2016-08-11T13:50:33-05:00 2015-09-30 020476956 TYLER SIMMS & ST SAUVEUR CPA PC 19 MORGAN DRIVE LEBANON NH 03766 990 2014-10-01 030183721 WINDSOR HOSPITAL CORPORATION WIND 8026746711 289 COUNTY ROAD WINDSOR VT 05089 DAVID SANVILLE CFO 8026746711 2016-08-11 1 W JAY SIMMS P00435321 6036530044 2016-08-10 2014 2016-09-27 15:27:22Z MTASCUTNEY HOSPITAL & HEALTH CENTER DAVID SANVILLE 289 COUNTY ROAD WINDSOR VT 05089 50103723 0 X MTASCUTNEYHOSPITAL.ORG X 1933 VT TO IMPROVE THE LIVES OF THOSE WE SERVE. OUR ACTIVITIES INCLUDE PROVIDING HEALTHCARE. 15 9 547 66 0 0 843257 2069750 47889922 47311078 474482 411240 175682 137949 49383343 49930017 0 0 0 0 28621744 28788615 0 0 257735 20562857 20334771 49184601 49123386 198742 806631 39743107 45798892 23412407 27255744 16330700 18543148 X MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER'S MISSION IS TO IMPROVE THE LIVES OF THOSE WE SERVE. 0 0 39899428 47380731 MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) OPERATES A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHICH PROVIDES PRIMARY AND SECONDARY HEALTH CARE. MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, CLAREMONT, WOODSTOCK, HARTLAND, SPRINGFIELD, AND BROWNSVILLE. THE HOSPITAL PROVIDES ESSENTIAL HEALTHCARE SERVICES INCLUDING EMERGENCY DEPARTMENT, MED/SURG INPATIENT, AND ANCILLARY DIAGNOSTIC TESTS, IMAGING/RADIOLOGY PROCEDURES, AND WELLNESS/PREVENTION SERVICES. MAHHC STAFFS A TOTAL OF 25 ACUTE MED/SURG BEDS AND 10 ACUTE REHABILITATION BEDS. DURING THE YEAR, THERE WERE 847 INPATIENT DISCHARGES, 1,548 OUTPATIENT SURGERIES, 64,915 OUTPATIENT LAB TESTS, AND 13,037 OUTPATIENT IMAGINING PROCEDURES. MAHHC IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING THE PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE AND PEDIATRICS IN WINDSOR AND WOODSTOCK. MAHHC PROVIDES FREE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. FOREGONE CHARGES FURNISHED UNDER MAHHC'S FREE CARE POLICY AMOUNTED TO $765,163 IN FY15. 39899428 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 66 0 1 547 1 0 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID SANVILLE 8026746711 289 COUNTY ROAD WINDSOR VT 05089 NANCY LOUX PAST-CHAIR (TERMED 1/15) 1.00 1.00 X X 0 0 0 SHELLEY SEWARD CHAIR 1.00 X X 0 0 0 HAROLD PYKE PAST- SECRETARY (TERMED 1/15) 1.00 0.50 X X 0 0 0 JOHN GILMAN TRUSTEE 1.00 0.50 X 0 0 0 MICHAEL NEWBOLD TRUSTEE 1.00 0.50 X 0 0 0 LYNN PETERSON MD TRUSTEE 1.00 X 0 0 0 HON DONNA SWEANEY SECRETARY 1.00 X X 0 0 0 STEVEN SMITH MD TRUSTEE 1.00 0.50 X 13308 163120 104187 DONNA VANFLEET VICE-CHAIR 1.00 X X 0 0 0 MARY JOYCE MD TRUSTEE (TERMED 1/15) 1.00 X 174662 0 19233 WILLIAM PALMER TRUSTEE 1.00 0.50 X 0 187453 173269 VINCENT FUSCA III DH REPRESENTATIVE 1.00 1.00 X 0 308695 22751 PATTY O'NEILL TREASURER 1.00 X X 0 0 0 DEANNA S HOWARD DH REPRESENTATIVE 1.00 X 0 251597 83169 MATTHEW S HOUDE DH REPRESENTATIVE 1.00 X 0 120519 28057 STEVEN D SURGENOR MD DH REPRESENTATIVE 1.00 X 0 427981 74908 ALAN KEILLER DH REPRESENTATIVE 1.00 X 0 0 0 JOHN TANSEY TRUSTEE 1.00 0.50 X 0 0 0 KEVIN DONOVAN CEO 40.00 1.00 X 