2015-08-14T13:49:21-05:00 2014-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-10-01 030266986 Northwestern Medical Center NORT 8025245911 133 Fairfield St St Albans VT 05478 Ted Sirotta CFO 8025245911 2015-08-10 1 Barbara J McGuan CPA P00219457 2077752387 2015-08-10 2013 2016-04-25 22:37:26Z Ted Sirotta 133 Fairfield St St Albans VT 05478 109965397 0 X www.northwesternmedicalcenter.org X 1977 VT Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 12 12 803 113 0 0 327555 590969 95171499 96775485 1636962 3387987 170889 201966 97306905 100956407 27000 27000 0 0 47497861 49968871 0 0 0 40477459 40346617 88002320 90342488 9304585 10613919 122454444 133221453 33631889 33095512 88822555 100125941 X Northwestern Medical Center's mission is to provide exceptional healthcare for our community. 0 0 69354472 27000 96977451 Providing inpatient and outpatient services to the general public in a full-service 70-bed hospital. The Hospital publishes an annual report. Please refer to the annual report for additional explanation of the Hospital's programs and achievements. Charity Care - The Hospital provides care to patients who meet certain criteria under its charity care policy. Because the Hospital does not pursue collection or amounts determined to qualify as charity care they are not reported in revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The 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 level of charity care provided during the year ended September 30, 2014.See continuation on Schedule O. Estimated costs and expenses incurred to provide charity care: $578,433.Number of charity care patients served: 1,535The Hospital provides health care services to residents of St. Albans, Vermont, and the surrounding area, without regard to the individual's ability to pay for their services. 69354472 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 91 0 1 803 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Ted Sirotta CFO 8025241042 133 Fairfield Street St Albans VT 05478 Kevin Manahan Vice President 5.00 X X 0 0 0 Michelle P Lawrence Member 5.00 X 0 0 0 Paul L Clark Member/Past President 5.00 X X 0 0 0 John T Hango President 5.00 X X 0 0 0 Paula J Kane Esq Member 5.00 X 0 0 0 Frank J Zsoldos MD Member 5.00 X 0 0 0 Patrick Talcott Treasurer 5.00 X X 0 0 0 William O'Connor Jr Secretary 5.00 X X 0 0 0 David Groening MD Past Member 5.00 X 0 0 0 Janet McCarthy Member 5.00 X 0 0 0 Marietta Scholten MD Member 5.00 X 0 0 0 Leon Berthiaume Member 5.00 X 0 0 0 John Minadeo MD Member 5.00 X 0 0 0 Jill Berry Bowen CEO 40.00 X 297441 0 25867 Ted Sirotta CFO 40.00 X 243816 0 36988 Michael Barnum MD Orthopedic Surgeon 40.00 X 928605 0 26195 Robert Beattie MD Orthopedic Surgeon 40.00 X 697657 0 5100 Jeremy Hatch MD Orthopedic Surgeon 40.00 X 451843 0 20573 Peter Burke MD Pathologist 40.00 X 385601 0 26195 Lawrence Sullivan MD CMO/OB GYN Physician 40.00 X 434002 0 26195 3438965 0 167113 52 0 1 1 Quorum Health Resources 105 Continental Place Brentwood TN 37027 Mgmt/Consulting (incl. CEO/CFO comp.) 1225050 University of Vermont Medical Center PO Box 1902 Burlington VT 05402 Lab & Stress Test Services 1027209 Clinical Colleagues 1121 N Bethlehem Pike Suite 60-23 Spring House PA 19477 Anesthesia Services 857971 E F Wall & Associates Inc 131 South Main Street Barre VT 05641 Construction Services 800106 Leaders for Today Inc 981 Worcester Street Suite 1C Wellesley MA 02482 Interim Management Services 787282 73 151976 438993 590969 Patient Service Revenue 900099 178553822 178553822 Other Operating Revenue 900099 2892239 2892239 Cafeteria 900099 483208 483208 Provision for Bad Debts 900099 -5295127 -5295127 Contractual Allowances/Char. Adj. 900099 -79858657 -79858657 96775485 1446749 1446749 211850 9884 201966 201966 201966 10925294 15050 8971693 27413 1953601 -12363 1941238 1941238 100956407 96494243 0 3871195 27000 27000 604131 604131 39689301 31084661 8604640 1382999 1083165 299834 5720803 4480533 1240270 2571637 2014106 557531 629650 629650 119165 119165 80450 80450 17597 17597 82979 82979 8426380 6613323 1813057 351026 274924 76102 920550 675345 245205 1854816 1452692 402124 326029 255346 70683 514834 514834 4147370 3248220 899150 949866 743935 205931 Supplies 10149710 7949253 2200457 Provider Tax 5329587 5329587 Miscellaneous 3518807 1194581 2324226 NOH 2927801 2927801 90342488 69354472 20988016 0 3708 3908 13497569 21658263 8775432 9111338 123800 96800 1742789 1667318 3000146 3030967 71990139 39852279 31143591 32137860 59499649 60429553 3806027 4213815 119332 102674 742401 768957 122454444 133221453 10364947 9605446 19317138 18595085 168389 158046 3781415 4736935 33631889 33095512 X 86574971 97601962 1314827 1565776 932757 958203 88822555 100125941 122454444 133221453 X 10613919 688948 519 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 17597 17597 0 Part II-B, Line 1: Northwestern Medical 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 Northwestern Medical Center and other member organizations in furtherance of their exempt purposes. Northwestern Medical Center does not directly perform any lobbying activities. 