2016-08-15T11:49:00-05:00 2015-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-10-01 030107300 Brattleboro Memorial Hospital BRAT 8022570341 17 Belmont Avenue Brattleboro VT 05301 Michael Rogers Vice President of Finance 8022570341 2016-08-08 1 Barbara J McGuan CPA P00219457 2077752387 2016-08-08 2014 2016-09-27 15:27:22Z Steven Gordon 17 Belmont Avenue Brattleboro VT 05301 90506055 0 X http://www.bmhvt.org X 1904 VT To provide health care services on a region-wide basis 10 8 653 124 0 0 6867870 2905897 74140837 77449697 679553 503890 -255779 -207714 81432481 80651770 32700 20475 0 0 39064697 41323441 0 0 0 33628892 35191616 72726289 76535532 8706192 4116238 75049525 78825149 22823903 22974245 52225622 55850904 X Brattleboro Memorial Hospital will provide community-based quality health services delivered with compassion and respect. 0 0 58387121 20475 73926829 Provision of Hospital Care, both inpatient and outpatient services, on a region-wide basis. Approximately 167,503 outpatients and 1,922 inpatients were served throughout the year.Brattleboro Memorial Hospital is a modern, well-equipped and professionally staffed community hospital which has been serving greater Brattleboro and the tri-state area since 1904. Throughout our more than a century of caring for our community, BMH has kept up with medical technology which, in turn, has drawn excellent physicians to our facility. The BMH Medical Staff boasts more than 100 board-certified physicians, active in both primary care and many specialties. 1760000 3522868 Charity Care:The Hospital's charity care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. Before completing an application for charity care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veteran's Benefits or other governmental or public assistance programs. The Hospital's qualifications for charity care are as follows:1) Charity care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by the charity care program.2) Patient's family income must be at or below 300% of the current Federal Poverty Income Guidelines for their applicable family size.The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the estimated cost of those services and supplies and equivalent service statistics. The following information measures the levels of the charity care provided during the year ended September 30, 2015:Equivalent percentage of charity care services to all services 2.30%Number of patients receiving charity care 8,347In addition, the Hospital also incurred payment shortfalls in the treatment of Medicare and Medicaid patients. Both of these government programs reimburse for medical services at less than published charges to provide those services. In 2015, the Hospital incurred shortfalls of approximately $8,158,930 and $9,242,483 related to treating Medicare and Medicaid patients, respectively.The Hospital also provided many other community benefits upon which no monetary value can be placed such as:-BMH provides space at no cost to the local non-profit Brattleboro Walk-in Clinic.-Promotes wellness through screening and demonstrations at our annual Health Fair.-Offers free smoking cessation classes.-Collaborates with other community agencies in publishing a community wellnes calenday twice a year. 60147121 1 1 0 1 0 0 0 0 0 0 1 0 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 1 0 0 0 0 0 0 1 0 0 0 1 106 0 1 653 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Michael Rogers 8022570341 17 Belmont Avenue Brattleboro VT 05301 John M Meyer Past Board Member 1.00 1.00 X 0 0 0 Jill Zachary Board Vice Chair 1.00 1.00 X X 0 0 0 Ben Taggard Past Board Member 1.00 1.00 X 0 0 0 Burton D Tepfer MD Board Member 5.70 1.00 X 24500 0 0 Peter Carvell Board Chair 1.00 1.00 X X 0 0 0 Deborah Boyle Board Member 1.00 1.00 X 0 0 0 Stephen Phillips Board Member 1.00 1.00 X 0 0 0 Patty O'Donnell Board Secretary 1.00 1.00 X X 0 0 0 George Idelkope MD Board Member 18.90 1.00 X 93070 0 0 Donna McElligott Board Member 1.00 1.00 X 0 0 0 William Daley Board Member 1.00 1.00 X 0 0 0 Michael Mandraccia Board Member 1.00 1.00 X 0 0 0 Steven Gordon President & CEO 40.00 2.00 X 0 349270 39583 Michael Rogers VP Finance, Treasurer & CFO 40.00 2.00 X 0 221887 45486 Mary Urquhart VP Patient Care Services 40.00 0.00 X 0 177869 21963 Bonnie McKellar VP Physician Service 40.00 0.00 X 0 181353 27678 Kathleen Mcgraw Chief Medical Officer 42.00 0.00 X 280830 0 38725 Thomas H Lewis MD General Surgeon 42.00 0.00 X 349307 0 50776 Robert M Burke MD Cardiologist 48.00 0.00 X 345625 0 46395 William A Wood MD Otolaryngologist 41.00 0.00 X 334568 0 42131 Elizabeth A McLarney MD Orthopedics 42.00 0.00 X 580911 0 36469 Jonathan C Thatcher MD Orthopedics 42.00 0.00 X 317412 0 18908 2326223 930379 368114 50 0 1 0 Dartmouth Hitchcock Keene 590 Court Street Keene NH 03431 ER Provider Staffing 2017753 Southern VT Health Services Corp 17 Belmont Avenue Brattleboro VT 05301 