6700 297261 50536 DAVID SANVILLE CFO 32.00 0.50 X 195090 0 0 JILL LORD CNO 40.00 X 159139 0 668 PETER RAUERT PHYSICIAN 40.00 X 306451 0 20053 CATHERINE SCHNEIDER CMO 40.00 X 259832 0 9383 CHRISTOPHER CONNOR MD OPTHALMOLOGIST 40.00 X 347090 0 10698 JOSEPH PERRAS PHYSICIAN 40.00 X 239706 0 24366 GERALD DRABYN MD PLASTIC SURGEON 40.00 X 274965 0 24366 1976943 1756626 645644 38 0 1 1 DARTMOUTH HITCHCOCK ONE MEDICAL CENTER DRIVE LEBANON NH 03756 PROFESSIONAL AND PHYSICIAN SERVICES 2446415 EMERGENCY SERVICES OF NEW ENGLAND PO BOX 12 CHESTER VT 05143 PHYSICIAN ASST FOR EMERGENCY ROOM 1355334 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 152516170 MNGMT & SUPPORT STAFF - ENVMMNTL SRVS 713336 DESTEFANO ARCHITECTS PLLC 23 HIGH STREET PORTSMOUTH NH 03801 ARCHITECTS FOR RENOVATION PROJECT 293349 AMERICAN HEALTH CENTERS INC 100 GRIFFIN ROAD SUITE C PORTSMOUTH NH 03801 MRI TRUCK SERVICE 200185 5 55000 665794 1348956 37842 2069750 PATIENT SERVICES 621110 83434612 83434612 PROGRAM & MISC OTHER 621110 1796562 1796562 DSH/VAHHS REVENUE 621110 376571 376571 PROVISION FOR DOUBTFUL ACCOUNTS 621110 -1493754 -1493754 CONTRACTUAL ALLOWANCES 621110 -36802913 -36802913 47311078 331524 331524 36647 0 36647 36647 36647 234266 0 154550 234266 -154550 79716 79716 50805 19156 31649 31649 EQUITY IN INCOME OF SUBSIDIARIES 621110 69653 69653 69653 49930017 47380731 0 479536 614923 249240 365683 22564409 19421003 2988042 155364 40430 34418 5741 271 3918865 3340186 552253 26426 1649988 1404635 234298 11055 64650 11170 53394 86 37241 37241 95507 9114 77055 9338 95340 41875 52249 1216 811961 173298 634608 4055 594228 566824 27404 81001 53948 26613 440 446591 446591 2844369 2844369 696770 493812 201042 1916 CONTRACTED LABOR 3938402 3408046 530356 PROFESSIONAL/CONSULTING 3452567 1894355 1542636 15576 SUPPLIES 3243526 3094928 135244 13354 DUES/FEES/TAXES 2261445 1905872 352982 2591 1671173 505744 1149382 16047 49123386 39899428 8966223 257735 2641381 2667684 170685 171112 614124 1293424 6972186 5602572 541316 469956 127828 275918 43066995 24586564 11549112 18480431 12862626 12645892 2035677 1885626 2228172 2306277 39743107 45798892 4419248 4881986 8047149 7796357 1417893 4267740 9528117 10309661 23412407 27255744 X 9213629 11126913 1196080 1638019 5920991 5778216 16330700 18543148 39743107 45798892 X 806631 -842870 2248687 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14375 14375 0 PART II-B, LINE 1: THE HOSPITAL PAID $12,173 IN THE FORM OF DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (VAHHS). VAHHS IS A MEMBER-OWNED ORGANIZATION DEVOTED TO IMPROVING THE HEALTH STATUS OF COMMUNITIES THROUGHOUT VERMONT THROUGH ACTIVITIES WHICH INCLUDE ADVOCACY, POLICY DEVELOPMENT, EDUCATION AND RESEARCH. THE HOSPITAL ALSO PAID $2,202 IN THE FORM OF DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA). 