2018-08-13T09:13:37-05:00 2017-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-10-01 463593492 GIFFORD RETIREMENT COMMUNITY INC % JEFFREY HEBERT GIFF 8027282356 44 S MAIN STREET RANDOLPH VT 05060 DANIEL BENNETT CEO 2018-01-03 true Brian D Todd P00422601 4178658701 2016 2022-09-23 18:48:47Z DANIEL BENNETT 44 SOUTH MAIN STREET RANDOLPH VT 05060 3953306 false X WWW.GIFFORDHEALTHCARE.ORG X 2013 VT GIFFORD RETIREMENT COMMUNITY, INC. OPENED ITS NEWLY CONSTRUCTED INDEPENDENT LIVING FACILITY IN AUGUST OF 2017. 19 18 0 18 0 0 3895 181217 3417096 3765661 497 6428 0 0 3421488 3953306 0 0 0 0 2754770 3574258 0 0 12829 1751022 2234224 4505792 5808482 -1084304 -1855176 2478477 15661985 3038444 17067084 -559967 -1405099 X AS A COMMUNITY HEALTH CENTER AND MEDICAL HOME, GIFFORD'S MISSION IS TO IMPROVE AND MANAGE THE HEALTH OF THE PEOPLE WE SERVE BY PROVIDING AND ASSURING ACCESS TO AFFORDABLE, HIGH-QUALITY HEALTH CARE, AND BY PROMOTING THE HEALTH & WELL-BEING OF EVERYONE IN OUR SERVICE AREA. true false 3805458 3125499 THE MENIG NURSING HOME IS ORANGE COUNTY'S ONLY NURSING HOME FACILITY. HOME TO 30 RESIDENTS, MENIG HAS BEEN RECOGNIZED FOR NUMEROUS STATE AND NATIONAL QUALITY RECOGNITIONS AND RESIDENT SATISFACTION AWARDS. THE FACILITY OPENED IN DOWNTOWN RANDOLPH (ATTACHED TO GIFFORD) IN 1999 AND TRANSITIONED IN 2015 TO ITS NEW LOCATION IN BEAUTIFUL RANDOLPH CENTER. 1125558 602506 GIFFORD RETIREMENT COMMUNITY, INC. OPERATES TWO ADULT DAY FACILITIES TO SERVE THE NEEDS OF THE ELDERLY AND DISABLED POPULATION IN THE AREA. THE FACILITIES ARE LOCATED IN BETHEL AND BARRE, VT. 428784 37656 GIFFORD RETIREMENT COMMUNITY, INC., OPENED AN INDEPENDENT LIVING FACILITY IN AUGUST 2017. THIS FACILITY WILL AID THOSE 55 AND OVER LOOKING TO DOWNSIZE AND LIVE A MORE CAREFREE LIFESTYLE. 5359800 true true false true false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true X 0 0 0 false false false false false false false false false false X 19 18 false false true false true true false true true false false true true true true true true false false false X JEFFREY HEBERT 8027282356 P O BOX 2000 RANDOLPH VT 05060 PETER NOWLAN CHAIR END 04/17/DIRECTOR 1.0 2.0 X X 0 0 0 MATT CONSIDINE CHAIR BEG 04/17 1.0 2.0 X X 0 0 0 LINCOLN CLARK VICE CHAIR BEG 04/17 1.0 2.0 X X 0 0 0 JODY DAVIGNON TREASURER BEG 04/17 1.0 2.0 X X 0 0 0 BARBARA ROCHAT SECRETARY 1.0 2.0 X X 0 0 0 AUGUST MEYER CHAIR END 12/16/DIRECTOR 1.0 2.0 X 0 0 0 BOB WRIGHT DIRECTOR 1.0 3.0 X 0 0 0 PAUL KENDALL DIRECTOR END 03/17 1.0 2.0 X 0 0 0 TODD WINSLOW DIRECTOR 1.0 3.0 X 0 0 0 SUE SYTSMA DIRECTOR 1.0 3.0 X 0 0 0 CLAY WESTBROOK DIRECTOR 1.0 3.0 X 0 0 0 SUE SHERMAN DIRECTOR 1.0 3.0 X 0 0 0 CAROL BUSHEY DIRECTOR 1.0 3.0 X 0 0 0 SHEILA JACOBS DIRECTOR 1.0 3.0 X 0 0 0 PETER REED DIRECTOR 1.0 3.0 X 0 0 0 BERTON WHITAKER INTERIM