medical Center 111 Colchester Ave Burlington VT 05401 030219309 Hospital VT 501(c)(3) Line 3 UVM HLTH Net 0 Central Vermont Medical Center 130 Fisher Road Berlin VT 05602 222547186 Hospital VT 501(c)(3) Line 3 UVM HLTH Net 0 Community Providers Inc 75 Beekman Street Plattsburgh NY 12901 222544844 Health Service Coordinator NY 501(c)(3) Line 12a, I UVM HLTH Net 0 Champlain Valley Phys Hospital 75 Beekman Street Plattsburgh NY 12901 141338471 Health Service Support NY 501(c)(3) Line 3 CPI 0 Elizabethtown Community Hospital 75 Park Street Elizabethtown NY 12932 141364513 Hospital NY 501(c)(3) Line 3 CPI 0 Emergency Medical Transport of CVPH Inc 75 Beekman Street Plattsburgh NY 12901 061718419 Ambulance Service NY 501(c)(3) Line 12b, II CPI 0 CVPH Medical Center Foundation 75 Beekman Street Plattsburgh NY 12901 141727048 Health Service Support NY 501(c)(3) Line 12b, II CVPH 0 University Health Center 111 Colchester Ave Burlington VT 05401 030229931 Hospital VT 501(c)(3) Line 12c, III-FI UVMMG 0 University Medical Education Associates 89 Beaumont Avenue Burlington VT 05401 237107832 Educational VT 501(c)(3) Line 10 UVMMG 0 Alice Hyde Medical Center 133 Park Street Malone NY 12953 150346515 Hospital NY 501(c)(3) Line 3 CPI 0 University of Vermont Med CTR Aux Inc 111 Colchester Ave Burlington VT 05401 208022004 Service VT 501(c)(3) Line 12c, III-FI N/A 0 Onecare Vermont ACO LLC 111 Colcester Ave Burlington VT 05401 455399218 Accountable Care VT NA Related 0 0 Adirondack ACO LLC 75 Beekman Street Plattsburgh NY 12901 462840926 Accountable Care NY NA N/A 0 0 Obnet Services LLC 1 Med Ctr Dr Lebanon NH 03766 043746287 Health Research NH UVMMC Related 0 0 UVMMC Health Ventures Inc 111 Colchester Ave Burlington VT 05401 043380045 Holding Company VT UVMMC C 0 VMC Indemnity Company LTD PO Box HM 3103 25 Church Street Hamilton HM FX BD Captive Insurance BD UVMMC C 0 Vermont Managed Care Inc 111 Colchester Ave Burlington VT 05401 030333056 Admin Services VT UVM HLTH VENT C 0 Charitable Remainder Trust (5) Support VT UVMMCCVMC T 0 Prepetural Trust (4) Support VT UVMMC T 0 Charitable Irrevocable Trust (7) Support VT CVMCUVMMC T 0 Champlain Valley Health Network 75 Beekman Street Plattsburgh NY 12901 161586102 Admin Service NY CPI C 0 Mediquest Inc PO Box 1656 Plattsburgh NY 12901 141663061 Med Office Lease NY CPI C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1