2015-08-14T09:59:47-05:00 2014-09-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2013-10-01 030177161 Carlos G Otis Health Care Center CARL 8023657920 PO Box 216 Townshend VT 053530216 Stephen A Brown CFO 8023657920 2015-08-13 1 Nicholas E Porto P01310283 2078792100 2015-08-13 2013 2016-03-07 17:11:31Z Grace Cottage Hospital Stephan Morse PO Box 216 Townshend VT 053530216 20774081 0 X www.gracecottage.org X 1949 VT Provision of health care services 10 8 208 103 0 0 684536 381563 20366174 20392276 198 242 0 0 21050908 20774081 0 0 0 0 12674441 12261442 0 0 156978 8850682 9449330 21525123 21710772 -474215 -936691 14546744 14414650 4787260 4706173 9759484 9708477 The Otis Health Care Center promotes excellence in healthcare and well being, putting people first. It aims to be the standard for patient care. 0 0 19748571 0 20392276 Grace Cottage Hospital is a critical access hospital offering 24-hour emergency services, inpatient acute and skilled care, 24-hour diagnostic imaging services, a full-service laboratory, a pharmacy, a variety of outpatient medical care services, including physical therapy, occupational therapy, and speech therapy, and a rural health clinic providing primary care and psychiatric services. 19748571 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 18 0 1 208 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephen A Brown 8023653601 185 Grafton Road Townshend VT 05353 X Edward Elliott MD Trustee (end 11/2013) 1.00 X 0 0 0 Barry Emerson Trustee 1.00 X 0 0 0 Stanley Holt Trustee 1.00 X 0 0 0 John Nopper Trustee 1.00 X 0 0 0 Timothy P Shafer MD Trustee/Family Physician 50.00 X 262175 0 28952 Allan Shirks Trustee 1.00 X 0 0 0 Roger Allbee Trustee/CEO (eff. 4/2014) 30.00 1.00 X X 0 0 0 Deborah Boyle Pres. (end 11/2013)/VP (eff. 11/2013) 1.00 X X 0 0 0 Stephan Morse VP (end 11/2013)/Pres. (eff. 11/2013) 1.00 X X 0 0 0 Kevin Meyer Treasurer 1.00 X X 0 0 0 J Walter Corcoran Secretary 1.00 1.00 X X 0 0 0 Margaret S Cleary FACHE Interim CEO (end 1/2014) 20.80 1.00 X 0 0 0 Stephen A Brown CFO 47.10 X 186453 0 27028 Maurice Geurts MD Family Physician 50.00 X 302387 0 28952 Moss J Linder MD Family Physician 44.00 X 230294 0 25921 Ewa Arnold MD Family Physician 50.00 X 164318 0 21738 Robert Backus MD Family Physician 41.00 X 141602 0 21014 Richard Meyer MD CMO/Emergency Physician 42.00 X 138203 0 24522 1425432 0 178127 18 0 1 0 Cerner Corporation PO Box 412702 Kansas City MO 64141 IT Support 816443 Helms and Company One Pillsbury Street Suite 200 Concord NH 033013570 Consulting/Management 204657 Brattleboro Retreat PO Box 803 Brattleboro VT 05302 Contracted Psychiatrist 176455 Baker Newman Noyes PO Box 507 Portland ME 041120507 Accounting 110551 4 236675 142781 2107 2107 381563 Patient Service Revenue 621400 16143075 16143075 Pharmacy Revenue 446110 3876706 3876706 GCF Administration/Other 621400 169486 169486 Miscellaneous Revenue 621400 128581 128581 Meaningful Use Revenue 621990 74428 74428 20392276 242 242 20774081 20392276 0 242 576511 303695 272816 9262840 8491364 663842 107634 165788 152316 11504 1968 1600424 1451376 130939 18109 655879 587677 60985 7217 65264 65264 21042 21042 79385 79385 698067 688622 9445 175030 9612 164655 763 589155 416333 158501 14321 656829 588730 65524 2575 273791 266381 7410 140375 115582 20744 4049 13590 13590 62199 29494 32705 1429173 1425152 4021 242775 205992 36441 342 Medical supplies & lab 3428129 3428129 Provision for bad debts 677685 677685 Medicaid tax 623191 623191 Equipment repair expens 273650 273650 21710772 19748571 1805223 156978 232224 33632 52679 35506 2135385 2382678 1009449 1267839 103585 215049 14535042 10654230 5132193 3880812 36185 32165 5845044 6566969 14546744 14414650 1667812 1490659 1310000 1190000 1674399 1088969 135049 936545 4787260 4706173 X 7117438 6634557 226364 505555 2415682 2568365 9759484 9708477 14546744 14414650 X -936691 885684 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3435 0 0 0 3435 0 Part II-B, Line 1: Carlos G. Otis Health Care Center is a member of the Vermont 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 Carlos G. Otis Health Care Center in furtherance of its exempt purpose. Carlos G. Otis Health Care Center does not directly perform any lobbying activities. AHA, portion of dues available for lobbying: $526 VAHHS, portion of dues available for lobbying: $2,909 2642046 451855 19982 3073919 2608707 48373 15034 2642046 2636804 1267 99915 129279 2608707 2443026 186971 25839 19032 2636804 2298260 104897 39869 2443026 0.15270 0.83550 0.01180 0 1 1 30549 30549 6361991 4437315 1924676 8044310 6165763 1878547 98192 51152 47040 3880812 Beneficial interest in net assets of GCF 6410308 Deposits with Trustee 57097 Meaningful use receivable 74428 Other Receivables 