2014-08-08T09:31:49-05:00 2013-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-10-01 030306549 Helen Porter Nursing Home Inc HELE 8023884701 115 Porter Drive Middlebury VT 05753 Steven T Ciampa 8023884701 2014-08-06 1 Barbara J McGuan CPA P00219457 2077752387 2014-08-06 2012 2015-11-30 17:44:51Z X Helen Porter Healthcare & Rehab Center James L Daily 115 Porter Drive Middlebury VT 05753 9584573 0 X www.portermedical.org X 1986 VT Operation of 105 bed skilled nursing home 11 9 275 36 0 0 120815 82029 9484317 9486666 475 15878 0 0 9605607 9584573 0 0 0 0 6983280 6856964 0 0 0 2476256 2902707 9459536 9759671 146071 -175098 3430359 3446271 6027910 5730582 -2597551 -2284311 X The mission of Helen Porter Healthcare and Rehabilitation Center is to provide health care and related services to the people of our region. The Organization will:1. Provide a broad spectrum of services including long-term, short-term rehabilitation, respite, hospice and dementia care;2. Ensure the delivery of high quality and compassionate care to all residents in a financially responsible manner that allows individuals to achieve their greatest level of independence and dignity;3. Serve as a leader and catalyst in helping to determine and to provide for the health needs of the community, while striving to remain a financially viable organization. 0 0 7314525 9479711 Operated long-term community oriented 105 bed skilled nursing home. The nursing home provided services to patients that totaled 35,171 resident days during the year ended 9/30/2013. 7314525 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 275 1 0 0 0 0 0 0 0 0 0 0 X 11 9 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 8023884701 115 Porter Drive Middlebury VT 05753 Linda Harmon 1.00 2.00 X X 0 0 0 Elizabeth Markowski 1.00 X X 0 0 0 Joe Sutton 1.00 4.00 X X 0 0 0 James L Daily 5.00 40.00 X X 0 354566 121556 Betsy Gossens 2.00 X 0 0 0 Nicholas Clifford 1.00 1.00 X 0 0 0 Betsy Gleason 1.00 2.00 X 0 0 0 Ann Hanson 1.00 2.00 X 0 0 0 Lynn Coale 1.00 1.00 X 0 0 0 Mary Jane Broughton 1.00 X 0 0 0 Carole Cummings 2.00 X 0 0 0 Bill Townsend 2.00 9.00 X 0 0 0 Carrie Wulfman 2.00 40.00 X 0 180799 11902 Steven T Ciampa 5.00 40.00 X 0 0 0 Marilyn Olejnik 5.00 40.00 X 0 215081 24674 Neil Gruber 40.00 X 142770 0 13331 142770 750446 171463 1 0 1 0 0 2000 80029 82029 Patient Revenue 623000 12763192 12763192 Other Revenue 623000 29711 22756 6955 Lifeline Revenue 623000 22465 22465 Provision for Bad Debt 623000 -75833 -75833 Contractual Allowances 623000 -3252869 -3252869 9486666 15878 15878 9584573 9479711 0 22833 156101 156101 5212861 4601879 610982 159634 143804 15830 910695 787341 123354 417673 358890 58783 183487 183487 7543 7543 44712 44712 121711 121711 4175 4175 28305 28305 78016 78016 9862 9862 79792 79792 252650 252650 91922 91922 Medical Supplies 1422611 1422611 Medicare Provider Tax 516551 516551 Miscellaneous Expense 52882 52882 Dues & Subscriptions 8488 8488 9759671 7314525 2445146 0 1500 38097 612596 570470 1326042 1242369 28146 27444 7260 92446 5633599 4263450 1346173 1370149 106945 93997 1697 11299 3430359 3446271 765004 686694 3585000 3475000 0 14898 8193 3652 741973 741973 927740 808365 6027910 5730582 X -2688571 -2296305 91020 11994 -2597551 -2284311 3430359 3446271 X -175098 488338 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 905 905 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 0 1 X 4582426 3583265 999161 871366 547509 323857 179807 132676 47131 1370149 Due to Affiliates 253830 Liability for Pension Benefits 514249 Estimated Third-Party Settlements 40286 808365 10072911 488338 488338 9584573 0 9584573 9759671 0 9759671 0 9759671 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 329,282. Equity Transfer from Affiliate 159,056. X X X X 0 1 0 0 0 0 0 0 0 James L Daily 0 320845 0 0 0 33721 0 91700 0 29856 0 476122 0 0 Carrie Wulfman 0 170773 0 6000 0 4026 0 7302 0 4600 0 192701 0 0 Marilyn Olejnik 0 197323 0 0 0 17758 0 6401 0 18273 0 239755 0 0 Neil Gruber 134381 0 0 0 8389 0 7725 0 5606 0 156101 0 0 0 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 9/30/13. 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 finance 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in Net Assets to Recognize Funded Status of Pension Plan 329,282. Equity Transfer from Affiliate 159,056. Reason for Public Charity Status Form 990, Schedule A, Part I, Line 3: 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 Porter Management Services Inc 37 Porter Drive Middlebury VT 05753 030308242 Management Services VT 501(c)(3) Line 11b, II 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 0 0 0 1 0 1 0 0 0 0