Management Fees 1637000 Anesthesia Physicians of Brattleboro 17 Belmont Avenue Brattleboro VT 05301 Medical Services 780000 Diversified Clinical Services PO Box 636981 Cincinnati OH 452636981 Wound Care Services 646074 Brattleboro Retreat 75 Linden Street Brattleboro VT 05301 Community Health Team Services 435167 24 571478 1146589 1187830 2905897 Patient Service Revenue 621400 153068996 153068996 Meaningful Use Revenue 900099 954777 954777 Miscellaneous Revenue 900099 754855 433892 320963 Provision for Bad Debt 621400 -4437076 -4437076 Contractual/Char. Adj. 621400 -72891855 -72891855 77449697 322548 322548 239533 447247 -207714 -207714 -207714 9588380 9406753 285 181627 -285 181342 181342 80651770 77128734 0 617139 X 20475 20475 437125 437125 32704565 26034180 6670385 1007516 804497 203019 5714419 4825129 889290 1459816 1165657 294159 1637000 277000 1360000 46577 46577 69629 69629 62390 62390 9852996 8207332 1645664 91712 22947 68765 1000081 635646 364435 1688484 431985 1256499 172425 116484 55941 232157 150702 81455 4266138 2769309 1496829 918507 339428 579079 Provider Taxes 4312811 4312811 Drugs 4070779 4070779 Medical/Surgical Suppli 3661586 3659731 1855 Lab Supplies 1286804 1280484 6320 1821540 585420 1236120 76535532 60147121 16388411 0 X 2400992 2647794 3731996 4287038 4718175 960000 6333462 5654890 2356444 2070515 315022 339093 63689453 36394996 28236324 27294457 25749604 31468354 371696 779379 101642 94828 734168 3228801 75049525 78825149 9025798 10038390 103080 8990000 8535000 3248 4701777 4400855 22823903 22974245 X 51771652 54987985 174989 584748 278981 278171 52225622 55850904 75049525 78825149 X 4116238 -846901 355945 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16669 16669 0 Part II-B, Line 1: BMH is a member of the VT Association of Hospitals and Health Systems and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of BMH and other member organizations in furtherance of their exempt purposes. BMH does not directly perform any lobbying activities. 45499 45499 39138520 20095745 19042775 22189769 14861081 7328688 2315665 1438170 877495 27294457 Estimated Third-Party Payor Settlements 3744093 Interest Rate Swap 656762 4400855 80098424 -846901 355945 -490956 80589380 62390 62390 80651770 76473142 0 76473142 62390 62390 76535532 Part XI, Line 2d - Other Adjustments: Unrealized Loss on Interest Rate Swap -51,738. Change in Interest in SVHSC 407,683. 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 1565555 1565555 0.02050 17518468 8275985 9242483 0.12080 19084023 8275985 10808038 0.14130 1172379 1002990 169389 0.00220 35475 35475 0.00050 1207854 1002990 204864 0.00270 20291877 9278975 11012902 0.14400 1 2216759 554190 17035158 25194088 -8158930 X 1 1 1 1 Brattleboro Memorial Hospital Inc 17 Belmont Ave Brattleboro VT 05301 www.bmhvt.org 840 X X X Community Hospital Brattleboro Memorial Hospital 1 0 0 1 X X X X X X X X X 12 1 1 0 1 X www.bmhvt.org/services/community-health-team/community-health-needs- X 1 12 1 www.bmhvt.org/services/community-health-team/community-health-needs- 0 0 1 X 250.000000000000 350.000000000000 X 1 1 X X X 1 X http://www.bmhvt.org X X X 1 X 0 X X X X 1 X X 0 0 Brattleboro Memorial Hospital Part V, Section B, Line 5: A Steering Committee was formed that represented a cross section of diverse community organizations and members that represented various community populations and age groups. Group forums, Steering Communitee meetings and various surveys were conducted during the time period from October 2011 and ending September 2012. The Needs Assessment was approved by the Board in December 2012. Brattleboro Memorial Hospital Part V, Section B, Line 6a: The Hospital's CHNA was conducted in partnership with Grace Cottage Hospital and The Brattleboro Retreat. Brattleboro Memorial Hospital Part V, Section B, Line 11: As a result of collecting comprehensive data using both quantitative and qualitative research methods with the participating health care organizations, Brattleboro Memorial Hospital identified the following goals:Improve the following health indicators of the community:1. Diabetes2. Obesity3. Support the expansion of health care services for seniors4. Improve community awareness of existing health and wellness programs and services5. Support the expansion of affordable dental care6. Improve mental health services in the community which includes improving community awareness and protocols for suicide prevention7. Provide community education about proactive strategies focusing on the prevention of Lyme diseaseDiabetes:Objective: Decrease the prevalence of Type II Diabetes and mitigate the long-term effects for those with Type I DiabetesObjective: Decrease the prevalence of Type II Diabetes from 5% to 3% which is the state-wide goal by 2015.Actions:1. BMH will offer a program on Type II Diabetes in 2013 for Wellness in Windham Health Education Calendar.2. Community Health Team RN Care