2015-08-06T09:24:46-05:00 2014-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-10-01 030181058 Porter Hospital Inc PORT 8023884752 115 Porter Drive Middlebury VT 05753 Steven T Ciampa CFO 8023884752 2015-08-04 1 Joseph R Byrne CPA P01289281 2077752387 2015-08-04 2013 2016-02-25 16:41:14Z James L Daily 115 Porter Drive Middlebury VT 05753 73706257 0 X www.portermedical.org X 1925 VT Critical Access Hospital 23 18 643 150 2509 0 335833 259816 72007106 72555055 308369 741226 70223 66732 72721531 73622829 7781 6380 0 0 39347408 41153274 0 0 0 30293174 30492521 69648363 71652175 3073168 1970654 55052502 56138406 30674206 30248033 24378296 25890373 X The mission of Porter Medical Center and its subsidiary companies is to improve the health status of those served. The Organization will:a. Treat and care for the sick and injured;b. Provide, in cooperation with the community, as appropriate, a continuum of health services including out-patient services, rehabilitation, long-term care, and wellness/prevention programs;c. Ensure the delivery of high quality care available to all without regard to their ability to pay;d. Serve as a leader and catalyst in helping to determine, and provide for, the health needs of the community, while remaining a financially healthy organization. 0 0 64995207 6380 72555055 Porter Hospital, Inc. ("Porter") operates a not-for-profit critical access hospital with patient care services including emergency room, maternity and medical/surgical inpatient and outpatient care, and ancillary services including rehabilitation, laboratory testing, and diagnostic imaging services. As a critical access hospital, Porter staffs a total of 25 beds. Of the 25 beds, six beds are located in the maternity unit and three beds are located in the special care unit. The remaining beds are located on the Medical/Surgical unit. Porter recorded approximately 6,101 inpatient days during the year. Emergency Room visits totaled 15,016 for the year. Surgeries for the year totaled 3,870. Support services for both inpatients and outpatients include but are not limited to Laboratory, Diagnostic Imaging services, cardiac services, and rehabilitation facilities. Imaging includes radiology, nuclear medicine, MRI, ultrasound and CT Scan. Porter provides free care to patients who meet certain criteria. Foregone charges furnished under Porter's free care policy amounted to $1,647,434 with a cost of $883,637 for the fiscal year ending 9/30/14. Porter provides a number of community health outreach programs to the general public for free or at a minimal charge. The programs include but are not limited to diabetes education, breast cancer screening, prenatal classes, breastfeeding classes and CPR courses. Porter provides clinical office space to the Open Door Clinic. Finally, Porter has partnered with a local career center, as well as colleges to provide clinical exposure to their students with goals of developing future healthcare workers for the community. 64995207 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 194 0 1 643 1 1 1 0 0 0 0 0 0 0 0 0 X 23 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 VT X Steven T Ciampa 8023884752 115 Porter Drive Middlebury VT 05753 Kristofer Anderson MD Director 43.00 2.00 X 240101 0 17184 Jan Bark Director 3.00 2.00 X 0 0 0 Mary Jane Broughton Director 3.00 2.00 X 0 0 0 Lynn Coale Past Director 3.00 2.00 X 0 0 0 Carole Cummings Past Director 3.00 2.00 X 0 0 0 Peter DeGraff Director 3.00 2.00 X 0 0 0 Kim Downs-Burns Vice-Chair 3.00 2.00 X X 0 0 0 Missy Foote Director 3.00 2.00 X 0 0 0 Betsy Gleason Past Director 3.00 2.00 X 0 0 0 Gerry Gossens Director 3.00 2.00 X 0 0 0 Edwin Grant Director 3.00 2.00 X 0 0 0 Ann Hanson Director 3.00 2.00 X 0 0 0 Linda Harmon Director 3.00 2.00 X 0 0 0 Jessica Holmes Secretary 3.00 2.00 X X 0 0 0 Holmes Jacobs Past Director 3.00 2.00 X 0 0 0 Michael Kiernan MD Director 33.00 2.00 X 168225 0 33024 Linn Larson Director 3.00 2.00 X 0 0 0 Elizabeth Markowski Director 3.00 2.00 X 0 0 0 Kate McIntosh Director 3.00 2.00 X 0 0 0 Maureen McLaughlin Director 3.00 2.00 X 0 0 0 Patrick Norton Director 3.00 2.00 X 0 0 0 Ken Perine Director 3.00 2.00 X 0 0 0 Susan Ritter Past Director 3.00 2.00 X 0 0 0 Benjamin Rosenberg MD Director 43.00 2.00 X 510540 0 33415 