25136 6566969 Estimated Third Party Payor Settlements 936545 936545 X 21659765 885684 885684 20774081 0 20774081 21710772 0 21710772 0 21710772 Part V, Line 4: OHCC uses its endowment funds to assist in the provision of health care. Part X, Line 2: OHCC and the Foundation are tax-exempt corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(a) and had been classified as an organization that is not a private foundation under Section 509(a)(2). Management evaluated the Organization's tax positions and concluded the Organization has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. With few exceptions, the Organization is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Increase in Beneficial Interest in Net Assets of GCF 885,684. 1 1 1 X 1 X 1 1 0 1 1 249253 249253 0.01190 3289927 1336935 1952992 0.09290 3539180 1336935 2202245 0.10480 57059 10134 46925 0.00220 57645 57645 0.00270 114704 10134 104570 0.00490 3653884 1347069 2306815 0.10970 1 505747 246339 9659654 9235238 424416 X 1 0 1 1 Grace Cottage Hospital 185 Grafton Road Townshend VT 05353 www.gracecottage.org 814 X X X X Grace Cottage Hospital 1 1 X X X X X X X X X 12 1 1 1 X See Section C X See Section C X X X X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X 1 0 1 X 0 1 Grace Cottage Hospital Part V, Section B, Line 3: As required by Vermont statute, Grace Cottage Hospital conducts a Community Health Needs Assessment (CNHA) every three years. Our most recent CHNA was done collaboratively in 2012 with Brattleboro Memorial Hospital (BMH) and the Brattleboro Retreat. These three healthcare organizations focused on involving as many stakeholders and community members as possible in the data collection. The three hospitals set up a steering committee made up of individuals from the State of Vermont Department of Health, Brattleboro Memorial Hospital, Grace Cottage Hospital, The Brattleboro Retreat, United Way of Windham County, Agency of Human Services, Visiting Nurse Association & Hospice of VT & NH, Valley Cares, West River Valley Assisted Living, and Senior Solutions. Additionally, the participating organizations engaged a wide range of stakeholders through the surveys and focus groups, including health care providers, human service organizations, youth development organizations, schools and other nonprofit organizations. An updated Community Health Needs Assessment will be completed in 2015.Grace Cottage Hospital continues to collaborate with BMH and the Brattleboro Retreat to improve community awareness of existing health and wellness programs and services to Windham County residents, which was one of the needs identified in the Community Health Needs Assessment. The three organizations publish a comprehensive Health and Wellness Calendar, distributed county-wide, twice annually, which includes listings of all health and wellness events and classes that are available for the public. In addition, the Wellness in Windham website (www.wellnessinwindham.org) is maintained by the three organizations with updated, current information on classes, programs, and services. Grace Cottage Hospital has been addressing two additional needs identified in the assessment:-Diabetes awareness, management and education. Through the Vermont Blueprint for Health initiative, Grace Cottage's Community Health Team, made up of skilled health professionals, works with diabetes patients, one-on-one, to help with disease management. -Transportation needs for the rural area in which we serve. During FY14, Grace Cottage Hospital was an active participant in the Brattleboro Business Transportation Roundtable group, working with United Way of Windham County, Windham Regional Commission, Connecticut River Transit, Go Vermont and Vital Communities to identify transportation issues in the West River Valley and in Brattleboro, and to work towards finding solutions to these issues. Grace Cottage Hospital Part V, Section B, Line 4: The 2012 Community Health Needs Assessment was conducted with Brattleboro Memorial Hospital and The Brattleboro Retreat. Grace Cottage Hospital Part V, Section B, Line 7: The community hospitals participating in the 2012 CHNA, Grace Cottage Hospital and Brattleboro Memorial Hospital, are not addressing Hepatitis C and Lyme Disease at this time as other priority health care conditions have been selected to focus on. The needs identified in the CHNA finalized at the end of fiscal year 2012 have been discussed in fiscal year 2014 as part of the Hospital's ongoing strategic planning process. Grace Cottage Hospital Part V, Section B, Line 19d: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. Grace Cottage Hospital Part V, Section B, Line 20d: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. Grace