2017-08-10T08:49:39-05:00 2016-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2015-10-01 030181058 Porter Hospital Inc PORT 8023884701 115 Porter Drive Middlebury VT 05753 Fred Kniffin President/CEO 8023884701 2017-08-09 1 Joseph R Byrne CPA P01289281 2077752387 2017-08-09 2015 2021-01-29 14:40:06Z Fred Kniffin 115 Porter Drive Middlebury VT 05753 80791903 0 X www.portermedical.org X 1925 VT Critical Access Hospital 18 15 659 80 225 -341 371053 279335 77428171 80161039 646156 -119958 -37113 84610 78408267 80405026 16536 6667 0 0 42876026 41145511 0 0 0 31955790 34354026 74848352 75506204 3559915 4898822 55578672 57191847 29082258 28990432 26496414 28201415 X The mission of Porter Medical Center and its subsidiary companies is to improve the health of our community, one patient at a time. 1 1 70359530 6667 80161039 Porter Hospital, Inc. ("Porter") operates a not-for profit critical access hospital with patient care services including emergency room, maternity and medical/surgical inpatient and outpatient care, and ancillary services including rehabilitation, laboratory testing, and diagnostic imaging services. As a critical access hospital, Porter staffs a total of 25 beds. Of the 25 beds, six beds are located in the maternity unit, and the remaining beds are located on the Medical/Surgical unit. Porter recorded approximately 6,103 inpatient days during the year. Emergency Room visits totaled 15,018 for the year. Surgeries for the year totaled 3,864. Support services for both inpatients and outpatients include but are not limited to laboratory, Diagnostic Imaging services, cardiac services, and rehabilitation facilities. Imaging includes radiology, nuclear medicine, MRI, ultrasound, and CT Scan. Porter provides free care to patients who meet certain criteria. Foregone charges furnished under Porter's Free care policy amounted to $1,438,965, with a cost of $631,916 for the fiscal year ending 9/30/16. Porter provides a number of community health outreach programs to the general public for free or at minimal charge. The programs include but are not limited to diabetes education, breast cancer screening, prenatal classes, breastfeeding classes, and CPR coerces. Porter provides clinical office space to the Open Door Clinic. Finally, Porter has partnered with local career center, as well as colleges to provided clinical exposure to their students with goals of developing future healthcare workers for the community. 70359530 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 139 0 1 659 1 0 0 0 0 0 0 0 0 0 0 X 18 15 1 0 0 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 40.00 2.00 X 323708 0 18327 Jud Bartlett Director 1.00 2.00 X 0 0 0 Sivan Cotel Director 1.00 2.00 X 0 0 0 Peter Degraff Director 1.00 2.00 X 0 0 0 Kim Downs-Burns Vice-Chair 1.00 2.00 X X 0 0 0 Richard Foote Director 1.00 2.00 X 0 0 0 Sherry Greifzu Director 1.00 2.00 X 0 0 0 Jim Keyes Director 1.00 2.00 X X 0 0 0 Michael Kiernan MD Director 40.00 2.00 X 209196 0 34257 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 MD Director 1.00 2.00 X 0 0 0 Maureen Mclaughlin Chairperson 1.00 2.00 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 Robert Thorn Director 1.00 2.00 X 0 0 0 Bill Townsend Secretary 3.00 2.00 X X 0 0 0 Jan Bark Past Director 1.00 2.00 X 0 0 0 Missy Foote Past Director 1.00 2.00 X 0 0 0 Carrie Wulfman MD Past Director 40.00 2.00 X 222007 0 32508 Lynn Boggs Past President/CEO 40.00 2.00 X X 0 181643 8418 Edwin Grant Past Director 1.00 2.00 X 0 0 0 Kenneth Perine Past Director 1.00 2.00 X 0 0 0 Benjamin Rosenberg MD Past Director 40.00 2.00 X 638855 0 12036 Patrick Norton Past Director 1.00 2.00 X 0 0 0 Ingrid Jackson Past Director 1.00 2.00 X 0 0 0 Fred Kniffin MD Interim CEO 40.00 2.00 X 212632 79989 30580 Steve Ciampa Past CFO 30.00 10.00 X 0 197253 20576 Eric Benz MD Physician 40.00 0.00 X 638271 0 38426 Daniel Huber MD Physician 40.00 0.00 X 254482 0 33219 Daniel Raabe MD Physician 40.00 0.00 X 298223 0 27800 David Turner MD Physician 40.00 0.00 X 246418 0 36251 Katherine J Wagner MD Physician 40.00 0.00 X 250473 0 35842 James Daily Former President/CEO 0.00 0.00 X 0 380963 41853 3294265 839848 370093 62 1 1 0 Medical Solutions 101 N 102nd St Suite 300 Omaha NE 68114 Temporary Labor 1151413 University of Vermont Medical Center PO Box 1902 Burlington VT 05402 Lab Services 727103 American Health Centers 100 Griffin Rd Ste C Portsmouth NH 03801 MRI Services 436746 Teknicor Healthcare USA 265 Franklin Street Suite 1702 Boston MA 02110 IT Consulting Services 398799 Marcam PO Box 60 Rochester NH 03866 Collection Services 312344 30 279335 279335 Patient Revenue 621110 156115976 156115976 Pharmacy Sales 621110 2974311 2974311 Miscellaneous Revenue 621110 2615139 2394519 225 220395 Provision for Bad Debt 621110 -2626646 -2626646 