Coordinator and Health Coach will work aggressively to mitigate the long-term effects of Type I Diabetes and intervene to decrease the incidence of Type II Diabetes with those at risk.3. BMH's current RN CDE will become part of the Blueprint Community Health Team in 2013.4. BMH will partner with the YMCA of Greater Burlington and the Department of Vermont Health Access (DVHA) to offer the YMCA Diabetes Prevention Program in Windham County in 2013.5. Cross-train current chronic disease self-management program leaders in the Diabetes Selfmanagement program supported by DVHA.Obesity:Objective: Decrease the rate of obesity in Windham County from 23% to 20% (State-wide goal is 15%).Actions:1. BMH Registered Dietician will partner with community organizations to assist them with starting a teen Taking Off Pounds Sensibly (TOPS) Program.2. BMH will continue to offer TOPS Program for adults.3. CHT will offer classes for patients for management of chronic diseases including diabetes.4.CHT Health Coach will continue to work aggressively with patient referrals to address obesity and diabetes through diet and exercise.5. CHT Health Coach will continue to partner with Brattleboro Food Co-op to offer healthy cooking classes to parents and their children.6. Cross-train current Chronic Pain/Healthier Living Workshop leaders to lead Diabetes Self-Management program.Support the expansion of health care services for seniors:Objective: Strengthen Home and Community-based Services for Seniors.Actions:1. The Community Health Team will collaborate with Support and Services At Home (SASH) wellness nurse and program coordinator to provide proactive wellness care to Seniors and the disabled living in Brattleboro Housing Authority residences or at home.2. Maintain Medical Director for Post Acute Services to enhance primary care of patients at skilled nursing facilities. This position has the following responsibilities:- Serve as Medical Director at the Skilled Nursing Facilities to meet the terms of the facility contract with Brattleboro Memorial Hospital.- Primary clinical care of patients at Skilled Nursing Facilities with which BMH has a contractual agreement (Pine Heights, Thompson House and Vernon Green Nursing Home).- Liaison with BMH ER physicians and Hospitalists on Post Acute care coordination.- Scheduling work assignments and holiday rotation for coverage of the Post Acute practice.- Regular meetings with each SNF administrator, director of nursing and other key decision makers in the SNF to achieve medical care goals.- Oversight of visit capture and coding service clinical encounters to ensure all necessary or required services are billed in compliance with applicable rules and regulations.- Oversee the quality of the Post Acute team including: Complaint investigation and follow-up, re-admission rates analysis, SNF quality initiatives, and Chart and Case reviews.- Arrange in a reasonable and timely manner for follow-up treatment of patients evaluated or treated by physician where such follow-up treatment is medically indicated.- Prepare and cause to be maintained in a timely fashion all necessary medical records for patients treated by physician.- Supervise the clinical performance of non-physician clinical staff such as nurses and nurse practitioners, if any.- Attend hospital monthly medical staff meetings, departmental and committee meetings and other meetings as requested by the hospital or required by the medical staff by-laws.- Provide the foregoing services at the physician's assigned location as mutually determined by the hospital and the physician.3. Continue to evaluate efficacy of BMH Delirium management protocols (BMH Care Management).4. Decrease the rate of reported ER falls admissions by 5% by 2015.5. CHT will work with Blueprint SASH Wellness Coordinator and Wellness Nurse at SASH to educate patients at risk for falling.6. BMH will offer Standing Tall Spine Health Class (Level 1 and 2) (ongoing 2013-2015).7. BMH will partner with Senior Solutions to offer research based program "A Matter of Balance" Fall Prevention Program to community members.Improve community awareness of existing health and wellness programs and services:Objective: Improve utilization of existing Health and Wellness services.Actions:1. Maintain an up-to-date Wellness in Windham Health Education Calendar of BMH and Wellness in Windham website (2013-2015).2. Offer community programming on 2-1-1 in partnership with Blueprint RN Care Coordinator's Community Resource Guide.3. Increase attendance at Wellness in Windham Health Festival (2013-2015).Action: Feature 2-1-1 program at Wellness in Windham Health Festival.Support the expansion of affordable dental care:Objective: Enhance opportunities for dental care for the underserved populations.Actions:1. Explore deeper partnerships with United Way to improve opportunities for dental care among the underserved populations (2013-2015).2. Continue