Cottage Hospital Part V, Section B, Line 22: As stated on line 20d, all charges billed were at standard facility rates. Schedule H, Part V, Section B, Line 5a: The Hospital's 2012 CHNA is available on its website at: http://gracecottage.org/about-grace-cottage/community-health-needs-assessments/ Schedule H, Part V, Section B, Line 5b: The Hospital's 2012 CHNA is available on the following websites: http://www.bmhvt.org/about/community-health-needs-assessmenthttp://www.brattlebororetreat.org/about/community-health-needs-assessment 2 Messenger Valley Pharmacy 170 Grafton Road Townshend VT 05353 Pharmacy Grace Cottage Family Health 185 Grafton Road Townshend VT 05353 Rural health clinic Part I, Line 3c: N/A Part I, Line 6a: N/A Part I, Line 7: The amounts reported for Charity Care and Means-Tested Government Programs were calculated using a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. Part I, Line 7g: N/A Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 677,685. Part II, Community Building Activities: See previous footnotes. Part III, Line 2: The cost of the bad debt expense reported on line 2 was calculated by applying the ratio of patient care cost-to-charges (calculated on Worksheet 2) to the total bad debt expense. The amount of bad debt expense for accounts written off as bad debt is the account balance after all charity care discounts, contractual allowances, and insurance/patient payments have been applied. Any cash collected on accounts previously written off is included as an offset to bad debt expense. Part III, Line 3: The amount of bad debt expense (at cost) attributable to patients eligible under our charity care policy reported on line 3 was estimated based on a review of Reduced Fee/Free Care Applications. The number of approved completed applications versus the number of incomplete applications was compared and a ratio applied to the Charity Care balance to estimate this number. It is felt that this estimate should actually be much higher because, though we work hard to educate our patients regarding the charity care policy, including having a Resource Advocate to help patients complete them if they require assistance, many of the applications we distribute to patients are not returned. Knowing our patient population as we do, we believe it is primarily attributable to patients not wanting to share the income information. Part III, Line 4: Please see responses above for information regarding costing methodology. See Page 8 of the attached audited financial statements for the footnote that addresses bad debt. Part III, Line 8: Medicare allowable costs reported in the Medicare Cost Report are reported in accordance with CMS Guidelines using the cost-to-charge ratio methodology. Part III, Line 9b: N/A Part VI, Line 2: Grace Cottage Hospital is such a small hospital in a rural, relatively sparsely populated area that our community leaders, patients, and members of the public are quick to inform our administrators and our medical staff about how Grace Cottage serves the healthcare needs of the public. Grace Cottage's small size ensures that we can be responsive to community requests made via our website, e-mails to members of our staff, or informal face-to-face meetings with people in the communities we serve. Part VI, Line 3: Although we are Vermont's smallest Critical Access Hospital, Grace Cottage Hospital believes that quality health care should be available to all; and that we all have a responsibility to help others in need regardless of their ability to pay. Posters and brochures detailing the availability of help with billing, public programs, and charity care are displayed in high traffic areas throughout the Hospital, rural health clinic and pharmacy, as well as listed on the Hospital's website. The staff reaches out to patients in a variety of ways to ensure that they are aware that help is available. During FY14, the Hospital employed a Resource Advocate to help uninsured and underinsured patients locate and procure services for which they may qualify. The Resource Advocate's services were free of charge for community members between the ages of 18-64 years (those 65 and older were encouraged to contact Senior Solutions, formerly Southeastern Vermont Council on Aging). The Hospital's Resource Advocate helped many people with a wide variety of resource issues, helping to fill out necessary forms and making connections for patients with other federal, state and local resources. This employee was an expert in filling out reduced fee applications, finding sources for reduced-cost or free prescription medications, and locating other avenues of support. Part VI, Line 4: Grace Cottage Hospital plays a vital role in healthcare for