932757 25446 958203 896871 35886 932757 884630 34994 22753 896871 847600 37030 884630 806185 41415 847600 0.00000 1.00000 0.00000 1 0 1020531 1020531 41128391 21202042 19926349 26435088 17241813 9193275 3406129 1408424 1997705 32137860 Estimated Third Party Settlements 3646314 Interest Rate Swaps 1090621 4736935 101562895 688948 519 689467 100873428 82979 82979 100956407 90259509 0 90259509 82979 82979 90342488 Part V, Line 4: The Organization intends to use the endowment funds in the manner prescribed by the donors. Part XI, Line 2d - Other Adjustments: Increase in Perpetual Trusts 25,446. Unrealized Loss on Interest Rate Swaps -24,927. Schedule D, Part V, Line 3a(i) The Organization has Beneficial Interest in Trusts which are not held at nor in the possession of the Organization. Central America and the Caribbean 0 0 Investments 4213815 0 0 0 0 0 0 4213815 0 4213815 0 0 0 0 0 0 1 1 1 X 300.000000000000 1 X 300.000000000000 1 1 0 0 578433 578433 0.00640 22700202 16683095 6017107 0.06660 23278635 16683095 6595540 0.07300 3106465 1877690 1228775 0.01360 59241 59241 0.00070 3165706 1877690 1288016 0.01430 26444341 18560785 7883556 0.08730 1 1906246 23785929 27561239 -3775310 X 1 1 1 1 Northwestern Medical Center 133 Fairfield Street St Albans VT 05478 X X X Northwestern Medical Center 1 1 X X X X X X X X X 11 1 0 1 X www.northwesternmedicalcenter.org X X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X X X 1 0 X X 1 X 0 0 Northwestern Medical Center Part V, Section B, Line 3: As part of our FY 2012 Community Health Needs Assessment, NMC used two initiatives to take into account input from persons who represent the community served. We deployed a Community Health Needs Assessment survey within the local population for any resident to complete. We received community input from 258 anonymous area residents which came in response to communication efforts including paid advertisements in the local newspaper and distributed to local civic and health organizations with a request for participation by their members and clients. Additional input was received by a local group of experts, who were asked to validate the assessments and to establish priority among various identified issues. The composition of this group of community members aligns with the Federal regulations for the involvement of community leaders with specified skills or representing specified constituencies or professions. Northwestern Medical Center Part V, Section B, Line 5d: In addition to making the Community Health Needs Assessment widely available via the hospital website and in response to requests, Northwestern Medical Center provided overviews of the Community Health Needs Assessment to members of the community through presentations at groups such as the NMC Incorporators (150 local members who elect the hospital Board) and the Franklin Grand Isle Community Partnership (40+ health, education, and social service agencies who meet on a regular basis to address concerns within the community). The priorities of the Community Health Needs Assessment are frequently referenced in other hospital documents, plans, publications, and presentations as we work to integrate these findings into our efforts to care for our community. 6 Northwestern Walk-in Clinic 927 Ethan Allen Hwy Ste 2 Georgia VT 05468 Diagnostic Imaging, Physical Therapy & Urgent Care Branon's Pools & Spa 248 North Main Street St Albans VT 05478 Physical Therapy Physical Therapy Services 44 Center Street Enosburg VT 05450 Physical Therapy Northwestern Georgia Health Center 4178 Highbridge Road Georgia VT 05486 Primary Care Northwestern Ophthalmology 53 Fairfax Road St Albans VT 05478 Ophthalmology Northwestern Comprehensive Pain 17-19 Catherine Street St Albans VT 05478 Pain Care Part I, Line 3c: Determining eligibility for free care and/or discounted care is not solely determined by Federal Poverty Guidelines (FPG). Other considerations, such as net worth, other financial obligations, and outstanding medical bills are reviewed in addition to income. Part I, Line 7g: Subsidized health services includes the Medicare shortfall from physician practices that are not included in the Hospital's cost reporting reflected on Part III, Line 7. 