CEO END 10/16 1.0 41.0 X X 0 160000 0 DANIEL BENNETT CEO BEGIN 10/16 1.0 41.0 X X 0 89453 6801 BRADFORD ATWOOD DIRECTOR BEG 05/17 1.0 2.0 X 0 0 0 JOAN GOLDSTEIN DIRECTOR BEG 05/17 1.0 0.0 X 0 0 0 BEN JICKLING DIRECTOR BEG 05/17 1.0 2.0 X 0 0 0 THERON MANNING DIRECTOR BEG 05/17 1.0 2.0 X 0 0 0 JEFFREY HEBERT CFO 1.0 41.0 X 0 182404 9799 JOSEPH WOODIN PRESIDENT & CEO ENDING 04/16 1.0 2.0 X 0 260404 18418 0 692261 35018 0 true true false 0 181217 181217 NET PATIENT SERVICE REVENUE 624100 3710435 3710435 CAFETERIA REVENUE 722514 15832 15832 OTHER REVENUE 900099 39394 39394 3765661 6428 6428 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3953306 3765661 6428 0 0 0 0 0 0 2652114 2474693 171421 6000 55782 52050 3606 126 612569 571589 39594 1386 253793 236815 16404 574 0 43348 43348 7372 7372 0 0 0 511334 466505 43698 1131 38845 36246 2511 88 441245 405004 35259 982 0 0 570903 532710 36901 1292 2335 2179 151 5 0 4614 4306 298 10 15912 14848 1028 36 0 107782 100571 6967 244 55300 51601 3574 125 LICENSES, DUES, SUBSCRIPTION 366989 342438 23721 830 MEDICAL SUPPLIES & DRUGS 68245 68245 5808482 5359800 435853 12829 9745 186111 139870 1171190 0 0 240905 447056 0 0 0 0 0 0 5221 5713 38227 77266 13741573 66563 1952011 13675010 0 97790 0 0 0 0 0 0 92498 1849 2478477 15661985 1733849 1415017 0 0 0 2196532 0 0 0 0 0 0 0 10804080 0 0 1304595 2651455 3038444 17067084 X -566991 -1566150 7024 161051 0 0 -559967 -1405099 2478477 15661985 X -1855176 1010044 X false true X true false X 0 0 6225 3895 181217 191337 1052308 3417096 3765661 8235065 0 0 0 0 0 1058533 3420991 3946878 8426402 0 0 0 8426402 243 497 6428 7168 0 243 497 6428 7168 0 0 0 0 1058776 3421488 3953306 8433570 X 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1380 1380 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: GIFFORD MEDICAL CENTER, INC., A RELATED ORGANIZATION, IS A MEMBER OF THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS, THE BI-STATE PRIMARY CARE ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF GIFFORD MEDICAL CENTER AND THE OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. GIFFORD MEDICAL CENTER DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. A PORTION OF THESE DUES HAVE BEEN ALLOCATED TO RELATED ORGANIZATIONS GIFFORD RETIREMENT COMMUNITY, INC. AND GIFFORD HEALTH CARE, INC. THESE ALLOCATED AMOUNTS ARE SHOWN ON THEIR RESPECTIVE SCHEDULE C. 12046111 52106 11994005 0 0 0 494420 4299 490121 1201042 10158 1190884 13675010 0 DUE TO AFFILIATES 2603333 DEFERRED LIABILITIES 48122 2651455 3795113 10714 10714 3784399 168907 168907 3953306 5808482 5808482 5808482 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D OTHER REVENUE ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ 10,714 NET ASSETS RELEASED FROM RESTRICTION SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 