this rural, mountainous community. Its federal designation as a critical access hospital recognizes its importance in providing health care to an otherwise medically underserved community. The Hospital's emergency department is especially vital to members of the community, who would otherwise have to travel many miles on winding, mountainous highways to reach emergency medical care at another hospital. Grace Cottage Hospital is located in Windham County, in southeastern Vermont. According to the U.S. Census Bureau, Windham County has an estimated total of 43,714 residents. Grace Cottage Hospital's patient base is approximately 26,000 residents, mostly from 21 surrounding towns. The median household income of Windham County, Vermont, is $50,234 (U.S. Census Bureau "Quick Facts," updated 2013). Income statistics for the total population served by Grace Cottage Hospital are not available because Grace Cottage only requires income information from patients requesting reduced fees or free care. Part VI, Line 5: Grace Cottage Hospital is a Critical Access Hospital located in rural, mountainous Townshend, Vermont. The Hospital is served by a board of trustees consisting of local citizens active in community businesses and organizations. Only two of the ten trustees, the CEO and a physician, are hospital employees. All trustees reside in the Hospital's service area and bring a wealth of community input to the Hospital's strategic planning process. The Hospital extends medical staff privileges to all qualified physicians in the community.Grace Cottage Hospital applies any surplus funds towards improving its ability to provide quality patient care and being an integral part of assuring the health and well-being of the communities we serve. Despite its small size, Grace Cottage Hospital is committed to giving back to the community to the greatest extent possible. Area non-profit organizations providing health-related and emergency preparedness-related services to the community are provided with meeting and training space at the Hospital. In response to the last Community Health Needs Assessment, the Hospital has worked collaboratively with local schools and organizations to promote healthy, fun activities and provides opportunities that make the most of staying as healthy as possible. Community Wellness: In 2014, there were a total of 3,263 wellness visits. Wellness activities included: dance meditation, strong bones exercise classes, meditation circle, weight control programs, and yoga. Tobacco cessation classes at Grace Cottage Hospital were held under the auspices of Vermont's Blueprint for Health program.For the third consecutive year, Grace Cottage Hospital employees collaborated with Brattleboro Memorial Hospital and The Brattleboro Retreat to organize and implement a Community Health Festival. Over 50 area non-profit organizations and more than 500 members of the community attended the Health Festival on September 20, 2014. In addition, Brattleboro Memorial Hospital, The Brattleboro Retreat, and Grace Cottage Hospital collaborate on a Wellness in Windham website and Health Education calendar. Grace Cottage employees also assisted in coordinating a community blood drive in Newfane, Vermont, in conjunction with the American Red Cross.Grace Cottage Hospital plays a pivotal role in Emergency/Disaster Preparedness in this rural, mountainous area of Windham County, Vermont. The Hospital works collaboratively with:- the local town volunteer fire and first responder rescue departments; - the regional ambulance service, Rescue Inc.;- Windham County Regional Commission the Local Emergency Planning Committee covering the towns that Grace Cottage serves;- the local Citizens Emergency Response Team (CERT); - the local Radio Amateur Civil Emergency Service (RACES) West River Radio Club meets and stores equipment at Grace Cottage Hospital; - Vermont Association of Hospitals and Health Systems; - Vermont Department of Health. Grace Cottage Hospital houses the local non-profit transport ambulance service, Rescue Inc., free of charge, on the Hospital grounds, providing an ambulance garage and two rooms for use by rescue personnel. Rescue Inc. is based in Brattleboro, VT, 18 miles away; the branch that is located at Grace Cottage 24 hours a day, 365 days a year, is known as Rescue Inc. Division Two. Grace Cottage Hospital staff participate in onsite training for disaster preparedness as well as offsite training with other hospitals. Part VI, Line 6: N/A Part VI, Line 7, Reports Filed With States VT X X 0 0 0 0 0 0 0 1 0 Timothy P Shafer MD Trustee/Family Physician 206661 0 52296 0 3218 0 7650 0 21302 0 291127 0 0 0 Stephen A Brown CFO 169264 0 0 0 17189 0 5726 0 21302 0 213481 0 0 0 