4759330 -30485 296865 4431980 4645093 312380 198143 4759330 4536888 298805 190600 4645093 4362400 174488 4536888 4443457 -81057 4362400 0.95180 0.04820 0 0 410000 410000 15938331 7466551 8471780 14363518 11538263 2825255 12355146 5581750 6773396 18480431 DEFERRED FINANCING COST, NET 25975 RENTAL DEPOSITS 5560 EQUITY IN SUBSIDIARY 2179527 OTHER RECEIVABLES 95215 2306277 OTHER CURRENT LIABILITIES 850110 EST. SETTLEMENTS W/ 3RD PARTY PAYORS 2436064 POST RETIREMENT BENEFIT OBLIGATION 6778813 INTEREST RATE SWAP 244674 10309661 X 48252107 -842870 -816955 -1659825 49911932 37241 -19156 18085 49930017 49105302 19157 19157 49086145 37241 37241 49123386 PART V, LINE 4: IN GENERAL, THE AMOUNT OF THE ORIGINAL GIFT AND ANY REQUIRED ACCUMULATIONS BY THE DONOR ARE NOT EXPENDABLE. HOWEVER, THE MARKET VALUE OF THE FUND MAY FALL BELOW THAT AMOUNT DEPENDING ON CURRENT FINANCIAL CONDITIONS IN THE UNDERLYING INVESTMENTS. UNDER THE POLICY OF THE HOSPITAL, THE ENDOWMENT ASSETS ARE INVESTED MODERATELY WITH THE INTENT OF PROVIDING A PREDICTABLE STREAM OF FUNDING TO THE HOSPITAL. THE HOSPITAL INVESTS IN EQUITY FUNDS, BOND FUNDS AND MONEY MARKET INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN LIMITED RISK CONSTRAINTS. ACTUAL RETURNS IN ANY YEAR MAY VARY FROM BUDGETED AMOUNTS DUE TO MARKET FLUCTUATIONS. PART X, LINE 2: ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ADDRESSES THE ACCOUNTING UNCERTAINTY OF INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF "MORE-LIKELY-THAN-NOT" FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON MEASUREMENT CLASSIFICATION, INTEREST AND PENALTIES AND DISCLOSURE. THE ORGANIZATION HAS DETERMINED THAT THE PROVISIONS OF SUBTOPIC 740-10 DO NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATIONS FOR FISCAL YEARS PRIOR TO 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE ON INTEREST RATE SWAP 120,150. CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST-RETIREMENT PLANS -937,105. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -19,156. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1. FUNDRAISING EXPENSES 19,156. GOLF TOURNAMENT 50805 50805 833 6578 7628 4117 50805 50805 833 6578 7628 4117 19156 31649 1 1 1 X 225.000000000000 1 X 1 1 1 0 1 1 393325 393325 0.00800 7268935 3070915 4198020 0.08550 7662260 3070915 4591345 0.09350 215283 215283 0.00440 58939 58939 0.00120 15041602 9132051 5909551 0.12030 8410 8410 0.00020 15324234 9132051 6192183 0.12610 22986494 12202966 10783528 0.21960 1 765163 20393235 20180456 212779 X 1 1 1 1 WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 X X X X DISTINCT PART REHAB UNIT WINDSOR HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X 14 1 1 0 1 X HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/COMMUNITY-SERVICES/COMMUNITY-RESOURCES/CO X X 1 14 1 WWW.MTASCUTNEYHOSPITAL.ORG 0 0 1 X 225.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/ X 1 0 X X 1 X 0 0 WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 5: METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH DIRECT MAIL AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE MT. ASCUTNEY HOSPITAL SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. AT THE BEGINNING OF THE SURVEY, RESPONDENTS WERE ASKED TO INDICATE THE REGION THEY PRIMARILY SERVE OR ARE MOST FAMILIAR WITH. A TOTAL