Contractual/Charity Care Adj. 621110 -78917741 -78917741 80161039 195661 195661 155668 71058 84610 84610 84610 200 315819 -315619 -315619 -315619 80405026 76966108 225 3159358 X 6667 6667 1729730 1490893 238837 30732257 28344695 2387562 1606163 1481382 124781 4875593 4496812 378781 2201768 2030715 171053 4766034 4395765 370269 85092 78481 6611 162692 150053 12639 8815759 8130870 684889 93734 86452 7282 2268358 2092130 176228 200383 184815 15568 2690265 2481261 209004 106378 98114 8264 129934 119840 10094 389138 358906 30232 2871626 2648532 223094 1177592 1086106 91486 Medical Supplies 6382877 6382877 Medicare Provider Tax 4214164 4214164 75506204 70359530 5146674 0 X 19281 22168 12097080 14449716 11022394 10463286 23804 19863 1167755 1547676 1106119 678754 51578335 31729200 20947612 19849135 4776553 5641277 3431932 3327709 986142 1192263 55578672 57191847 7586537 7533155 12609832 12002820 935474 787039 7950415 8667418 29082258 28990432 X 22544986 24442649 401814 313375 3549614 3445391 26496414 28201415 55578672 57191847 X 4898822 -135276 -3058545 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14031 14031 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 3549614 -104223 3445391 3603171 -53557 3549614 3423515 179656 3603171 3096516 326999 3423515 2968901 127615 3096516 0.00000 1.00000 0.00000 1 0 26198374 12813604 13384770 22939469 17708073 5231396 2440492 1207523 1232969 19849135 Beneficial Interest in Trusts 3327709 F 3327709 Estimated Third Party Settlements 1098085 Deferred Compensation 778056 Due to Affiliate 626219 Liability for Pension Benefits 6165058 8667418 Part V, Line 4: Income from endowments supports the Organization's mission by providing funds for charity care and additionally offsets a portion of the Organization's operating expenses. 1 1 1 X 1 X 1 1 1 0 0 631916 631916 0.00840 11977986 9103720 2874266 0.03810 12609902 9103720 3506182 0.04650 407104 407104 0.00540 6667 6667 0.00010 413771 413771 0.00550 13023673 9103720 3919953 0.05200 1 1167455 0 15944365 15329262 615103 X 1 1 1 1 Porter Hospital Inc 115 Porter Drive Middlebury VT 05753 www.portermedical.org 430030181058F01 X X X X Porter Hospital Inc 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X http://www.portermedical.org/ADDISON%20COUNTY%20needs%20update%202015.pdf X 1 14 1 http://www.portermedical.org/CHNA%20Implementation%20Report.pdf 1 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X http://portermedical.org/patient_financial_information.html X http://portermedical.org/patient_financial_information.html X X X 1 X 0 X X X 1 X 0 0 Porter Hospital, Inc. Part V, Section B, Line 5: At the outset of the original CHNA project, a number of resources were read, reviewed and/or reevaluated in order to better prepare for our interviews and position ourselves to assess and draw meaningful conclusions from our findings. Included in this review were: Porter Medical Center's Act 53 Community Needs Assessment, Healthy Vermonters 2020, The Health Disparities of Vermonters, 2012, AHEC's 2012 Snapshot of the Vermont Primary Care Workforce, and Vermont's Blueprint for Health.Interviews, information and data were collected from a variety of sources and individuals throughout our community, including information from the newly formed (2015) "Community Health Action Team" (CHAT) which is comprised of the following organizations:- Porter Hospital- Porter Practice Management- Helen Porter Healthcare & Rehabilitation Center- Counselling Service of Addison County- Addison County Home Health & Hospice- Open Door Clinic- Elderly Services- SASH- VCCI- Department of Health- Agency of Human Services- Turning Point Center- Addison Respite Care Home- United Way of Addison County- Parent Child Center- Mountain Health Center FQHC- Rainbow Pediatrics- Middlebury Family Health/Health First- Blueprint Project Manager- Blueprint Practice Facilitator- OneCare VT Porter Hospital, Inc. Part V, Section B, Line 11: Please see attached Community Health Needs Assessment & Implementation Plan. The Hospital's CHNA & Implementation Plan can also be accessed via the Hospital's website - www.portermedical.org. Porter Hospital, Inc. Part V, Section B, Line 22d: The Organization will initially bill a patient not having insurance the Organization's standard and customary gross charges. Upon knowledge that the patient may be medically indigent and require financial assistance, the Organization will initiate the process of financial counseling and assistance whereby the patient would receive an adjusted bill reflective of the financial assistance provided, i.e. a zero bill for 100% free care or discounted bill. Porter Hospital, Inc. Part V, Section B, Line 23: The Organization does bill gross charges to patients when the patient has no form of insurance. The Organization will and does provide