2018-05-03T07:57:48-05:00 2017-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-07-01 222541478 Crotched Mountain Rehabilitation Center CROT 6035473311 1 Verney Drive Greenfield NH 03047 Scott Graff CFO 6035473311 2018-04-27 1 Barbara J McGuan CPA P00219457 2077752387 2018-04-27 69.49.157.66 2018-04-27 11:04:03 ED P 53CA451596873B86A1E24CFE6767DCEC9A681D0F 110E64D7D7C632CB204D3607306484447A51AD6C 2016 2021-01-29 14:40:06Z Michael Coughlin 1 Verney Drive Greenfield NH 03047 52796407 0 X www.cmf.org X 1985 NH The Crotched Mountain Rehabilitation Center provides education, hospital-level rehabilitation, outpatient clinics and residential programs for people with disabilities. 6 4 807 178 0 0 5431308 7804777 46475060 44991630 669 0 0 0 51907037 52796407 0 14320 0 0 36454578 36906796 0 0 0 15727576 16098930 52182154 53020046 -275117 -223639 45694490 44580329 40377235 39182679 5317255 5397650 X The mission of the Crotched Mountain Rehabilitation Center is to serve individuals with disabilities and their families, embracing personal choice and development, and building communities of mutual support. CMRC operates a residential and day school for children with special needs, a specialty rehabilitation hospital, outpatient clinics and residential programs for children and adults. 0 1 10400026 14320 7585348 Crotched Mountain Specialty Hospital provides unsurpassed medical care and comprehensive rehabilitation services to children and adults throughout the Northeast who have experienced brain injuries, spinal cord injuries and other serious medical conditions. Through compassionate care and transformative rehabilitation, Crotched Mountain renews hope and restores lives. 7633386 11651398 Crotched Mountain School offers a joyful place to learn for children ages 5-22 who have physical disabilities, developmental disabilities and/or emotional disabilities. Students in grades K-12 thrive with the individualized educational and therapeutic services they receive throughout the year. Through individualized education plans (IEPs) and supports, students are encouraged to learn and grow at their own pace and at their own level. This may include a mastery of daily living skills through a high school diploma. 18223450 20520036 Many children who attend Crotched Mountain School live on campus, in settings that nurture their personal growth, skill development, shared experiences and connections with others. We offer a variety of living arrangements - from group homes or apartment living to shared living with staff or at Crotched Mountain Specialty Hospital. Each student's individual needs are thoughtfully considered in selecting the most appropriate residential setting. 14542777 5234848 Expenses relating to the operation of an educational and rehabilitation care facility. 14542777 5234848 50799639 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 85 0 1 807 1 0 0 0 0 0 0 0 0 0 0 X 6 4 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 NH X Scott Graff 6035471500 1 Verney Drive Greenfield NH 03047 James W Varnum Past Chairman 0.50 X X 0 0 0 Benjamin F Gayman Secretary 0.50 4.50 X X 0 0 0 David H Barnes Director 0.50 4.00 X 0 0 0 Bruce King Vice Chairman 0.50 4.50 X X 0 0 0 Nancy Van Vranken MD Chairman 0.50 4.50 X X 0 0 0 Michael Coughlin President & CEO 0.50 44.00 X X 0 186538 0 James C Piet Director 0.50 4.50 X 0 0 0 Michael Redmond Chief of Strategy, Hospital & Clinical Services 0.50 40.00 X 0 164617 16812 Deborah DeCicco Assistant Secretary 0.50 44.00 X 0 48735 16030 Thomas Zubricki Past CFO & Treasurer 0.50 44.00 X 0 178790 16812 Melissa White Chief of School & Community Living 40.00 3.00 X 51154 0 0 Scott Graff Chief Financial Officer 0.50 44.00 X 0 50538 0 Christopher McCartie Director of Pediatric Care 40.00 0.00 X 143532 0 20216 Andra Hall Director of Education 40.00 0.00 X 101389 0 20216 Dr Frederick Bruch Chief Medical Officer 40.00 0.50 X 288002 0 0 584077 629218 90086 3 0 1 1 Readylink Inc PO Box 1047 Thousand Palms CA 92276 RN Services 446880 Dartmouth-Hitchcock 1 Medical Center Drive Lebanon NH 03756 Medical - Doctors 288002 Palmer College of Chiropractic 1000 Brady Street Davenport IA 52803 Medical - Doctors 187500 Luis Loaiza 31 Jowders Cove Road Rindge NH 03461 ISO Provider 120276 Mauricio Vivas 2 Dunster Hill Road Greenville NH 03048 ISO Provider 120276 7 7702254 102523 7804777 Room & Board 621400 20189140 20189140 Tuition 621400 12513544 12513544 Other Revenue 621400 9165521 9165521 Special Services 621400 3632766 3632766 Contractual/Charity Adj./Bad Debt 621400 -509341 -509341 44991630 52796407 44991630 0 0 14320 14320 51154 51154 29308250 28625897 682353 5399897 5260920 138977 2147495 2092789 54706 3482705 3362320 120385 57277 50340 6937 3028575 2955544 73031 487 428 59 393252 371398 21854 13918 13701 217 1339087 1108704 230383 85409 85058 351 18812 17879 933 1241353 1071115 170238 2390961 1929184 461777 631536 504965 126571 Supplies 2631849 2585857 45992 Nursing Home Tax 390590 390590 Miscellaneous 205431 198067 7364 Auto Expense 187688 160563 27125 53020046 50799639 2220407 0 X 877874 1553786 1037142 1039721 10034855 10202400 415614 305414 204821 93609 79835285 54040204 27202670 25795081 5921514 5590318 45694490 44580329 4114690 4525657 25291952 24497398 4312715 4342195 6657878 5817429 40377235 39182679 X -602105 -190514 4776359 4445163 1143001 1143001 5317255 5397650 45694490 44580329 X -223639 304034 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2466 2466 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which is attributable to lobbying. 