168,907 TEMPORARILY RESTRICTED CONTRIBUTIONS false false false false false false false false false JOSEPH WOODIN PRESIDENT & CEO ENDING 04/16 0 157274 0 40000 0 63130 0 11430 0 6988 0 278822 0 0 BERTON WHITAKER INTERIM CEO END 10/16 0 160000 0 0 0 0 0 0 0 0 0 160000 0 0 JEFFREY HEBERT CFO 0 175302 0 0 0 7102 0 9109 0 690 0 192203 0 0 SCHEDULE J, PART I, LINE 3: CEO COMPENSATION REVIEW: GIFFORD MEDICAL CENTER, INC., A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO USING THE FOLLOWING METHODS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART III, LINE 2 NEW PROGRAM SERVICES: GIFFORD RETIREMENT COMMUNITY OPENED AN INDEPENDENT LIVING FACILITY IN AUGUST 2017. FORM 990, PART V, LINE 2A W-2'S FILED: GIFFORD MEDICAL CENTER, A RELATED ORGANIZATION OF GIFFORD RETIREMENT COMMUNITY, FILES ALL W-2'S FOR THE ORGANIZATION. SALARIES, PENSION, PAYROLL TAXES, AND EMPLOYEE BENEFITS OF THOSE INDIVIDUALS ARE THEN ALLOCATED FOR THE AMOUNTS THAT REPRESENT WORK PERFORMED FOR GIFFORD RETIREMENT COMMUNITY. IN ADDITION, BERTON WHITATER AND DANIEL BENNETT SERVED AS CEO AND JEFFREY HERBET SERVED AS CFO OVER GIFFORD MEDICAL CENTER, GIFFORD HEALTH CARE, AND GIFFORD RETIREMENT COMMUNITY. THEIR COMPENSATION HAS BEEN SHOWN IN PART VII AS PAID BY GIFFORD MEDICAL CENTER ONLY, ALTHOUGH THEIR TIME SPENT IS ATTRIBUTABLE TO ALL THREE ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: DURING FISCAL YEAR 2017, GRC AMENDED ITS BYLAWS TO INCLUDE THE FOLLOWING SIGNIFICANT CHANGES: -BOARD OF TRUSTEES 4.3 COMPOSITION. THE BOARD OF GRC SHALL BE COMPOSED OF ELECTED AND EX OFFICIO TRUSTEES. (A) ELECTED TRUSTEES: THE ELECTED MEMBERS OF THE GHC BOARD OF DIRECTORS SHALL BE MEMBERS OF THE GIFFORD RETIREMENT COMMUNITY BOARD OF TRUSTEES WITH POWER TO VOTE. UP TO FIVE (5) ADDITIONAL TRUSTEES MAY BE ELECTED. (B) USER TRUSTEES: AT LEAST 51% OF THE TRUSTEES SHALL BE INDIVIDUALS WHO ARE ACTIVE USERS OF GRC OR GHC'S SERVICES AND WHO, AS A GROUP, REPRESENT THE INDIVIDUALS BEING SERVED IN TERMS OF DEMOGRAPHIC FACTORS, SUCH AS RACE, ETHNICITY, AND SEX. THESE TRUSTEES SHALL USE GHC'S AS THEIR PRINCIPAL SOURCE OF PRIMARY MEDICAL CARE SERVICES AND SHALL HAVE USED GRC'S OR GHC'S SERVICES WITHIN THE LAST TWO (2) YEARS. THESE TRUSTEES MUST LIVE IN GRC'S SERVICE AREA. A LEGAL GUARDIAN OF A USER WHO IS A DEPENDENT CHILD OR ADULT, OR A LEGAL SPONSOR OF A USER WHO IS AN IMMIGRANT, MAY BE CONSIDERED A USER FOR BOARD COMPOSITION PURPOSES. (C) NON-USER TRUSTEES: TRUSTEES WHO ARE NOT DESCRIBED IN SUBSECTION (B) (I.E., ARE NOT ACTIVE USERS OF GRC'S OR GHC'S SERVICES) SHALL BE REPRESENTATIVE OF THE COMMUNITY SERVED BY GRC AND GHC AND SHALL BE SELECTED FOR THEIR EXPERTISE IN COMMUNITY AFFAIRS, LOCAL GOVERNMENT, FINANCE AND BANKING, LEGAL AFFAIRS, TRADE UNIONS, OTHER COMMERCIAL AND