Robin Scheu Past Director 3.00 2.00 X 0 0 0 Joe Sutton Director 3.00 2.00 X 0 0 0 Steve Terry Director 3.00 2.00 X 0 0 0 Bill Townsend Chairman 5.00 4.00 X X 0 0 0 Carrie Wulfman MD Director 37.00 2.00 X 203405 0 32656 Steven T Ciampa CFO 30.00 10.00 X 0 55231 0 James Daily President/CEO 30.00 10.00 X 0 336919 118759 Salvatore Morana Past Dir. Professional Services 40.00 0.00 X 178827 0 33142 Jean Cotner VP of Porter Practice Management 40.00 0.00 X 178946 0 23526 Patricia Jannene Past Chief Nursing Officer 40.00 0.00 X 174519 0 2189 Fred Kniffin Chief Medical Officer 40.00 0.00 X 253912 0 29877 Eric Benz MD Orthopedic Surgeon 40.00 0.00 X 510562 0 32734 Anders Holm MD MD Otolaryngology 40.00 0.00 X 334686 0 40792 Daniel Raabe MD MD Cardiology 36.00 0.00 X 365976 0 27495 David Turner MD MD OB/GYN 40.00 0.00 X 238753 0 35684 Katherine Wagner MD MD OB/GYN 40.00 0.00 X 227142 0 33974 Marilyn Olejnik Former CFO 0.00 0.00 X 0 130717 1115 3585594 522867 495566 41 1 1 0 Porter Medical Center 115 Porter Drive Middlebury VT 05753 Mgmt. & Admin. Services 2247458 Fletcher Allen Health Care PO Box 1902 Burlington VT 05402 Various Medical Services 717560 American Health Centers 100 Griffin Rd Ste C Portsmouth NH 03801 Imaging Services 438523 Apogee Medical Management 2525 E Camelback Road Suite 1100 Phoenix AZ 85016 Hospitalist 410485 Medical Solutions 1010 N 102nd St Ste 300 Omaha NE 68114 Traveler Nurses 317351 20 62512 197304 259816 Patient Revenue 621110 133682765 133682765 Miscellaneous Revenue 621110 3307306 3089755 2509 215042 Pharmacy Sales 621110 3222964 3222964 Provision for Bad Debt 621110 -2006720 -2006720 Contractual/Charity Care Adj. 621110 -65651260 -65651260 72555055 279672 279672 150160 83428 66732 66732 66732 461554 0 461554 461554 461554 73622829 69114540 2509 4245964 6380 6380 2113488 2113488 30295196 26839583 3455613 1174698 1042805 131893 5370369 4777946 592423 2199523 1963503 236020 2174900 1941522 233378 198756 177428 21328 42385 37837 4548 31715 31715 6165069 5503527 661542 118285 105592 12693 1971646 1759395 212251 713047 636534 76513 3177594 2836622 340972 89823 80185 9638 409969 365977 43992 4501518 4018483 483035 1019641 910227 109414 Medical Supplies 5967238 5967238 Medicare Provider Tax 3910935 3910935 71652175 64995207 6656968 0 27740 16489 8206994 11646379 11764158 12477506 31499 27787 1244257 1219291 1053616 1300287 51017360 30111872 24139639 20905488 3497553 3753886 3305833 3485489 130637 124626 1650576 1181178 55052502 56138406 9591676 8948992 13535000 13170000 2321004 1193415 5226526 6935626 30674206 30248033 X 20686456 22003895 268325 283307 3423515 3603171 24378296 25890373 55052502 56138406 X 1970654 -169286 -289291 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12990 12990 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 3423515 179656 3603171 3096516 326999 3423515 2968901 127615 3096516 3070087 -101186 2968901 2659814 410273 3070087 0.00000 1.00000 0.00000 1 0 25970829 11037150 14933679 22746537 18037383 4709154 2299994 1037339 1262655 20905488 Beneficial Interest in Trusts 3485489 F 3485489 Estimated Third Party Settlements 1968929 Deferred Compensation 815975 Due to Affiliate 388697 Liability for Pension Benefits 3762025 6935626 73215965 -169286 263084 93798 73122167 31715 468947 500662 73622829 71703888 83428 83428 71620460 31715 31715 71652175 Part V, Line 4: Income from endowments supports the Organization's mission by providing funds for charity care and additionally offsets a portion of the Organization's operating expenses. Part XI, Line 2d - Other Adjustments: Change in Beneficial Interest in Perpetual Trusts 179,656. Rental Expenses 83,428. Part XI, Line 4b - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan 468,947. Part XII, Line 2d - Other Adjustments: Rental Expenses 83,428. 