3308233 3308233 62233640 41586810 20646830 11545199 9995056 1550143 2748213 2458338 289875 25795081 Interest in Net Assets of Crotched Mountain Foundation 5588164 Security Deposits 2154 5590318 Fair Value of Interest Rate Swap 1006189 Due to Affiliate 4811240 5817429 53100441 635230 635230 52465211 331196 331196 52796407 53020046 0 53020046 0 53020046 Part XI, Line 2d - Other Adjustments: Change in Fair Value of Interest Rate Swap 635,230. Part XI, Line 4b - Other Adjustments: Change in Interest in Net Assets of Crotched Mountain Foundation 331,196. 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 Schedule E, Part I, Line 3 Racial Non-Discriminatory Policy is stated in all promotional materials used for solicitation and registration. Schedule E, Part I, Line 6 Crotched Mountain Rehabilitation Center receives Medicare and Medicaid payments. 1 1 1 X 0 0 0 1 1 756349 756349 0.01430 756349 756349 0.01430 151156 151156 0.00290 48328 48328 0.00090 14320 14320 0.00030 213804 213804 0.00410 970153 970153 0.01840 1 1126 X 0 1 1 Crotched Mountain Rehabilitation Center 1 Verney Drive Greenfield NH 03047 00299 X Skilled Nursing Facility Crotched Mountain Rehab Center 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X http://monadnockcommunityhospital.com/pdf/community-matters/CHNA_2015.pdf 1 15 1 http://monadnockcommunityhospital.com/pdf/MonadnockCommunityHospitalImpleme 0 1 X 200.000000000000 X X X X X 1 1 X X X 1 X 1 X 0 X 0 X X 0 0 Crotched Mountain Rehab Center Part V, Section B, Line 5: The objective of the Leadership Group was to engage a broad cross-section of the community that could reasonably represent the very diverse consumers who comprise the service area. An expansive and highly diverse group of individuals was reached out to, to participate in the CHNA leadership team and to contribute insight from community service organizaitons. Each member provided project insight, feedback regarding perceptions of area health needs, data evaluation, and other guidance during the CHNA process. These individuals had a breadth of community health vision, knowledge, and power to impact the well-being of the service area. Crotched Mountain Rehab Center Part V, Section B, Line 6a: The Organization Community Health Needs Assessment was conducted with Monadnock Community Hospital. Crotched Mountain Rehab Center Part V, Section B, Line 11: Since the most recent Community Health Need Assessment was conducted in conjunction with Monadnock Community Hospital, none of the needs identified in the Community Health Needs Assessment related to the Organization's operations and, therefore, have not been addressed by the Organization but rather by Monadnock Community Hospital. Part I, Line 7: Cost accounting system is used to calculate costs. Part III, Line 4: Management provides for probable uncollectible amounts through a charge to earnings and a credit to a valuation allowance based on historical account write-off patterns by payors. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to accounts receivable. Part VI, Line 2: Crotched Mountain's community benefits plan is based, in part, upon a collaborative needs assessment which was conducted by a committee representing several healthcare charitable trusts throughout the Monadnock region of New Hampshire. Additionally, we conducted a series of disability related needs assessments associated with CMRC's three key operations which are the Brain Injury Center, the Children's Specialty Hospital and Crotched Mountain School. Part VI, Line 3: Crotched Mountain actively meets with each person who indicates they have no insurance or will have difficulty with paying their obligations, to inform and work with them to understand what local programs are available to them. Part VI, Line 4: As a specialty hospital and rehabilitation center for children and adults with disabilities, we recognize two distinct communities of need and service. First, CMRC serves the community of people with disabilities and their families throughout New Hampshire and other states through three key operations. Crotched Mountain School serves students with disabilities from all over the country. The Crotched Mountain Specialty Hospital serves children and adults with brain injuries, strokes, spinal