OF 33 KEY STAKEHOLDER RESPONDENTS INDICATED THAT THEIR RESPONSES WERE REFLECTIVE OF THE GREATER WINDSOR SERVICE AREA. RESPONDENTS REPRESENTED THE FOLLOWING SECTORS: HUMAN SERVICE/SOCIAL SERVICE 21% MENTAL /BEHAVIORAL HEALTH 3% HOME HEALTH CARE 6% PRIMARY HEALTH CARE 12% MEDICAL SUBSPECIALTY 6% PUBLIC SAFETY/FIRE 3% EMERGENCY MEDICAL SERVICES 3% EDUCATION/YOUTH SERVICES 6% MUNICIPAL/COUNTY GOVERNMENT 6% COMMUNITY MEMBER/VOLUNTEER 6% WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 6A: OTHER FACILITIES WERE DARTMOUTH HITCHCOCK MEDICAL CENTER, ALICE PECK DAY MEMORIAL HOSPITAL, NEW LONDON HOSPITAL AND VALLEY REGIONAL HOSPITAL. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 7D: A BENEFIT REPORT WAS PREPARED AND MADE AVAILABLE AND DISTRIBUTED THROUGH 5 COMMUNITY PRESENTATIONS, CONDUCTED BY THE COMMUNITY BENEFIT STAFF, AS WELL AS A THOROUGH PRESENTATION MADE TO THE HOSPITAL'S BOARD OF TRUSTEES. THE MT. ASCUTNEY COMMUNITY HEALTH FOUNDATION AND COMMITTEE, AS WELL AS THE WINDSOR AREA COMMUNITY PARTNERSHIP, PARTICIPATED IN THE DISTRIBUTION OF THE REPORT. THE CHNA AND ALL INFORMATION IN THE NEEDS ASSESSMENT IS AVAILABLE FOR STAKEHOLDERS. THE CHNA IS ALSO AVAILABLE VIA PAPER COPY FOR PUBLIC INSPECTION UPON REQUEST AT THE HOSPITAL'S MAIN INFORMATION DESK. IT IS ALSO AVAILABLE PROMINENTLY ON THE HOSPITAL'S OPENING/HOME WEBPAGE. WWW.MTASCUTNEYHOSPITAL.ORG. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 11: COMMUNITY HEALTH ISSUES HAVE BEEN DETERMINED TO BE THE FOLLOWING 11 HEALTH NEEDS:1) ISSUE: ALCOHOL AND DRUG MISUSE INCLUDING HEROIN AND MISUSE OF PAIN MEDICATIONS. MAHHC ACTIONS: WORK WITH HOSPITAL MEDICAL STAFF TO: A) DEVELOP PROTOCOL/SKILL TRAINING FOR WITHDRAWAL FROM CHRONIC LONG-TERM OPIOIDS B) DEVELOP PROTOCOL FOR PATIENTS IN RECOVERY WHO HAVE PLANNED SURGERY, TRAUMA OR GENERAL ISSUES THAT WILL REQUIRE OPIOIDS OR PAIN CONTROL REGIME C) CREATE AN INTERDISCIPLINARY TEAM APPROACH IN THE PROVISION OF ALTERNATIVE SERVICES FOR PATIENTS WITH CHRONIC PAIN, PROMOTE A CLEAR PATHWAY FOR QUICKER ACCESS TO INDIVIDUALIZED TREATMENT AND RECOVERY, IMPLEMENT A MEDICATION ASSISTED THERAPY PROGRAM FOR ADDICTED MOMS OF THE PEDIATRIC PRACTICE, PROVIDE CHRONIC PAIN WORKSHOPS FOR SELF-MANAGEMENT SKILLS IN CONJUNCTION WITH RECOVERY SERVICES, ADDRESS THE SOCIAL DETERMINANTS OF HEALTH (HOUSING, EMPLOYMENT, TRANSPORTATION, ETC.) THROUGH INTERAGENCY CARE MANAGEMENT, SUPPORT COUNTY-WIDE MEDICATION DISPOSAL AND INCINERATION PRACTICES, UTILIZE MEDIA OUTLETS TO PROMOTE: A) PARTY SAFE (HOLIDAYS, GRADUATION, PROM) B) TEXT-A-TIP UNDERAGE DRINKING PARTY CAMPAIGN C) APRIL AS ALCOHOL AWARENESS MONTH, RECOGNIZE LOCAL RETAILERS WHO PASS DEPARTMENT OF LIQUOR CONTROL COMPLIANCE CHECKS, WORK WITH LOCAL STORES TO DECREASE ALCOHOL ADVERTISING, DIRECT EDUCATION AND SUPPORT EDUCATION IN THE SCHOOLS ON SUBSTANCE ABUSE.2) ISSUE: ACCESS TO MENTAL HEALTH CARE. MAHHC ACTIONS: SUPPORT AND ASSIST IN INTEGRATION OF NEW PSYCHIATRIST IN PATIENT CENTERED MEDICAL HOME, REVISE/REDISTRIBUTE BROCHURE OF LOCAL MENTAL HEALTH COUNSELORS, INCLUDE TARGET POPULATION