1 1 1 X 1 X 1 1 1 0 0 883637 883637 0.01230 11173440 8808016 2365424 0.03300 12057077 8808016 3249061 0.04530 23863 10329 13534 0.00020 424266 424266 0.00590 6380 6380 0.00010 454509 10329 444180 0.00620 12511586 8818345 3693241 0.05150 1 963025 0 13374117 14196932 -822815 X 1 1 1 1 Porter Hospital Inc 37 Porter Drive Middlebury VT 05753 X X X X Porter Hospital Inc 1 1 X X X X X X X X X 12 1 0 1 X www.portermedical.org X X X X X X 0 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 X X X 1 X 0 0 Porter Hospital, Inc. Part V, Section B, Line 3: The Hospital interviewed 25 individuals who represented a wide variety of community organizations/constituents. The individuals represented the following organizations/constituents:Vermont Department of Health, Women Safe, Planned Parenthood, Helen Porter Healthcare and Rehabilitation Center, a State Senator, a State Representative, Addison County Home Health and Hospice, Community Services of Addison County, Middlebury Family Health, Harvey Green Dentistry, United Way of Addison County, a Porter Hospital Board Member, Middlebury Police Department, a Student Assistant Program Counselor at Mount Abe Union High School, a school based Clinician at Vergennes Union High School, Addison County Youth Prevention and Control Grants, the Executive Director of HOPE, the Middlebury Town Planner, Bristol Internal Medicine, Addison County Parent/Child Center, Open Door clinic, Elderly Services, a Pediatrician, Tapestry Midwifery, and the President of Porter Medical Center.The Hospital published our annual "Act 53 Report Card" which provides information to our community on quality, safety, patient satisfaction and financial measures. Each of our Primary Care Practices achieved national recognition (NCQA) as "Patient Centered Medical Homes." Porter Hospital, Inc. Part V, Section B, Line 7: Dentistry and homelessness fall outside the scope of the Hospital's mission. As it pertains to mental health, Porter has made new investments over the past year on a new safe room for the Emergency Department and additional staff resources to address the unmet community need for mental health services since the closing of the VT State Hospital. Additionally, we have made a significant investment in the new Suboxone Treatment Program at Bristol Internal Medicine to address the unmet community need regarding opiate addiction. Porter Hospital, Inc. Part V, Section B, Line 12i: The Organization uses asset levels to calculate the amounts charged to patients, but only monetary assets, no other property. Porter Hospital, Inc. Part V, Section B, Line 20d: The Organization will initially bill a patient not having insurance the Organization's standard and customary gross charges. Upon knowledge that the patient may be medically indigent and require financial assistance, the Organization will initiate the process of financial counseling and assistance whereby the patient would receive an adjusted bill reflective of the financial assistance provided, i.e. a zero bill for 100% free care or discounted bill. Porter Hospital, Inc. Part V, Section B, Line 21: The Organization does bill gross charges to patients when the patient has no form of insurance. The Organization will and does provide discounts as needed to patients that are in the position of having no insurance. These discounts range from 20% to 100% of the charge depending upon financial need. 11 Champlian Valley Orthopedics 1436 Exchange Street Middlebury VT 05753 Physician Clinic Addison Associates in OBGYN 116 Porter Drive Middlebury VT 05753 OB/GYN Addison Family Medicine 82 Catamount Park Middlebury VT 05753 Family Physician Clinic Little City Family Practice 10 North Street Vergennes VT 05491 Family Physician Clinic Middlebury Pediatric & Adolescent Med 1330 Exchange Street 201 Middlebury VT 05753 Physician Clinic Neshobe Family Medicine 61 Court Drive Brandon VT 05733 Family Physician Clinic Porter Ear Nose & Throat 1330 Exchange Street 202 Middlebury VT 05753 Physician Clinic Bristol Internal Medicine 61 Pine Street Bristol VT 05443 Physician Clinic Porter Internal Medicine 116 Porter Drive Middlebury VT 05753 Physician Clinic Porter Cardiology 115 Porter Drive Middlebury VT 05753 Physician Clinic Tapestry Midwifery 20 Armory Lane Vergennes VT 05491 Physician Clinic Part I, Line 6a: The annual community benefit report is prepared by Porter Medical Center, the parent Company of Porter Hospital, Inc. Part I, Line 7: The Organization used a cost-to-charge ratio as its methodology for calculating amounts on Lines 7a & 7b. An actual costing methodology was used to calculate the amounts on lines 7e, 7g & 7i. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect for services rendered from third-party payors, patients and others. Management provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Accounts are considered delinquent and subsequently written off as uncollectible based on individual credit evaluation and specific circumstances of the account.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third- party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts. For receivables associates with self- pay patients (which included both patients without insurance and patients with deductible and copayment balances due for which third- party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rate if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost.The Organization used the Medicare Cost Report to report Medicare allowable costs of care related to the payments on Schedule H, Part III, Section B. Medicare, Line 6. Part III, Line 9b: Porter Hospital, Inc. recognizes that it has a responsibility to provide care to all patients regardless of their ability to pay and make available financial assistance for those patients that have been identified as financially needy through written documentation. Information regarding financial assistance is made available upon request. Part VI, Line 2: Porter Hospital, Inc. maintains an active list of Quality Improvement Projects and Initiatives that are identified by our clinical staff in response to either internal or external assessments of how we can implement "best practices" for our patients. The list of projects and initiatives is updated annually as part of the State of Vermont's Act 53. Porter Hospital's Community Advisory Committee assess community needs biennially. The results of the assessment are posted on Porter Medical Center's Web Site. Part VI, Line 3: Porter Hospital's Financial Assistance Program is posted on the Porter Medical Center Web Site. In addition, all patients receive a brochure entitled "Important Information About your rights and responsibilities as a patient". The brochure states that the patient has the right to receive the most appropriate medical treatment available regardless of ability to pay and receive information about financial assistance. Part VI, Line 4: Porter Hospital, Inc. is the major provider of health care in Addison County, Vermont. Porter Hospital, Inc. also provides services to residents of northern Rutland County, Vermont, Essex County, New York and elsewhere in this region. Part VI, Line 5: Porter Hospital, Inc. provides rent free clinic space and vouchers for no-cost ancillary services to the local Open Door Clinic in its role as a catalyst in the delivery of health care services to its entire community.Porter Hospital, Inc. offers free and low cost community education programs on health care topics including memory loss, dementia, breast cancer screening, basic diabetes, CPR, smoking cessation, parenting, prenatal exercise and breast feeding.A majority of the governing body is comprised of persons who reside in its service area and who are neither employees nor contractors of Porter Hospital, Inc. nor family members thereof. Medical staff privileges are extended to all qualified physicians in the community.Surplus funds are invested in technology, facilities and programs. Porter Hospital and the local Career Center collaborate on a new Health Careers Education program. Part VI, Line 6: Porter Hospital, Inc. and Helen Porter Nursing Home, Inc. are wholly owned subsidiaries of Porter Medical Center. Through its subsidiaries, Porter Medical Center provides a continuum of health services including in-patient care, out-patient care, short-term rehabilitation, long-term rehabilitation, long-term care, dementia care, wellness programs and prevention programs. Part VI, Line 7, Reports Filed With States VT 1 Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 6380 FMV Use of space on Hospital Campus and satellite physician practice site Operational Assistance 1 0 Part I, Line 2: Porter Hospital provides physician office space on campus as well as at one of Porter Hospital's off-site physician practice office to the Open Door Clinic. Porter Hospital provides this in-kind, non-cash assistance to further the mission of out-reach to the medically needy within the Addison County healthcare community. This support dovetails with the mission of the Blueprint for Health to stabilize chronic health conditions for the most fragile social-economic population. 