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 major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. For receivables relating to services provided to patients having third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a corresponding provision for bad debts at varying levels based on the age of the receivables and the payor source. For receivables relating to self-pay patients (which includes both patients without insurance and patients with deductibles, and copayment balances due for which third-party coverage exists for part of the bills), the Hospital records a provision for bad debts in the period of service based on past experience which indicates 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. Part III, Line 8: The cost was determined using the cost to charge ratio. Part III, Line 9b: During the collection process, financial assistance, a payment plan or a discount may be offered to the patient, if appropriate, and in accordance with established hospital policy. Part VI, Line 2: In alignment with the new Federal mandate, Northwestern Medical Center completed a comprehensive community health needs assessment in September of 2012. The document was formally approved by the hospital's Board of Directors at their October 3, 2012 meeting. The 2012 assessment identified 11 high priorities and 13 additional priorities facing the community. The top 5 most pressing priorities were: Mental Health & Substance Abuse; access/availability to healthcare and physicians; obesity; smoking; and cancer. The findings influenced many of the strategic initiatives contained within the hospital's Strategic Plan for Fiscal Year's 2014-2016. The FY 2012 Community Health Needs Assessment is available free of charge to the public via the Northwestern Medical Center website. The hospital also collaborates in smaller, more focused community needs assessments through our partnerships with agencies such as the Franklin Grand Isle United Way. Part VI, Line 3: The Hospital uses a variety of methods of communication to inform and educate patients about its financial assistance program. For example, information related to financial assistance and charity care is available on the Hospital's website and patient portal, included on the back of patient statements, posted on signs at registration areas, and patients may speak on the phone with a collection specialist. The Hospital's financial assistance program is also widely publicized within the community, including published information regularly placed in the local newspaper and information brochures displayed at local United Way and Department of Health offices. Part VI, Line 4: The Hospital serves the greater Franklin and Grand Isle counties in northwestern Vermont. The service area consists of approximately 54,000 people and the area is primarily rural and agricultural in nature with some light industry. Part VI, Line 5: The Hospital maintains an open medical staff and a community based Board of Directors. The Hospital's Board of Directors is elected by the Hospital's Board of Incorporators, which consists of approximately 150 local residents. The Hospital created and funds a program known as The Center for Health and Wellness, which is committed to a collaborative approach to community health improvement. 1 Franklin Grande Isle United Way 40 Lower Newton Street St Albans VT 05478 030273929 501(c)(3) 15000 Support programs complimentary to the Hospital's exempt purpose. HowardCenter Inc 208 Flynn Avenue Suite 3J Burlington VT 05401 030179433 501(c)(3) 12000 Support programs complimentary to the Hospital's exempt purpose. 