supporting the free clinic offering preventative and restorative dental care (2013-2015).3. Engage Windham Co. dental practices in a formal discussion about how to improve access to affordable dental care (2013-2015)Improve mental health in the community (Collaborate with Grace Cottage Hospital and The Brattleboro Retreat)Objective: Decrease completed suicide rate in Windham County by 10% by 2015.Actions:1. Partner with Center for Health and Learning to provide UMatter Youth Suicide Prevention workshop twice annually in the Wellness in Windham Health Education Calendar.2. Provide suicide risk training for health professionals, offering CME's for MD's and contact hours for nurses.3. Continue to evaluate efficacy and ongoing updates of BMH's care management protocols for suicide 1:1 patient monitoring.4. Collaborate with community agencies to develop strategies to decrease the rates of alcohol, tobacco and other drug use as reported in the Vermont High School Youth Risk Behavior Survey.5. Collaborate with school educators and school nurses to elevate awareness about youth suicide prevention strategies6. Collaborate with school educators and school nurses to develop strategies to decrease the rates of alcohol, tobacco and other drug use as reported in the Vermont High School Youth Risk Behavior Survey. Continuation of Part V, Section B, Line 11: Improve community awareness about methods to prevent the acquisition of Lyme disease:Objective: Provide community education about Lyme diseaseActions:1. Provide two community seminars on Lyme disease prevention strategies through the Wellness in Windham Health Education Calendar in 2013-2015.2. Provide community education about Lyme disease prevention strategies at the Wellness in Windham Health Festival.Several needs emerged in the research findings that the participating health care organizations cannot fully address at this time. These unmet needs are as follows: Hepatitis C prevention, improved transportation, violence prevention and poverty reduction.The hospital is not addressing Hepatitis C prevention at this time due to other priority health care conditions being selected to focus on for the upcoming three-year period.While the hospital is not currently adressing the needs for improved transportation, violence prevention and poverty reduction they are supporting several community initiatives aimed at addressing these needs. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Brattleboro Memorial Hospital Part V, Section B, line 16a website: http://www.bmhvt.org Part I, Line 3c: Brattleboro Memorial Hospital's Free Care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. When making application for Free Care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veterans' Benefits or other governmental or public assistance programs. Free Care should always be the payor of last resort.A. Qualifications for Free Care:1. Free Care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by Free Care;2. Patients' family income must be at or below 250% of the current Federal Poverty Income Guidelines for their family size;3. Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate;4. Free Care applications will be processed within two weeks of the date of their receipt in our Business Office;5. Free Care applies only to those patient accounts still in active Accounts Receivable; no Free Care allowance may be applied against accounts that have been forwarded to a collection agency as Bad Debt.B. Patients will be notified in writing of their approval or denial status within 30 days of the date of receipt of the application and any required supporting documentation. All accounts written off to Free Care must be approved by the Director of Patient Financial Services or the Vice-President of Finance. Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. Part II, Community Building Activities: 1.Health Fair 2.Director of the Community Health Team participates in community coalitions such as Fit & Health Kid's Coalition, Healthier Communities Coalition. The HCC coalition, of which the Director of the Community Health Team, is a member, has been instrumental in advocating for healthy nutrition, exercise, food security, Farm to School programming & advocating for improving the built environment & town policies to support health & wellness. Many of the health improvement needs identified by & advocated for by the coalition have been incorporated into the new town plan for Brattleboro. The HCC was recognized for its success & effectiveness. The HCC has conducted Community Healthier Living Index (CHLI) assessments at Green Street School and at BMH. This YMCA tool measures community organization support for physical activity & health eating. Mini grant money will be used to implement strategies for improvements in the areas of health nutrition and exercise. 