AND INSURANCES ACCEPTED - PRINT AND ONLINE, PROVIDE REGULAR WRAP PROGRAMS IN OUR COMMUNITY.3) ISSUE: ACCESS TO DENTAL CARE. MAHHC ACTIONS: PROVIDE DENTAL CLINIC IN THE SCHOOL FOR DENTAL EDUCATION, DENTAL SCREENING AND SEALANT APPLICATION, HOSPITAL-EMPLOYED PEDIATRICIANS ARE PROVIDING ORAL HEALTH EDUCATION, ORAL RISK ASSESSMENT AND FLUORIDE APPLICATION, DENTAL VOUCHER PROGRAM FOR THOSE IN PARTICULAR DENTAL CRISIS AND WITH NO ABILITY TO PAY4) ISSUE: ACCESS TO ENOUGH AND AFFORDABLE HEALTH INSURANCE; COST OF PRESCRIPTION DRUGS. MAHHC ACTIONS: HOSPITAL DEPARTMENT (WCHC) ASSISTS PATIENTS TO APPLY FOR HEALTH INSURANCE FOR WHICH THEY ARE ELIGIBLE, MEDICATION VOUCHER PROGRAM FOR THOSE PATIENTS IN PARTICULAR PHARMACEUTICAL CRISIS AND WITH NO ABILITY TO PAY, WORK WITH SENIORS TO UNDERSTAND MEDICARE, EXPLORE OPTIONS AND OPPORTUNITIES TO HELP THE UNDERINSURED POPULATIONS WITH HIGH DEDUCTIBLES TO ACCESS CARE.5) ISSUE: NUTRITION/ACCESS TO AFFORDABLE HEALTHY FOOD. MAHHC ACTIONS: ESTABLISH A FOOD DISTRIBUTION SITE IN WINDSOR WORKING WITH WILLING HANDS AND THE FOOD BANK, ESTABLISH A DONATION DRIVE NETWORK OF AGENCIES THAT COULD PROVIDE FOOD IN TIMES OF HIGH NEED, WORK WITH LOCAL FARMERS TO CREATE OPTIONS FOR FOOD PURCHASING SYSTEM, LOCALLY.6) ISSUE: LACK OF PHYSICAL ACTIVITY; NEED FOR RECREATIONAL OPPORTUNITIES, ACTIVE LIVING. MAHHC ACTIONS: PARTNER WITH HEALTHY COMMUNITY DESIGN EFFORTS, PARTNER WITH HOSPITAL PEDIATRIC PRACTICE WITH OUTREACH TO PATIENTS AND FAMILIES REGARDING EXERCISE OPTIONS, IE: STATE PARK PRESCRIPTIONS, LOCAL ADVENTURE QUEST PROGRAM7) ISSUE: INCOME, POVERTY AND FAMILY STRESS. MAHHC ACTIONS: PATCH, AT WCRC, WILL SUPPORT THE PRESENCE OF A REFERRAL TO ECONOMIC SERVICES, MENTAL HEALTH SERVICES, EMPLOYMENT SERVICES FOR THE COMMUNITY, PEDIATRICS TO OFFER FAMILY SUPPORT PROGRAM8) ISSUE: ACCESS TO TRANSPORTATION. MAHHC ACTIONS: HOSPITAL DEPARTMENT (WCHC) ADMINISTER A TRANSPORTATION VOUCHER PROGRAM FOR RIDES TO MEDICAL CARE, SUPPORT RECRUITMENT AND USE OF VOLUNTEER DRIVERS, REPRESENT WINDSOR IS REGIONAL TRANSPORTATION COALITION9) ISSUE: ACCESS TO PRIMARY HEALTH CARE. MAHHC ACTIONS: RESTRUCTURE CLINIC TO ALLOW OPTIMIZED CAPACITY THROUGH TEAM BASED CARE MODEL, SCHEDULE FOR SAME DAY ACCESS, IMPLEMENT TEAM-BASED CARE MODEL AS PATIENT CENTERED MEDICAL HOME, USE GCAHPS SCORES TO ASSESS EFFECTIVENESS OF ACCESS TO CARE10) ISSUE: HEALTH CARE FOR SENIORS. MAHHC ACTIONS: IMPLEMENT GERIATRIC WORKFORCE ENHANCEMENT PROGRAM (GWEP), WORK WITH SENIOR SOLUTIONS FOR OUTREACH11) ISSUE: TOBACCO USE/SMOKING. MAHHC ACTIONS: PROVIDE INDIVIDUAL AND GROUP CESSATION PROGRAMS, WORK WITH LOCAL STORES TO DECREASE TOBACCO ADVERTISING, PROVIDE COMMUNITY EDUCATION ABOUT THE IMPACT OF VAPING, PROMOTE MODEL TOWN ORDINANCES THAT RESTRICT USE OF ADULT -ONLY SUBSTANCE USE AT PUBLIC EVENTS. WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 22D: THE HOSPITAL PROVIDES A DISCOUNT RANGING FROM 20%-100% FOR FAP-ELIGIBLE INDIVIDUALS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY WINDSOR HOSPITAL CORPORATION PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/ PART I, LINE 7: PART I, LINE 7. A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. A COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENTS SEGMENTS. A COST-TO-CHARGE RATIO WAS USED. PART I, LINE 7G: PART I, LINE 7G. PHYSICIAN CLINIC COSTS INCLUDED WITHIN SUBSIDIZED HEALTH SERVICES ARE $5,909,551 OF THE TOTAL COMMUNITY BENEFIT EXPENSES AND $9,132,051 OF THE DIRECT OFFSETTING REVENUE. PART III, LINE 4: 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 STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE PROVISION FOR DOUBTFUL ACCOUNTS AND A CREDIT TO ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR DOUBTFUL ACCOUNTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR DOUBTFUL ACCOUNTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR DOUBTFUL ACCOUNTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACTUAL WRITE-OFFS ARE CHARGED AGAINST THE PROVISION FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: PART III, LINE 8. THE SHORTFALL REPRESENTS THE PPS REIMBURSEMENT DIFFERENCE ON THE REHAB UNITS. SINCE THE REIMBURSEMENT DOES NOT COVER THE COSTS OF THESE UNITS, A SUBSIDY IS CREATED. BECAUSE THE HOSPITAL DETERMINED THAT THESE SERVICES ARE IMPORTANT TO OUR SERVICE AREA, THE HOSPITAL COVERS THE SUBSIDY. THE COSTING METHODOLOGY USED ABOVE WAS THE COST TO CHARGE RATIO. PART III, LINE 9B: PART III, LINE 9B. MAHHC'S COLLECTION POLICY AND CHARITABLE CARE POLICIES ARE CONSISTENTLY APPLIED TO ALL PATIENTS. OUR COLLECTION POLICY APPLIES TO ANY BALANCE OWED BY THE PATIENT WHETHER IT IS A BALANCE AFTER INSURANCE, A BALANCE WITH NO INSURANCE, OR A BALANCE AFTER AN ADJUSTMENT FOR PARTIAL CHARITABLE CARE. STATEMENTS, CREDIT REPORTING, COLLECTION EFFORTS, AND WRITE-OFF CRITERIA ARE THE SAME FOR ALL LIKE BALANCES, REGARDLESS OF THE REASON FOR THE BALANCE AND REGARDLESS OF WHETHER IT IS A BALANCE AFTER CHARITABLE CARE OR NOT. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE THE APPROPRIATE ADJUSTMENT ON THEIR BILL. IF A BALANCE REMAINS AFTER THAT ADJUSTMENT, THEY ARE BILLED ACCORDING TO THE COLLECTION POLICY, FOR THE REMAINDER. PART VI, LINE 2: THE NEEDS OF THE COMMUNITY, BEYOND THE COMMUNITY HEALTH NEEDS ASSESSMENT, ARE NOT FORMALLY ASSESSED. HOWEVER, EACH OF THE COMMUNITY PROGRAMS AND WELLNESS SESSIONS ARE EVALUATED POST-SESSION AND THAT FEEDBACK IS INCORPORATED IN THE DEVELOPMENT OF FUTURE SESSIONS. ALSO, ONECARE VT (ACCOUNTABLE CARE ORGANIZATION) PROVIDES THE HOSPITAL WITH OUTCOMES DATA (SUCH AS COPD, USE OF HOSPICE, FREQUENT ADMISSIONS TO EMERGENCY ROOM) WHERE THE HOSPITAL CAN EVALUATE PROGRAMING AND QUALITY. PART VI, LINE 3: WINDSOR COMMUNITY HEALTH CLINIC (A DEPARTMENT WITHIN THE HOSPITAL) PROVIDES INFORMATION AND ONE-ON-ONE ASSISTANCE WITH ANY INDIVIDUAL THAT IS IDENTIFIED WITHOUT INSURANCE. THIS BEGINS AT THE TIME THAT A PATIENT PRESENTS FOR THEIR HEALTH CARE APPOINTMENT; THE REGISTRATION STAFF MAKE THE INTRODUCTION AND PROVIDE INFORMATION TO THE PATIENT ON THE SERVICES. ALSO, A REFERRAL FROM THE PHYSICIAN/PROVIDER MAY DIRECT A PATIENT TO THIS DEPARTMENT. THE