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 030306549 Helen Porter Nursing Home Inc HELE 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 2016-12-15 16:53:06Z Helen Porter Healthcare & Rehab Center Fred Kniffin 115 Porter Drive Middlebury VT 05753 10113844 0 X www.portermedical.org X 1986 VT Operation of 105 bed skilled nursing home 22 17 263 30 0 0 132028 79451 9957511 10104232 286 420 0 -70259 10089825 10113844 0 0 0 0 7412885 7725723 0 0 0 3166536 3482808 10579421 11208531 -489596 -1094687 3338181 3309324 6004222 5827984 -2666041 -2518660 The mission of Helen Porter Healthcare and Rehabilitation Center is to improve the health of our community, one patient at a time. 0 0 9422135 10104232 Operated long-term community oriented 105 bed skilled nursing home. The nursing home provided services to patients that totaled 34,752 resident days during the year ended 9/30/2015. 9422135 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 263 1 0 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 1.00 44.00 X 0 255705 18179 Jan Bark Director 1.00 4.00 X 0 0 0 Jud Bartlett Director 1.00 4.00 X 0 0 0 Sivan Cotel Director 1.00 4.00 X 0 0 0 Peter DeGraff Director 1.00 4.00 X 0 0 0 Kim Downs-Burns Vice-Chair 1.00 4.00 X X 0 0 0 Missy Foote Director 1.00 4.00 X 0 0 0 Richard Foote Director 1.00 4.00 X 0 0 0 Edwin Grant Director 1.00 4.00 X 0 0 0 Ingrid Jackson Director 1.00 4.00 X 0 0 0 Michael Kiernan MD Director 1.00 44.00 X 0 196354 38470 Stephen Koller MD Director 1.00 4.00 X 0 0 0 Linn Larson MD Director 1.00 4.00 X 0 0 0 Kate McIntosh MD Director 1.00 4.00 X 0 0 0 Maureen McLaughlin Director 1.00 4.00 X 0 0 0 Patrick Norton Director 1.00 4.00 X 0 0 0 Ken Perine Director 1.00 4.00 X 0 0 0 Benjamin Rosenberg MD Director 1.00 44.00 X 0 469339 34317 Linda Schiffer Director 1.00 4.00 X 0 0 0 Steve Terry Director 1.00 4.00 X 0 0 0 Bill Townsend Chairman 2.00 7.00 X X 0 0 0 Carrie Wulfman MD Director 1.00 44.00 X 0 243243 35532 Mary Jane Broughton Past Director 1.00 4.00 X 0 0 0 Gerry Gossens Past Director 1.00 4.00 X 0 0 0 Ann Hanson Past Director 1.00 4.00 X 0 0 0 Linda Harmon Past Director 1.00 4.00 X 0 0 0 Joe Sutton Past Director 1.00 4.00 X 0 0 0 Jessica Holmes Past Secretary 1.00 4.00 X X 0 0 0 Elizabeth Markowski Past Secretary 1.00 4.00 X X 0 0 0 Lynn Boggs President/CEO 5.00 35.00 X 0 0 0 Steven T Ciampa CFO 5.00 35.00 X 0 213265 15506 James Daily Past President/CEO 1.00 44.00 X 0 393707 43259 0 1771613 185263 0 0 1 0 0 79451 79451 Patient Revenue 623000 13186644 13186644 Lifeline Revenue 623000 95218 95218 Other Revenue 623000 31143 25986 5157 Provision for Bad Debts 623000 -54280 -54280 Contractual Allowances 623000 -3154493 -3154493 10104232 420 420 Loss on early extinguishment of d 900099 -70259 -70259 -70259 10113844 10099075 0 -64682 5968251 5253895 714356 190118 167362 22756 1110914 977946 132968 456440 401807 54633 306932 306932 18133 18133 21300 21300 147450 147450 41170 41170 14343 14343 89873 89873 3573 3573 78126 78126 289236 289236 102009 102009 Medical Supplies 1815338 1815338 Medicaid Provider Tax 516551 516551 Miscellaneous Expense 20425 20425 Dues & Subscriptions 18349 18349 11208531 9422135 1786396 0 X 131411 150940 400975 550309 1209291 1104529 8904 12666 95161 110083 6108835 4772407 1346761 1336428 81049 64629 44369 3338181 3309324 768094 779788 3355000 3055920 12947 16786 92032 64613 741973 741973 1034176 1168904 6004222 5827984 X -2749638 -2602607 83597 83947 -2666041 -2518660 3338181 3309324 X -1094687 1242068 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1698 1698 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 0 1 X 4693382 3934511 758871 1094446 686873 407573 321007 151023 169984 1336428 Due to Affiliates 192063 Liability for Pension Benefits 909675 Estimated Third-Party Settlements 67166 1168904 11355912 1242068 1242068 10113844 0 10113844 11208531 0 11208531 0 11208531 Part IV, Line 2b: The Organization holds funds belonging to residents for their personal use. The funds are made available to the residents as requested or needed. Part XI, Line 2d - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan -218,117. Equity Transfer from Affiliate 1,460,185. 0 1 0 0 0 0 0 1 0 Kristofer Anderson MD Director 0 255173 0 0 0 532 0 7723 0 10456 0 273884 0 0 Michael Kiernan MD Director 0 195614 0 0 0 740 0 8975 0 29495 0 234824 0 0 Benjamin Rosenberg MD Director 0 430446 0 36595 0 2298 0 7800 0 26517 0 503656 0 0 Carrie Wulfman MD Director 0 234404 0 8000 0 839 0 9855 0 25677 0 278775 0 0 Steven T Ciampa CFO 0 197679 0 15000 0 586 0 6221 0 9285 0 228771 0 0 James Daily Past President/CEO 0 311399 0 0 0 82308 0 15600 0 27659 0 436966 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, MD received a bonus based on his Relative Value Units (RVU's) of services exceeding a target amount. Carrie Wulfman, MD received a bonus stipend for unassigned patients at Helen Porter Nursing Home. A Vermont Educational and Health Buildings Financing Agency 237154467 2015-08-01 3100000 Refunding 2000 Series A Bonds 0 0 0 A 9844 3100000 34525 3065475 2015 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 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 directors of the Organization. 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 expenditures, and approve 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 Organization'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 X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Helen Porter Nursing Home, Inc. 115 Porter Drive Middlebury, VT 05753 EIN 03-0306549 Helen Porter Nursing Home, 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 -218,117. Equity Transfer from Affiliate 1,460,185. Form 990, Schedule A, Part I, Line 3: Reason for Public Charity Status: The Organization's exemption is based upon being classified as a hospital or cooperative hospital service organization described in 170(b)(1)(A)(iii). Since the Organization is not licensed in the state of Vermont as a hospital, but rather as a skilled nursing facility, Schedule H is not required. Porter Hospital Inc 37 Porter Drive Middlebury VT 05753 030181058 Critical Access Hospital VT 501(c)(3) Line 3 Porter Medical Center Inc 0 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 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 0 0 0 1 0 1 1 1 0 1