2016-08-12T08:54:48-05:00 2015-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-10-01 030181058 Porter Hospital Inc PORT 8023884701 115 Porter Drive Middlebury VT 05753 Steven T Ciampa CFO 8023884701 2016-08-11 1 Barbara J McGuan CPA P00219457 2077752387 2016-08-11 2014 2016-09-27 15:27:22Z Fred Kniffin 115 Porter Drive Middlebury VT 05753 82273159 0 X www.portermedical.org X 1925 VT Critical Access Hospital 22 17 650 70 1290 0 259816 371053 72555055 77428171 741226 646156 66732 -37113 73622829 78408267 6380 16536 0 0 41153274 42876026 0 0 0 30492521 31955790 71652175 74848352 1970654 3559915 56138406 55578672 30248033 29082258 25890373 26496414 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 0 69033448 16536 77428171 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 three beds are located in the special care unit. The remaining beds are located on the Medical/Surgical unit. Porter recorded approximately 6,357 inpatient days during the year. Emergency Room visits totaled 15,374 for the year. Surgeries for the year totaled 3,686. 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 $1,171,520 with a cost of $618,135 for the fiscal year ending 9/30/15. Porter provides a number of community health outreach programs to the general public for free or at a minimal charge. The programs include but are not limited to diabetes education, breast cancer screening, prenatal classes, breastfeeding classes and CPR courses. Porter provides clinical office space to the Open Door Clinic. Finally, Porter has partnered with a local career center, as well as colleges to provide clinical exposure to their students with goals of developing future healthcare workers for the community. 69033448 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 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 1 147 0 1 650 1 1 1 0 0 0 0 0 0 0 0 0 X 22 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 VT X Steven T Ciampa 8023884701 115 Porter Drive Middlebury VT 05753 Kristofer Anderson MD Director 43.00 2.00 X 255705 0 18179 Jan Bark Director 3.00 2.00 X 0 0 0 Jud Bartlett Director 3.00 2.00 X 0 0 0 Sivan Cotel Director 3.00 2.00 X 0 0 0 Peter DeGraff Director 3.00 2.00 X 0 0 0 Kim Downs-Burns Vice-Chair 3.00 2.00 X X 0 0 0 Missy Foote Director 3.00 2.00 X 0 0 0 Richard Foote Director 3.00 2.00 X 0 0 0 Edwin Grant Director 3.00 2.00 X 0 0 0 Ingrid Jackson Director 3.00 2.00 X 0 0 0 Michael Kiernan MD Director 43.00 2.00 X 196354 0 38470 Stephen Koller MD Director 3.00 2.00 X 0 0 0 Linn Larson MD Director 3.00 2.00 X 0 0 0 Kate McIntosh MD Director 3.00 2.00 X 0 0 0 Maureen McLaughlin Director 3.00 2.00 X 0 0 0 Patrick Norton Director 3.00 2.00 X 0 0 0 Ken Perine Director 3.00 2.00 X 0 0 0 Benjamin Rosenberg MD Director 43.00 2.00 X 469339 0 34317 Linda Schiffer Director 3.00 2.00 X 0 0 0 Steve Terry Director 3.00 2.00 X 0 0 0 Bill Townsend Chairman 5.00 4.00 X X 0 0 0 Carrie Wulfman MD Director 43.00 2.00 X 243243 0 35532 Mary Jane Broughton Past Director 3.00 2.00 X 0 0 0 Gerry Gossens Past Director 3.00 2.00 X 0 0 0 Ann Hanson Past Director 3.00 2.00 X 0 0 0 Linda Harmon Past Director 3.00 2.00 X 0 0 0 Joe Sutton Past Director 3.00 2.00 X 0 0 0 Jessica Holmes Past Secretary 3.00 2.00 X X 0 0 0 Elizabeth Markowski Past Secretary 3.00 2.00 X X 0 0 0 Lynn Boggs President/CEO 43.00 2.00 X 0 0 0 Steven T Ciampa CFO 30.00 10.00 X 0 213265 15505 James Daily Past President/CEO 43.00 2.00 X 0 393707 43259 Fred Kniffin MD Chief Medical Officer 40.00 0.00 X 291759 0 31684 Jean Cotner Past VP of Porter Practice Mgt. 40.00 0.00 X 192570 0 27001 Eric Benz MD Orthopedic Surgeon 40.00 0.00 X 477412 0 35058 Anders Holm MD MD Otolaryngology 40.00 0.00 X 360504 0 43352 Daniel Raabe MD MD Cardiology 36.00 0.00 X 380308 0 28387 David Turner MD MD OB/GYN 40.00 0.00 X 278655 0 37234 Katherine Wagner