INDUSTRIAL CONCERNS, OR SOCIAL AGENCIES WITHIN THE SERVICE COMMUNITY. THE TRUSTEES DESCRIBED IN THIS SUBSECTION MUST WORK OR LIVE IN GRC'S SERVICE AREA. NO MORE THAN FIFTY PERCENT (50%) OF THE NON-USER TRUSTEES DESCRIBED IN THIS SUBSECTION MAY BE INDIVIDUALS WHO DERIVE MORE THAN TEN PERCENT (10%) OF THEIR ANNUAL INCOME FROM THE HEALTH CARE INDUSTRY. (D) PERSONS PROHIBITED FROM SERVING AS TRUSTEES. EXCEPT AS PROVIDED IN SUBSECTION (E) (EX OFFICIO TRUSTEES), NO EMPLOYEE OF GRC OR GHC MAY SERVE AS A TRUSTEE. (E) EX OFFICIO TRUSTEES: THE FOLLOWING TWO (2) INDIVIDUALS SHALL SERVE AS TRUSTEES EX OFFICIO WITH THE POWER TO VOTE: I. THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION II. THE ADMINISTRATOR OF GIFFORD RETIREMENT COMMUNITY FORM 990, PART VI, SECTION A, LINES 6 & 7A ORGANIZATION'S MEMBERS: GIFFORD HEALTH CARE, INC. (GHC) MUST CONSTITUTE THE MAJORITY OF THE MEMBERS OF GIFFORD RETIREMENT COMMUNITY, INC. (GRC) BOARD. THE GHC DIRECTORS ELECT THE MEMBERS OF THE GRC BOARD. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FIRST REVIEWS THE FORM 990. THEN THE FULL BOARD OF TRUSTEES REVIEWS THE COMPLETE FORM 990 AT ONE OF THE BOARD MEETINGS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: GIFFORD RETIREMENT COMMUNITY, INC. REQUIRES BOARD MEMBERS TO COMPLETE A YEARLY CONFLICT OF INTEREST SURVEY. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY DIRECTOR SHALL BE DISCLOSED TO THE OTHER BOARD MEMBERS. ANY DIRECTOR HAVING DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE PRESENT FOR DISCUSSION OF THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE AND THAT THE DIRECTOR ABSTAINED FROM VOTING AND DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15A CEO COMPENSATION REVIEW: GIFFORD MEDICAL CENTER, A RELATED ORGANIZATION, USES A BOARD COMPENSATION COMMITTEE WITH INPUT AND DATA FROM A VARIETY OF INDEPENDENT SOURCES. THE EVALUATION AND RECOMMENDATION IS THEN PRESENTED TO THAT BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 15B OTHER OFFICER & KEY EMPLOYEE COMPENSATION REVIEW: TO EVALUATE THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES, THE COMPENSATION REVIEW IS ADMINISTERED BY HUMAN RESOURCES AND THE CEO. THE HUMAN RESOURCES DEPARTMENT HAS SOME INTERNAL AND EXTERNAL SOURCES THAT ARE UTILIZED TO COMPARE COMPENSATION AMOUNTS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE, ANOTHER'S WEBSITE AND UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 1,010,044 TRANSFERS FROM AFFILIATES GIFFORD HEALTH CARE INC 44 SOUTH MAIN STREET RANDOLPH VT 05060 460938716 FQHC/PARENT VT 501(C)(3) 10 NA false GIFFORD MEDICAL CENTER INC 44 SOUTH MAIN STREET RANDOLPH VT 05060 030179418 HOSPITAL VT 501(C)(3) 3 GHC false false false false false true false false false false false true false false true false true false false true