STAFF OF THIS DEPARTMENT ASSIST PATIENTS IN APPLYING FOR HEALTH INSURANCE, WHETHER ON THE COMMERCIAL "EXCHANGE", OR IN GOVERNMENTAL INSURERS. THEY ALSO PROVIDE INFORMATION ON AND THE APPLICATION FOR FINANCIAL ASSISTANCE; OFTEN TIME, ASSISTING PATIENTS WITH COMPLETING THE APPLICATION. THIS IS A DEDICATED STAFF THAT IS ON SITE DURING THE NORMAL BUSINESS HOURS WHEN THE MAJORITY OF PATIENTS WOULD BE SEEKING CARE. PART VI, LINE 4: MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, CLAREMONT, WOODSTOCK, HARTLAND, SPRINGFIELD, CORNISH, PLAINFIELD AND BROWNSVILLE. PART VI, LINE 5: WE HAVE ESTABLISHED A DIRECTOR OF COMMUNITY HEALTH, A COMMUNITY HEALTH COMMITTEE WHICH IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES AND COMMUNITY HEALTH OUTREACH DEPT. OUR STAFF ORGANIZES AND LEADS THE MT. ASCUTNEY PREVENTION PARTNERSHIP WHOSE ROLE IS TO IMPLEMENT HEALTH PROMOTION AND PREVENTION PROGRAM FOR HIGH RISK BEHAVIORS SUCH AS ALCOHOL, TOBACCO, AND DRUG ABUSE. WE PROMOTE EXERCISE AND NUTRITION PROGRAMS AS WELL AS ENVIRONMENTAL STRATEGIES TO REDUCE AND PREVENT HIGH RISK BEHAVIOR. PART VI, LINE 6: THE HOSPITAL COMMUNITY BENEFIT STAFF IS AN ACTIVE PARTICIPANT IN REGIONAL COMMUNITY HEALTH COMMITTEE, WHICH IS LEAD AND ORGANIZED BY DARTMOUTH-HITCHCOCK. THE HOSPITAL IS AFFILIATED, FORMALLY, WITH DARTMOUTH-HITCHCOCK. AS ARE OTHER LOCAL HOSPITALS, ALICE PECK DAY MEMORIAL HOSPITAL AND NEW LONDON HOSPITAL. VALLEY REGIONAL HOSPITAL IS ALSO PART OF THE REGIONAL COMMUNITY HEALTH COMMITTEE. THE PARTICIPANTS COLLABORATE, COMPARE SOLUTIONS AND OFFER SUPPORT TO EACH OTHER AS ALL ARE SERVING OVERLAPPING SERVICE AREAS. X X X X 0 0 0 0 0 0 0 1 0 STEVEN SMITH MD TRUSTEE 3908 162376 9400 0 0 744 0 83910 0 20277 13308 267307 0 0 MARY JOYCE MD TRUSTEE (TERMED 1/15) 164746 0 8900 0 1016 0 0 0 19233 0 193895 0 0 0 WILLIAM PALMER TRUSTEE 0 186709 0 0 0 744 0 161685 0 11584 0 360722 0 0 VINCENT FUSCA III DH REPRESENTATIVE 0 306308 0 0 0 2387 0 21284 0 1467 0 331446 0 0 DEANNA S HOWARD DH REPRESENTATIVE 0 248770 0 0 0 2827 0 75155 0 8014 0 334766 0 0 STEVEN D SURGENOR MD DH REPRESENTATIVE 0 330146 0 74000 0 23835 0 54354 0 20554 0 502889 0 0 KEVIN DONOVAN CEO 6700 295217 0 0 0 2044 0 32459 0 18077 6700 347797 0 0 DAVID SANVILLE CFO 195090 0 0 0 0 0 0 0 0 0 195090 0 0 0 JILL LORD CNO 157726 0 0 0 1413 0 0 0 668 0 159807 0 0 0 PETER RAUERT PHYSICIAN 306260 0 0 0 191 0 0 0 20053 0 326504 0 0 0 CATHERINE SCHNEIDER CMO 259228 0 0 0 604 0 0 0 9383 0 269215 0 0 0 CHRISTOPHER CONNOR MD OPTHALMOLOGIST 346058 0 0 0 1032 0 0 0 10698 0 357788 0 0 0 JOSEPH PERRAS PHYSICIAN 239466 0 0 0 240 0 0 0 24366 0 264072 0 0 0 GERALD DRABYN MD PLASTIC SURGEON 270021 0 0 0 4944 0 0 0 24366 0 299331 0 0 0 PART I, LINE 7 STEVEN SMITH, MD AND MARY JOYCE, MD RECEIVED BONUSES WHICH WERE BASED UPON RELATIVE VALUE UNITS (RVU'S). PART III GIFFORD MEDICAL CENTER, AN UNRELATED ORGANIZATION, WAS PAID $195,090 FOR DAVID SANVILLE'S SERVICES AS CFO. A VERMONT EDUCATIONAL AND HEALTH BUILDINGS FINANCING AGENCY 237154467 2010-02-02 9244000 REFINANCING OF 2004 AND 2005 BONDS 0 0 