3.Our Director of Nutrition Services supports local agriculture & has been recognized for BMH's level of support. 550 BMH employees benefit from local foods & healthy choices on our breakfast, lunch & dinner menus daily. Part III, Line 3: A simple RCC was utilized to reduce charges to cost. The estimated bad debt that may be eligible for our charity care policy was based on a 25% eligibility rate. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. 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 patient accounts receivable.In evaluating the collectibility 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, if necessary. For receivables associated with self-pay patients (which include 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 rates 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.During 2015, the Hospital increased its estimate from $4,769,579 to $5,266,350 in the allowance for doubtful accounts relating to self-pay patients and during 2014 the Hospital increased its estimate from $4,050,526 to $4,769,579 in the allowance for doubtful accounts relating to self-pay patients. During 2015, self-pay write-offs increased from $3,767,572 to $4,069,764 and during 2014 self-pay write-offs decreased from $3,889,453 to $3,767,572. The changes resulted from trends experienced in the collection of amounts from self-pay patients. Part III, Line 8: The Medicare shortfall should be considered a community benefit in its entirety. A cost-to-charge ratio was used. Part III, Line 9b: Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate. Part VI, Line 2: BMH conducted the December 2012 Community Health Needs Assessment. The needs assessment addressed health and wellness in Windham County, inclusive of lifestyle, access to care, maternal & child health, illness & death, and injury. Methodology included data analysis, on-line surveys, survey questionnaire distribution at public events, various focus groups, provider surveys and 7 formal Steering Committee meetings. Highest priority issues about healthcare & healthcare access were identified.Evaluations were given to all participants of the Community Health Needs Assessment. Participants are asked what health & wellness topics they would like to have presented. Each participant developed an implementation plan. These responses are compiled & prioritized. The committee for the calendar uses these priority requests to plan content of future calendars. Part VI, Line 4: BMH serves a total service area that includes:- 22 towns- A population of 59,000- Compared to VT/US, residents of the service area tend to be: a. Older b. Similarly well off, especially in the secondary service area c. Less at risk for obesityThe 65+ population will be the fastest growing segment, while the 0-17 and 18-44 age cohorts drop. VT is the second oldest state in the country (after Maine). Median age in the PSA & SSA is higher than Vermont overall & significantly higher than the US median. Brattleboro area employers, like Vermont employers generally, are small in size. The 3 largest employers are: C&S Wholesale, Entergy VT, and BMH. 11,474 people commute to Brattleboro to work. The unemployment rate for Windham County as of April 2012 was 5.7%. The VT Department of Health publishes a comprehensive Health Status Report every 5 years. The most recent report is dated 2008. County data is compared to goals for VT. The indicators for Windham County for 2008 identified the following areas of concern:1. Access to health care - residents without a usual doctor; lack of health insurance2. Breast, Colon and Cervical Cancer screening rates are worse than in Vermont or less than the healthy Vermonter goal. 3. Rates of Injury in Windham County were higher than Vermont in all age groups except 0-9 year olds. 0 The Strolling of the Heifers Inc 105 Partridge Road Dummerston VT 05346 020638820 501(c)(3) 6000 FMV Event promotions 1 0 Part I, Line 2: The Organization makes contributions to small community events and no monitoring is deemed necessary. X X X X X 0 0 0 0 0 1 1 1 0 Steven Gordon President & CEO 0 307714 0 25000 0 16556 0 13650 0 25933 0 388853 0 0 Michael Rogers VP Finance, Treasurer & CFO 0 189627 0 20000 0 12260 0 16396 0 29090 0 267373 0 0 Mary Urquhart VP Patient Care Services 0 176837 0 0 0 1032 0 9027 0 12936 0 199832 0 0 Bonnie McKellar VP Physician Service 0 169769 0 10000 0 1584 0 2449 0 25229 0 209031 0 0 Kathleen Mcgraw Chief Medical Officer 265278 0 15000 0 552 0 0 0 38725 0 319555 0 0 0 Thomas H Lewis MD General Surgeon 347275 0 1000 0 1032 0 13650 0 37126 0 400083 0 0 0 Robert M Burke MD Cardiologist 344593 0 0 0 1032 0 10400 0 35995 0 392020 0 0 0 William A Wood MD Otolaryngologist 334208 0 0 0 360 0 4333 0 37798 0 376699 0 0 0 Elizabeth A McLarney MD Orthopedics 304355 0 276096 0 460 0 0 0 36469 0 617380 0 0 0 Jonathan C Thatcher MD Orthopedics 312404 0 3688 0 1320 0 0 0 18908 0 336320 0 0 0 Part I, Line 6 Bonuses paid in calendar year 2014 are mostly