1 1 0 0 0 0 0 1 0 Kristofer Anderson MD Director 239602 0 0 0 499 0 7255 0 9929 0 257285 0 0 0 Michael Kiernan MD Director 157657 0 10000 0 568 0 7737 0 25287 0 201249 0 0 0 Benjamin Rosenberg MD Director 414288 0 94039 0 2213 0 7650 0 25765 0 543955 0 0 0 Carrie Wulfman MD Director 194662 0 8000 0 743 0 8269 0 24387 0 236061 0 0 0 James Daily President/CEO 0 333811 0 0 0 3108 0 91950 0 26809 0 455678 0 0 Salvatore Morana Past Dir. Professional Services 171038 0 7536 0 253 0 5491 0 27651 0 211969 0 0 0 Jean Cotner VP of Porter Practice Management 177467 0 0 0 1479 0 5460 0 18066 0 202472 0 0 0 Patricia Jannene Past Chief Nursing Officer 20231 0 0 0 154288 0 0 0 2189 0 176708 0 0 0 Fred Kniffin Chief Medical Officer 252779 0 0 0 1133 0 12582 0 17295 0 283789 0 0 0 Eric Benz MD Orthopedic Surgeon 415080 0 94039 0 1443 0 7650 0 25084 0 543296 0 0 0 Anders Holm MD MD Otolaryngology 333922 0 0 0 764 0 10200 0 30592 0 375478 0 0 0 Daniel Raabe MD MD Cardiology 349620 0 0 0 16356 0 7650 0 19845 0 393471 0 0 0 David Turner MD MD OB/GYN 238254 0 0 0 499 0 7395 0 28289 0 274437 0 0 0 Katherine Wagner MD MD OB/GYN 226713 0 0 0 429 0 7007 0 26967 0 261116 0 0 0 Marilyn Olejnik Former CFO 0 30483 0 0 0 100234 0 0 0 1115 0 131832 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, Lines 4a-b Marilyn Olejnik, Former CFO, received a severance payment in the amount of $100,000 during calendar year 2013. James Daily, President/CEO, participates in a 457(f) plan, and $79,200 was deferred on his behalf to the plan during FY 9/30/14. Part I, Line 7 Benjamin Rosenberg, M.D., and Eric Benz, M.D. received bonuses which were based on their Relative Value Units (RVU's) of services exceeding a target amount. Michael Kiernan, M.D. received a bonus stipend as Medical Staff President. Carrie Wulfman, M.D. also received a bonus stipend for unassigned patients at Helen Porter Nursing Home. Salvatore Morana received a bonus for the launch of the 340b program. A Vermont Educational and Health Buildings Financing Agency 237154467 9241607X6 2005-06-17 15430000 Funding for new Construction 0 0 0 A 2260000 15430000 4974901 207863 170152 10077084 2005 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Remora LLC An entity more than 5% owned directly by Bill Townsend, Board Director 157700 Rental of Property 0 Form 990, Part VI, Section A, line 6 Porter Medical Center, Inc. is the parent holding company and sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to appoint Hospital directors. Form 990, Part VI, Section A, line 7b Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to approve major hospital expenditures and approve hospital long-term borrowings. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by management and the Audit committee before filing. The form 990 is also made available electronically to the Board of Directors before filing. Form 990, Part VI, Section B, line 12c The Organization's CFO is responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. When bids are solicited to include the business of a Board member, those bids are reviewed by the Board of Directors to assure adherence to the Hospital's lowest bid policy. When an issue comes up to a vote and it is connected, in any way, to the business of a Board member, the member must recuse him/herself from the vote. Form 990, Part VI, Section B, line 15a The Organization's executive committee reviews comparative data prepared by a consultant prior to referral of compensation to the board of directors. The board of directors review the findings of the consultant and vote to approve the salary of the CEO. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Change in Net Assets to Recognize Funded Status of Pension Plan -468,947. Change in Beneficial Interest in Perpetual Trusts 179,656. Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 11b, II N/A 0 Helen Porter Nursing Home Inc DBA Helen Porter Healthcare & Rehab Center 37 Porter Drive Middlebury VT 05753 030306549 Nursing Home VT 501(c)(3) Line 3 Porter Medical Center Inc 0 Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 11b, II Porter Medical Center Inc 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0