0 A 1196851 9244000 128133 9115867 2010 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 TD BANK NA 18.000000000000 0 0 0 0 0 A 0 X 4 37842 FAIR MARKET VALUE 0 0 1 PART I, LINE 32B: THE HOSPITAL USES TIAA-CREF TO PROCESS AND SELL NON-CASH CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11 BOARD OF TRUSTEES REVIEWED PRIOR TO FILING, PROVIDED MULTIPLE DAYS TO PROVIDE FEEDBACK AND/OR QUESTIONS AND HOSPITAL THEN FILED AFTER THERE WAS SATISFACTION. FORM 990, PART VI, SECTION B, LINE 12C THE FINANCE AND AUDIT COMMITTEE MONITOR AND REPORT TO THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD MEETS ANNUALLY TO REVIEW COMPENSATION FOR THE CEO, USING INDEPENDENT SURVEYS OF AREA COMPENSATION FOR EXECUTIVES OF VARIOUS SIZED HOSPITALS. OTHER OFFICERS AND KEY EMPLOYEES SALARIES ARE DETERMINED, BY THE HR DEPARTMENT USING COMPARABLE MARKET DATA. FORM 990, PART VI, SECTION C, LINE 19 ALL INTERNAL POLICIES, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST FORM 990, PART XI, LINE 9: CHANGE IN ACCOUNTING PRINCIPLE 3,065,643. CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST RETIREMENT PLANS -937,105. CHANGE IN FAIR VALUE ON INTEREST RATE SWAP 120,150. ROUNDING -1. HISTORIC HOMES OF RUNNEMEDE 40 MAXWELL PERKINS LANE WINDSOR VT 05089 237396147 PROVIDING SERVICES FOR THE AGING VT 501(C)(3) 9 WINDSOR HOSPITAL CORPORATION 1 MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION INC 289 COUNTY ROAD WINDSOR VT 05089 030300481 TO PROVIDE HEALTH EDUCATION AND HEALTH PROMOTION PROGRAMS AND SERVICES VT 501(C)(3) 3 WINDSOR HOSPITAL CORPORATION 1 DARTMOUTH-HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222715483 SUPPORTING ORG NH 501(C)(3) 11 TYPE I N/A 0 MOUNT ASCUTNEY PROFESSIONAL CENTER OWNERS ASSOCIATION 289 COUNTY ROAD WINDSOR VT 05089 030320283 OWNERS ASSOCIATION FOR 13 CONDOMINIUM UNITS VT 501(C)(3) 3 WINDSOR HOSPITAL CORPORATION 1 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(C)(3) 3 DARTMOUTH-HITCHCOCK HEALTH 0 DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 SUPPORTING ORG NH 501(C)(3) 11 TYPE II N/A 0 DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYS SVCS NH 501(C)(3) 9 DARTMOUTH-HITCHCOCK HEALTH 0 THE HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222139 HLTHCRE RSRCH NH 501(C)(3) 7 DARTMOUTH-HITCHCOCK CLINIC 0 HAMDEN RISK RETENTION GROUP INC 30 MAIN STREET SUITE 330 BURLINGTON VT 05401 208530788 SELF INS VT 501(C)(3) 11 TYPE I DARTMOUTH-HITCHCOCK CLINIC 0 THE NEW LONDON HOSPITAL ASSOC INC 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(C)(3) 3 DARTMOUTH-HITCHCOCK HEALTH 0 EVERWELL INC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 352505275 SUPPORTING ORG NH 501(C)(3) 11 TYPE I DARTMOUTH-HITCHCOCK HEALTH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 MT ASCUTNEY PROFESSIONAL CENTER OWNERS ASSOCIATION R 72000 ACTUAL DARTMOUTH-HITCHCOCK CLINIC O 1937391 ACTUAL MARY HITCHCOCK MEMORIAL HOSPITAL Q 109104 ACTUAL HISTORIC HOMES OF RUNNEMEDE Q 155735 ACTUAL DARTMOUTH-HITCHCOCK CLINIC Q 307662 ACTUAL MARY HITCHCOCK MEMORIAL HOSPITAL Q 577000 ACTUAL