discounts as needed to patients that are in the position of having no insurance. These discounts range from 20% to 100% of the charge depending upon financial need. 11 1 - UVMHN-PMC Orthopedics 1436 Exchange Street Middlebury VT 05753 Physician Clinic 2 - UVMHN-PMC Primary Care-Middlebury 82 Catamount Park Middlebury VT 05753 Family Physician Clinic 3 - UVMHN-PMC Primary Care-Vergennes 10 North Street Vergennes VT 05491 Family Physician Clinic 4 - UVMHN-PMC Pediatric Primary Care 1330 Exchange Street 201 Middlebury VT 05753 Physician Clinic 5 - UVMHN-PMC Primary Care-Brandon 61 Court Drive Brandon VT 05733 Family Physician Clinic 6 - UVMHN-PMC Ear Nose & Throat 1330 Exchange Street 202 Middlebury VT 05753 Physician Clinic 7 - UVMHN-PMC Primary Care-Bristol 61 Pine Street Bristol VT 05443 Physician Clinic 8 - UVMHN-PMC Cardiology 115 Porter Drive Middlebury VT 05753 Physician Clinic 9 - UVMHN-PMC Podiatry 76 Court Street Middlebury VT 05753 Physician Clinic 10 - UVMHN-PMC Women's Health 116 Porter Drive Middlebury VT 05753 Physician Clinic 11 - Porter Internal Medicine 116 Porter Drive Middlebury VT 05753 Physician Clinic Part I, Line 6a: The annual community benefit report is prepared by Porter Medical Center, the parent Company of Porter Hospital, Inc. Part I, Line 7: The Organization used a cost-to-charge ratio as its methodology for calculating amounts on Lines 7a & 7b. An actual costing methodology was used to calculate the amounts on lines 7f & 7i. Part III, Line 2: The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect for services rendered from third-party payors, patients and others. Management provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Accounts are considered delinquent and subsequently written off as uncollectible based on individual credit evaluation and specific circumstances of the account.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources 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. For receivables associates with self- pay patients (which included 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 based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rate if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. The Organization used the Medicare Cost Report to report Medicare allowable costs of care related to the payments on Schedule H, Part III, Section B. Medicare, Line 6. Part III, Line 9b: Porter Hospital, Inc. recognizes that it has a responsibility to provide care to all patients regardless of their ability to pay and make available financial assistance for those patients that have been identified as financially needy through written documentation. Information regarding financial assistance is made available upon request. Part VI, Line 2: Please see attached Community Health Needs Assessment & Implementation Plan. The Hospital's CHNA & Implementation Plan can also be accessed via the Hospital's website - www.portermedical.org. Part VI, Line 3: Porter Hospital's Financial Assistance Program is posted on the Porter Medical Center Web Site. In addition, all patients receive a brochure entitled "Important Information About your rights and responsibilities as a patient". The brochure states that the patient has the right to receive the most appropriate medical treatment available regardless of ability to pay and receive information about financial assistance. Part VI, Line 4: Porter Hospital, Inc. is the major provider of health care in Addison County, Vermont. Porter Hospital, Inc. also provides services to residents of northern Rutland County, Vermont, Essex County, New York and elsewhere in this region. Part VI, Line 5: Porter Hospital, Inc. provides rent free clinic space and vouchers for no-cost ancillary services to the local Open Door Clinic in its role as a catalyst in the delivery of health care services to its entire community.Porter Hospital, Inc. offers free and low cost community education programs on health care topics including memory loss, dementia, breast cancer screening, basic diabetes, CPR, smoking cessation, parenting, prenatal exercise and breast feeding.A majority of the governing body is comprised of persons who reside in its service area and who are neither employees nor contractors of Porter Hospital, Inc. nor family members thereof. Medical staff privileges are extended to all qualified physicians in the community.Surplus funds are invested in technology, facilities and programs. Porter Hospital and the local Career Center collaborate on a new Health Careers Education program. Part VI, Line 6: Porter Hospital, Inc. and Helen Porter Nursing Home, Inc. are wholly owned subsidiaries of Porter Medical Center. Through its subsidiaries, Porter Medical Center provides a continuum of health services including in-patient care, out-patient care, short-term