MD MD OB/GYN 40.00 0.00 X 246400 0 37833 3392249 606972 425811 61 0 1 0 Porter Medical Center 115 Porter Drive Middlebury VT 05753 Mgmt. & Admin. Services 2710040 University of Vermont Medical Center PO Box 1902 Burlington VT 05402 Lab Services 939706 Medical Solutions 101 N 102nd Street Suite 300 Omaha NE 68114 Temporary Labor 797217 American Health Centers 100 Griffin Rd Suite C Portsmouth NH 03801 MRI Services 427825 Apogee Medical Management 2525 E Camelback Rd Suite 1100 Phoenix AZ 85016 Hospitalist Labor 358706 18 25000 4502 341551 371053 Patient Revenue 621110 142248483 142248483 Miscellaneous Revenue 621110 3509111 3274176 1290 233645 Pharmacy Sales 621110 3269712 3269712 Provision for Bad Debt 621110 -3256616 -3256616 Contractual/Charity Care Adj. 621110 -68342519 -68342519 77428171 274007 274007 158671 76167 82504 82504 82504 4158924 1950 3631743 156982 527181 -155032 372149 372149 Loss on early extinguishment of d 900099 -119617 -119617 -119617 78408267 73923524 1290 4112400 X 16536 16536 1834153 1834153 32260526 29263307 2997219 1583327 1436225 147102 4919265 4462232 457033 2278755 2067043 211712 2710040 2458259 251781 273309 247917 25392 46500 42180 4320 26569 26569 8160309 7402162 758147 107027 97083 9944 2188359 1985046 203313 226080 205076 21004 2909132 2638854 270278 129737 117684 12053 322120 292193 29927 3055269 2771414 283855 1132906 1027651 105255 Medical Supplies 6621546 6621546 Medicare Provider Tax 4046887 4046887 74848352 69033448 5814904 0 X 16489 19281 11646379 12097080 12477506 11022394 27787 23804 1219291 1167755 1300287 1106119 53941409 32993797 20905488 20947612 3753886 4776553 3485489 3431932 124626 1181178 986142 56138406 55578672 8948992 7586537 13170000 12609832 1193415 935474 6935626 7950415 30248033 29082258 X 22003895 22544986 283307 401814 3603171 3549614 25890373 26496414 56138406 55578672 X 3559915 -619622 -2334252 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16178 16178 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 3603171 -53557 3549614 3423515 179656 3603171 3096516 326999 3423515 2968901 127615 3096516 3070087 -101186 2968901 0.00000 1.00000 0.00000 1 0 26126556 12234463 13892093 25313261 19632195 5681066 2501592 1127139 1374453 20947612 Beneficial Interest in Trusts 3431932 F 3431932 Estimated Third Party Settlements 1558015 Deferred Compensation 714382 Due to Affiliate 382191 Liability for Pension Benefits 5295827 7950415 75503991 -619622 76167 -543455 76047446 26569 2334252 2360821 78408267 74897950 76167 76167 74821783 26569 26569 74848352 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. Part XI, Line 2d - Other Adjustments: Rental Expenses 76,167. Part XI, Line 4b - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan 1,240,510. Change in Beneficial Interest in Perpetual Trusts 53,557. Equity Transfer to Affiliates 1,040,185. Part XII, Line 2d - Other Adjustments: Rental Expenses 76,167. 1 1 1 X 1 X 1 1 1 0 0 555651 555651 0.00740 11734335 8911881 2822454 0.03770 12289986 8911881 3378105 0.04510 381039 381039 0.00510 16536 16536 0.00020 397575 397575 0.00530 12687561 8911881 3775680 0.05040 1 1544287 0 15682969 14310691 1372278 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 www.portermedical.org X 1 14 1 www.portermedical.org 1 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X www.portermedical.org/FinancialAssistancePolicy.pdf#search=financial X www.portermedical.org/financialassistanceforms2016.pdf 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Porter Hospital, Inc. Part V, Section B, line 16a website: www.portermedical.org/FinancialAssistancePolicy.pdf#search=financial Porter Hospital, Inc. Part V, Section B, line 16b website: www.portermedical.org/financialassistanceforms2016.pdf 12 Champlian Valley Orthopedics 1436 Exchange Street Middlebury VT 05753 Physician Clinic