cord injuries, other neurological impairments and injuries and other serious health conditions from New Hampshire and other states. Third, CMRC also serves the State and local Monadnock community through multiple specialty Outpatient Clinics that focus on people with disabilities. Part VI, Line 6: See page 2 of Form 990 Part VI, Line 7, Reports Filed With States NH X X X X X 0 0 0 0 0 0 0 0 0 Michael Coughlin President & CEO 0 186538 0 0 0 0 0 0 0 0 0 186538 0 0 Michael Redmond Chief of Strategy, Hospital & Clinic 0 164617 0 0 0 0 0 0 0 16812 0 181429 0 0 Thomas Zubricki Past CFO & Treasurer 0 178790 0 0 0 0 0 0 0 16812 0 195602 0 0 Christopher McCartie Director of Pediatric Care 143532 0 0 0 0 0 0 0 20216 0 163748 0 0 0 Dr Frederick Bruch Chief Medical Officer 288002 0 0 0 0 0 0 0 0 0 288002 0 0 0 Related Organization: Explanation: All officer's compensation reported as paid by a related organization was paid by Crotched Mountain Foundation. Form 990, Page 8, Part VII, Question 5 Dr. Frederick Bruch is compensated by Dartmouth-Hitchcock. The Organization pays a fee to Dartmouth-Hitchcock for Dr. Bruch's services, this fee is included as Dr. Bruch's wages. A New Hampshire Health and Education Facilities Authority 020279866 644614QL6 2010-11-30 30000000 Pay off existing bond 0 0 0 A 5502602 30000000 443878 29556122 2011 1 0 1 1 A 0 0 0 0 0 0 1 A 1 1 1 TD Bank NA 25.000000000000 0 0 0 0 1 A 0 Form 990, Part III, line 3 During the year ended June 30, 2017, as a result of continued losses, the Center's Board of Directors approved the closure of its Brain Injury Unit specialty hospital, resulting in the termination of the Organization's involvement in the business. Form 990, Part VI, Section A, line 2 Benjamin Gayman and David Barnes have a business relationship. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Organization's President and Senior Managers. A complete copy is provided to the Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c An Annual Disclosure statement is requested by the Secretary of the Board of Directors. The Secretary follows up with all the Board members to ensure the form is submitted. Conflicts of interest, if any, are then published in the local papers. The public is able to comment on disclosures that they are aware of but that may not have not been included in the publication. Form 990, Part VI, Section B, line 15 The Organization's CEO and other officers are compensated by the parent Organization, Crotched Mountain Foundation. There is no compensation review conducted by the filing organization; however, Crotched Mountain Foundation's Board of Directors approve the CEO's compensation annually. They request information from compensation consultants and review other market data. For other officers, and key employees, the human resource director reviews market data in order to set salary ranges. The HR director and the CEO determine compensation. 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: Crotched Mountain Rehabilitation Center 1 Verney Drive Greenfield, NH 03047 EIN: 22-2541478 Crotched Mountain Rehabilitation Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Fair Value of Interest Rate Swap 635,230. Change in Interest in Net Assets of Crotched Mountain Foundation -331,196. Crotched Mountain Foundation 1 Verney Drive Greenfield NH 03047 020222168 Rehabilitative and Residential Support NH 501(c)(3) Line 7 N/A 0 Sunnyfield Farms Inc 1 Verney Drive Greenfield NH 03047 201700093 Vocational and Social Support NH 501(c)(3) Line 12a, I Crotched Mountain Foundation 0 NH Assistive Technology Center 1 Verney Drive Greenfield NH 03047 020488042 Home Healthcare Services Delivery NH 501(c)(3) Line 7 Crotched Mountain Foundation 0 Crotched Mountain Community Care Inc 1 Verney Drive Greenfield NH 03047 020404562 Social Service NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 CMRS Inc 1 Verney Drive Greenfield NH 03047 222849875 Care Management Facility NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 CMRS II Inc 1 Verney Drive Greenfield NH 03047 222540660 Residential and Day Support NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 CMRS IV Inc 1 Verney Drive Greenfield NH 03047 223292356 Residential and Day Support NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 CMRS Whitefield Inc 1 Verney Drive Greenfield NH 03047 222540983 Residential and Day Support NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 Crotched Mountain of NY I East Greenbush Inc 1 Verney Drive Greenfield NH 03047 141785202 Residential and Day Support NH 501(c)(3) Line 10 Crotched Mountain Foundation 0 C-MAT Inc 1 Verney Drive Greenfield NH 03047 550838643 Medical Equipment Wholesaler NH Crotched Mountain Foundation C 0 CRUT Frank W Bartlett Trust C/O Debra A Green Bank of America N New York NY 10036 Perpetual Trust NH Crotched Mountain Foundation T 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0