2 0 Part I, Line 2: All assistance is given to either 501(c)(3) public charities or governmental units and their affiliates. Therefore, additional monitoring is not deemed necessary. X 1 1 X X X 0 0 0 0 0 0 0 1 0 Jill Berry Bowen CEO 272629 0 17552 0 7260 0 8925 0 16942 0 323308 0 0 0 Ted Sirotta CFO 234176 0 9640 0 0 0 7417 0 29571 0 280804 0 0 0 Michael Barnum MD Orthopedic Surgeon 750585 0 168795 0 9225 0 5100 0 21095 0 954800 0 0 0 Robert Beattie MD Orthopedic Surgeon 678907 0 5000 0 13750 0 5100 0 0 0 702757 0 0 0 Jeremy Hatch MD Orthopedic Surgeon 446843 0 5000 0 0 0 5100 0 15473 0 472416 0 0 0 Peter Burke MD Pathologist 380401 0 5000 0 200 0 5100 0 21095 0 411796 0 0 0 Lawrence Sullivan MD CMO/OB GYN Physician 331638 0 102034 0 330 0 5100 0 21095 0 460197 0 0 0 Part I, Line 1a Northwestern Medical Center provides fitness club membership automatically for all employees. The employees are required to sign in at the fitness club and those records are provided regularly to the Hospital to determine the amount of payment due to the fitness club. Part I, Line 7 Jill Berry Bowen, CEO, and Ted Sirotta, CFO, compensation plans may include, among other things, elements that require meeting or exceeding financial performance measures, including profitability. Michael Barnum, Robert Beattie, Jeremy Hatch, Peter Burke, and Lawrence Sullivan, Highest Compensated Employees, received bonuses as part of an organization wide bonus payment, whereby the bonus payment was determined based on the number of hours worked during the year. Form 990, Part VII, line 5: Jill Berry Bowen, CEO, was compensated through a contract with Quorum Health Resources. Her total compensation for the period ended December 31, 2013 was $323,308. Ted Sirotta, CFO, was compensated through a contract with Quorum Health Resources. His total compensation for the period ended December 31, 2013 was $280,804. A Vermont Educational & Health Building Financing Agency 227154467 2012-11-01 19900000 Refund 2010A Bond and new capital projects 0 0 0 A 1304915 19900000 1571257 124765 242021 17961957 1 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 1 Deutsche Bank AG 18.000000000000 0 0 0 0 1 A 0 Form 990, Schedule K, Part IV, Line 4a: The Organization has entered into two qualfied hedge agreements with respect to the bond issue. In addition to the Deutsche Bank AG agreement shown on Schedule K, Part IV, Line 4b, the Organization also has an agreement with Morgan Stanley. Form 990, Part VI, Section A, line 3 The Organization's CEO, Jill Berry Bowen & CFO, Ted Sirotta are employees of Quorum Health Resources, an unrelated management company. Please refer to Form 990, Part VII for compensation paid to these individuals by Quorum Health Resources. Form 990, Part VI, Section A, line 6 The organization has a maximum of 150 members, elected at the annual meeting from a slate of candidates nominated by the Nominating Committee. Other candidates for membership may be nominated from the floor at the annual meeting. Any person whose term as a Corporation Director has expired shall automatically become a member if that person consents to become a member. Form 990, Part VI, Section A, line 7a The membership elects a presiding membership officer, an alternate presiding membership officer and a membership secretary. Said officers are designated as Chair, Vice Chair and Recording Secretary of the membership. Form 990, Part VI, Section B, line 11 The CFO reviews the 990 and compares it to the audited financial statements. In addition, a copy of the 990 is provided to all members of the Hospital's Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c Regular monitoring occurs at a minimum annually when each individual must complete the annual disclosure form. Form 990, Part VI, Section B, line 15 The CEO and CFO are not employees of Northwestern Medical Center. They are employees of Quorum Health Resources and their respective contracts, including compensation, are approved by the Board of Directors on an annual basis. Form 990, Part VI, Section C, line 19 Northwestern Medical Center does not formally make its governing documents and conflict of interest policy available to the public. Financial information is available to the public through the annual tax return filing, annual Medicare and Medicaid cost report filing, and financial data published by the Green Mountain Care Board and available on the Hospital's website, as well as summarized financial information and statistics published in the Hospital's annual report distributed to local communities and published on the Hospital's website. Form 990, Part XI, line 9: Unrealized Loss on Interest Rate Swaps -24,927. Increase in Perpetual Trusts 25,446. Northwestern Occupational Health LLC 133 Fairfield street St Albans VT 05478 030360669 Medical rehabilitative and urgent care services VT 2470931 1446922 Northwestern Medical Center Northwestern Medical Center Auxiliary Inc 133 Fairfield St St Albans VT 05478 030278425 Promotion and Support of Northwestern Medical Center VT 501(c)(3) Line 11a, I Northwestern Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0