Addison Associates in OBGYN 116 Porter Drive Middlebury VT 05753 OB/GYN Addison Family Medicine 82 Catamount Park Middlebury VT 05753 Family Physician Clinic Little City Family Practice 10 North Street Vergennes VT 05491 Family Physician Clinic Middlebury Pediatric & Adolescent Med 1330 Exchange Street 201 Middlebury VT 05753 Physician Clinic Neshobe Family Medicine 61 Court Drive Brandon VT 05733 Family Physician Clinic Porter Ear Nose & Throat 1330 Exchange Street 202 Middlebury VT 05753 Physician Clinic Bristol Internal Medicine 61 Pine Street Bristol VT 05443 Physician Clinic Porter Internal Medicine 116 Porter Drive Middlebury VT 05753 Physician Clinic Porter Cardiology 115 Porter Drive Middlebury VT 05753 Physician Clinic Tapestry Midwifery 20 Armory Lane Vergennes VT 05491 Physician Clinic Middlebury Foot Care 76 Court Street 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 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 cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost.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. 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) 6536 FMV Use of space on Hospital Campus and satellite physician practice site Operational Assistance Champlain Valley Area Health Education Centers 92 Fairfield Street St Albans VT 05478 030179440 501(c)(3) 10000 Grant provided for assistance in the recruitment and retention of providers within the Vermont Area. 2 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 255173 0 0 0 532 0 7723 0 10456 0 273884 0 0 0 Michael Kiernan MD Director 195614 0 0 0 740 0 8975 0 29495 0 234824 0 0 0 Benjamin Rosenberg MD Director 430446 0 36595 0 2298 0 7800 0 26517 0 503656 0 0 0 Carrie Wulfman MD Director 234404 0 8000 0 839 0 9855 0 25677 0 278775 0 0 0 Steven T Ciampa CFO 0 197679 0 15000 0 586 0 6221 0 9284 0 228770 0 0 James Daily Past President/CEO 0 311399 0 0 0 82308 0 15600 0 27659 0 436966 0 0 Fred Kniffin MD Chief Medical Officer 290419 0 0 0 1340 0 13000 0 18684 0 323443 0 0 0 Jean Cotner Past VP of Porter Practice Mgt. 190945 0 0 0 1625 0 5919 0 21082 0 219571 0 0 0 Eric Benz MD Orthopedic Surgeon 439318 0 36595 0 1499 0 7800 0 27258 0 512470 0 0 0 Anders Holm MD MD Otolaryngology 359710 0 0 0 794 0 10400 0 32952 0 403856 0 0 0 Daniel Raabe MD MD Cardiology 370587 0 0 0 9721 0 7800 0 20587 0 408695 0 0 0 David Turner MD MD OB/GYN 278123 0 0 0 532 0 7800 0 29434 0 315889 0 0 0 Katherine Wagner MD MD OB/GYN 245943 0 0 0 457 0 7426 0 30407 0 284233 0 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, President/CEO, participates in a 457(f) plan, and $79,200 was deferred on his behalf to the plan during FY 9/30/15. Part I, Line 7 Steven T. Ciampa, CFO received performance related compensation in the amount of $15,000. 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. also 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 40168 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 5% owned directly by Bill Townsend, Board Director 157700 Rental of Property 0 Form 990, Part III, line 2 Middlebury Foot Care was acquired by Porter Hospital on March 31, 2015. Podiatry is an essential service for patients in Addison County. Diabetic foot care is a critical element of primary care services. The availability of these services is heavily relied upon by patients and providers alike. 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 Audit 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 is 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 7,402,162. Management and general expenses 758,147. Fundraising expenses 0. Total expenses 8,160,309. 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 -1,240,510. Change in Beneficial Interest in Perpetual Trusts -53,557. Equity Transfer to Affiliate -1,040,185. 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