Maurice Geurts MD Family Physician 247302 0 52627 0 2458 0 7650 0 21302 0 331339 0 0 0 Moss J Linder MD Family Physician 194289 0 33242 0 2763 0 4619 0 21302 0 256215 0 0 0 Ewa Arnold MD Family Physician 127385 0 34775 0 2158 0 2119 0 19619 0 186056 0 0 0 Robert Backus MD Family Physician 132387 0 4269 0 4946 0 4335 0 16679 0 162616 0 0 0 Richard Meyer MD CMO/Emergency Physician 135620 0 425 0 2158 0 3605 0 20917 0 162725 0 0 0 Part I, Line 7 Physician contracts provide the opportunity to receive additional payments for productivity above minimum thresholds. For the period reported, five physicians listed in Part VII were under such a contract: Dr. Maurice Geurts, Dr. Moss Linder, Dr. Ewa Arnold, Dr. Timothy Shafer, and Dr. Robert Backus, who received incentive compensation payments of $52,627, $33,242, $34,775, $52,296, and $4,269, respectively. Helms & Company Inc Interim CEO and Principal 204657 Margaret S. Cleary, FACHE, who served as an interim-CEO of the Hospital until January, 2014, is a principal of Helms & Company, Inc. who were paid for management and consulting services rendered to the Organization. Helms and Company was paid $39,664 related to interim-CEO contracted services and $204,657 in total. 0 Form 990, Part VI, Section A, line 3 The Organization paid Helms & Company, Inc., a healthcare consulting and management company, for interim CEO Margaret S. Cleary, FACHE, who served the Hospital from October 2013 until January 2014. Total fiscal year 2014 amount paid to Helms & Company, Inc. for providing CEO services was $30,664. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is initially reviewed in detail by Carlos G. Otis Health Care Center's key finance employees. Thereafter, the final draft is provided to the full Board for review prior to filing with the IRS. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to the Board of Trustees and each trustee signs to confirm that they have thoroughly read, understand, and agree to comply with the conflict of interest policy. Form 990, Part VI, Section B, line 15 CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted and voted on by the full board annually. The Board used external market compensation data to determine the CEO's initial compensation when hired and annually uses such data to compare OHCC's CEO compensation with that of other hospital executives in the Northeast region. The CEO is excused from Board discussion and voting on issues surrounding CEO compensation and benefits. Compensation of other hospital employees: The CEO reviews the salaries of employees annually and determines compensation based on performance and salary ranges, using regional salary range data for comparison. Form 990, Part VI, Section C, line 19 Upon request, Carlos G. Otis Health Care Center, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part VII, Section A: OHCC had two interim CEOs during the year. Margaret S. Cleary, FACHE, was interim CEO from October, 2013 to January, 2014. Roger N. Allbee was then hired on a contracted basis at the end of December, 2013. In April 2014, Mr. Allbee became the permanent CEO and a full-time employee and officer of OHCC. Ms. Cleary was a contracted employee of Helms & Company, an unrelated management services company during the calendar year 2013. See Schedule O, Part VI, Line 3 for more information. Because IRS instructions require that compensation and benefit information be reported on Form 990, Part VII on a calendar year basis, no compensation and benefits are reported on this Form 990 for either CEO. The Organization's 2014 Form 990 will reflect Mr. Allbee's compensation information for calendar year ending 2014 which includes his time as an independent contractor and then a hired employee. Accordingly, Mr. Allbee has not been listed as an independent board member on this Form 990 for fiscal year ended September 30, 2014. The compensation reported for Dr. Timothy Shafer was for his services as a full-time physician. He was not compensated for his services as members of OHCC's Board of Trustees. Form 990, Part XI, line 9: Increase in Beneficial Interest in Net Assets of GCF 885,684. Form 990, Part XI, Line 2c: The Finance and Audit Committee oversees the audit process for the Carlos G. Otis Health Care Center, Inc. and Grace Cottage Foundation, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for both fiscal years. Grace Cottage Foundation Inc PO Box 1 Townshend VT 05353 030343282 Solicit contributions for the funding of health care services by OHCC VT 501(c)(3) Line 11a, I Carlos G Otis Health Care Center 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Grace Cottage Foundation Inc Q 169486 Actual per books Grace Cottage Foundation Inc C 236675 Actual per books