contractual however the net earnings are a minor consideration in the senior leadership bonus amounts. Part I, Line 7 Bonus payments made to Elizabeth McLarney, Jonathan Thatcher & Thomas Lewis are quantative bonuses based in part on worked Relative Value Units (RVUs) performed in excess of baseline expectations. A Vermont Educational and Health Building Financing Agency 237154467 924166BQ3 2008-02-01 11180000 Advance refund of previously issued bonds 0 0 0 A 2645000 11180000 145933 11034067 2008 1 0 1 1 A 0 0 0 0 0 0 1 A 1 1 1 Duetsche Bank 15.000000000000 0 0 0 0 0 A 1 JoAnne Rogers Family Member of Michael Rogers, VP of Finance, Treasurer & CFO 40290 Employment 0 Judith McBean Family Member of Donna McElligott, Board Member 288897 Employment 0 Form 990, Part VI, Section A, line 6 The sole member of the Hospital shall be Southern Vermont Health Services Corporation, a Vermont not-for-profit corporation. Form 990, Part VI, Section A, line 7a The Board of Directors of the Hospital shall consist of eleven persons elected by Southern Vermont Health Service Corporation (sole member) from among membership of the sole member, plus the President and Medical Staff President ex officio but without the power to vote. Directors shall be elected annually by the sole member to hold office for three years and until their successors have been elected and qualified or until thier death or resignation. Elected directors may serve for a maximum of three consective three-year terms. Form 990, Part VI, Section A, line 7b The Board of Directors may not take any of the following actions without the prior approval of Southern Vermont Health Service Corporation (sole member): a) Adopt any annual or long-term capital or operating budget of the Hospital; b) Authorize the Hospital to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operating budget of the Hospital approved by the sole member, where the amount involved exceeds an amount as determined from time to time by the sole member; c) Authorize the Hospital to transfer funds or other assets to any other organization or corporation, where the amount involved exceeds an amount as determined from time to time by the sole member; d) Authorized the Hospital to engage in, or enter into, any transaction involving the borrowing of funds, incurring of debt, and/or guaranteeing, pledging, or collateralizing of any of its assets in connection therewith; e) Adopt any new, or any changes to the existing, long-range or master plans or the Hospital; or f) Organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the Hospital. Form 990, Part VI, Section B, line 11 The role of the Hospital's Audit Committee includes review of the 990. The Audit Committee engages the auditors and receives the audit and a complete copy of the Form 990, including all schedules. The Audit Committee will report to the Board that the 990 review has occurred. The Board accepts the the Audit Committee reports and the 990. All members of the Board will have access to the 990 prior to filing. Form 990, Part VI, Section B, line 12c Each December, Board Members are required to complete a Conflict of Interest Statement. Beginning FY 2010, these statements were reviewed by outside counsel and reported back to the Board of Directors along with recommendations for action. Form 990, Part VI, Section B, line 15 The Executive Compensation Committe (ECC) of the Board of Directors (BOD) engages an outside compensation consultant to review executive compensation policies, procedures and conduct an independent regional and national market survey for senior leadership positions. The ECC sets the CEO's compensation and reviews the CEO's recommendations for other senior leadership compensation. The actions of the ECC are reviewed and approved by the BOD. Form 990, Part VI, Section C, line 19 Financial statements are published on our website. Our governing documents and conflict of interest policies are not made available to the public. Form 990, Part IX, line 11g Contract Services & Consultant: Program service expenses 6,402,632. Management and general expenses 1,146,797. Fundraising expenses 0. Total expenses 7,549,429. Contract Temp.: Program service expenses 442,080. Management and general expenses 4,620. Fundraising expenses 0. Total expenses 446,700. Service Contracts: Program service expenses 1,362,620. Management and general expenses 494,247. Fundraising expenses 0. Total expenses 1,856,867. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Brattleboro Memorial Hospital 17 Belmont Avenue Brattleboro, VT 05301 EIN: 03-0107300 Brattleboro Memorial Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Loss on Interest Rate Swap -51,738. Change in Interest in SVHSC 407,683. Southern Vermont Health Services Corp 17 Belmont Ave Brattleboro VT 05301 222564588 Provide Health Management Services VT 501(c)(3) Line 7 N/A 0 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0