rehabilitation, long-term rehabilitation, long-term care, dementia care, wellness programs and prevention programs. Part VI, Line 7, Reports Filed With States VT 1 Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 6667 FMV Use of space on Hospital Campus Operational Assistance 1 0 Part I, Line 2: Porter Hospital provides physician office space on campus as well as at one of Porter Hospital's off-site physician practice office to the Open Door Clinic. Porter Hospital provides this in-kind, non-cash assistance to further the mission of out-reach to the medically needy within the Addison County healthcare community. This support dovetails with the mission of the Blueprint for Health to stabilize chronic health conditions for the most fragile social-economic population. 0 1 0 0 0 0 0 1 0 Kristofer Anderson MD Director 323008 0 0 0 700 0 7950 0 10377 0 342035 0 0 0 Michael Kiernan MD Director 208293 0 0 0 903 0 9537 0 24720 0 243453 0 0 0 Carrie Wulfman MD Past Director 217687 0 3500 0 820 0 8771 0 23737 0 254515 0 0 0 Lynn Boggs Past President/CEO 0 155410 0 25000 0 1233 0 0 0 8418 0 190061 0 0 Benjamin Rosenberg MD Past Director 548751 0 87114 0 2990 0 7950 0 4086 0 650891 0 0 0 Fred Kniffin MD Interim CEO 211671 79989 0 0 961 0 13250 0 12954 4376 238836 84365 0 0 Steve Ciampa Past CFO 0 196385 0 0 0 868 0 6421 0 14155 0 217829 0 0 Eric Benz MD Physician 549207 0 87114 0 1950 0 7950 0 30476 0 676697 0 0 0 Daniel Huber MD Physician 250476 0 3500 0 506 0 7437 0 25782 0 287701 0 0 0 Daniel Raabe MD Physician 291233 0 0 0 6990 0 7950 0 19850 0 326023 0 0 0 David Turner MD Physician 245889 0 0 0 529 0 7632 0 28619 0 282669 0 0 0 Katherine J Wagner MD Physician 250012 0 0 0 461 0 7445 0 28397 0 286315 0 0 0 James Daily Former President/CEO 0 298774 0 0 0 82189 0 15900 0 25953 0 422816 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, Line 4b James Daily, Former President/CEO, participates in a 457(f) plan, and $79,200 was deferred on his behalf to the plan during FY 09/30/16. Part I, Line 7 Benjamin Rosenberg, M.D., and Eric Benz, M.D. received bonuses which were based on their Relative Value Units (RVU's) of services exceeding a target amount. Carrie Wulfman, M.D., and Daniel Huber, M.D. received a bonus stipend for unassigned patients at Helen Porter Nursing Home. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-08-06 12650000 Refund 2006 Series A Bonds 0 0 0 A 516488 12650000 138787 12511213 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 Remora LLC An entity more than 35% owned directly by Bill Townsend, Board Director 135480 Rental of Property 0 Form 990, Part III, line 2 In the later part of November 2015, Porter Hospital expanded its infusion services by creating an Infusion Center within the hospital. This provided a higher level of quality and an enhanced level of care to our patients. Form 990, Part III, line 3 In May 2015, Tapestry Midwifery and Addison Association of OB/GYN practices were merged to form Porter Women's Health. As a result, Porter Hospital was able to fully integrate women's health services within our community into one practice. Due to changes in provider staffing, Porter Internal Medicine closed in May 2016. The remaining providers were reallocated to another practice within Porter Hospital's practice network. Form 990, Part VI, Section A, line 2 Missy Foote and Richard Foote have a family relationship Form 990, Part VI, Section A, line 6 Porter Medical Center, Inc. is the parent holding company and sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to appoint Hospital directors Form 990, Part VI, Section A, line 7b Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to approve major hospital expenditures and approve hospital long-term borrowings. Form 990, Part VI, Section B, line 11 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 Hospital'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 IX, line 11g Purchased Services: Program service expenses 8,130,870. Management and general expenses 684,889. Fundraising expenses 0. Total expenses 8,815,759. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Porter Hospital, Inc. 115 Porter Drive Middlebury, VT 05753 EIN 03-0181058 Porter 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 Net Assets to Recognize Funded Status of Pension Plan -704,322. Change in Beneficial Interest in Perpetual Trusts -104,223. Equity Transfer to Affiliate -2,250,000. Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 11b, II N/A 0 Helen Porter Nursing Home Inc DBA Helen Porter Healthcare & Rehab Center 37 Porter Drive Middlebury VT 05753 030306549 Nursing Home VT 501(c)(3) Line 3 Porter Medical Center Inc 0 Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 11b, II Porter Medical Center Inc 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0