BRATTLEBORO MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
BRATTLEBORO MEMORIAL HOSPITAL (EIN 03-0107300)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-04
IRS object ID
201422169349300787
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-08-04T11:31:44-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN010523282EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Berry Dunn McNeil & Parker LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1100AddressLine1
CityPortlandCity
StateMEState
ZIP Code041041100ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN030107300EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Brattleboro Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBRATNameControl
Phone8022570341Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 Belmont AvenueAddressLine1
CityBrattleboroCity
StateVTState
ZIP Code05301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMichael RogersName
TitleVice President of FinanceTitle
Phone8022570341Phone
Date Signed2014-07-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBarbara J McGuan CPAName
PTINP00219457PTIN
Phone2077752387Phone
Date Prepared2014-07-31DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael RogersNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line117 Belmont AvenueAddressLine1
CityBrattleboroCity
StateVTState
ZIP Code05301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts84126334GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitehttp://www.bmhvt.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1904YearFormation
State Legal DomicileVTStateLegalDomicile
Activity Or Mission DescriptionTo provide health care services on a region-wide basisActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees601TotalNbrEmployees
Total Nbr Volunteers106TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year459540ContributionsGrantsPriorYear
Contributions Grants Current Year1138632ContributionsGrantsCurrentYear
Program Service Revenue Prior Year68487383ProgramServiceRevenuePriorYear
Program Service Revenue CY69672915ProgramServiceRevenueCY
Investment Income Prior Year427213InvestmentIncomePriorYear
Investment Income Current Year779610InvestmentIncomeCurrentYear
Other Revenue Prior Year-178982OtherRevenuePriorYear
Other Revenue Current Year-214705OtherRevenueCurrentYear
Total Revenue Prior Year69195154TotalRevenuePriorYear
Total Revenue Current Year71376452TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY22135GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year36264557SalariesEtcPriorYear
Salaries Etc Current Year36732788SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year29030577OtherExpensePriorYear
Other Expenses Current Year30467394OtherExpensesCurrentYear
Total Expenses Prior Year65295134TotalExpensesPriorYear
Total Expenses Current Year67222317TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3900020RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4154135RevenuesLessExpensesCY
Total Assets BOY63371670TotalAssetsBOY
Total Assets EOY72348530TotalAssetsEOY
Total Liabilities BOY25078736TotalLiabilitiesBOY
Total Liabilities EOY29308672TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY38292934NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY43039858NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionBrattleboro Memorial Hospital will provide community-based quality health services delivered with compassion and respect.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense53487921Expense
Grants22135Grants
Revenue66943855Revenue
DescriptionProvision of Hospital Care, both inpatient and outpatient services, on a region-wide basis. Approximately 144,386 outpatients and 2,026 inpatients were served throughout the year.Brattleboro Memorial Hospital is a modern, well-equipped and professionally staffed community hospital which has been serving greater Brattleboro and the tri-state area since 1904. Throughout our more than a century of caring for our community, BMH has kept up with medical technology which, in turn, has drawn excellent physicians to our facility. The BMH Medical Staff boasts more than 100 board-certified physicians, active in both primary care and many specialties.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1430300Expense
Revenue2729060Revenue
DescriptionCharity Care:The Hospital's charity care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. Before completing an application for charity care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veteran's Benefits or other governmental or public assistance programs. The Hospital's qualifications for charity care are as follows:1) Charity care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by the charity care program.2) Patient's family income must be at or below 300% of the current Federal Poverty Income Guidelines for their applicable family size.The Hospital maintains records to identify and monitor the level of charity care it provides. These 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 levels of the charity care provided during the year ended September 30, 2013:Equivalent percentage of charity care services to all services 2.13%Number of patients receiving charity care 4,922In addition, the Hospital also incurred payment shortfalls in the treatment of Medicare and Medicaid patients. Both of these government programs reimburse for medical services at less than published charges to provide those services. In 2013, the Hospital incurred shortfalls of approximately $5,391,000 and $6,612,000 related to treating Medicare and Medicaid patients, respectively.The Hospital also provided many other community benefits upon which no monetary value can be placed such as:-BMH provides space at no cost to the local non-profit Brattleboro Walk-in Clinic.-Promotes wellness through screening and demonstrations at our annual Health Fair.-Offers free smoking cessation classes.-Collaborates with other community agencies in publishing a community wellnes calenday twice a year.Description
FieldValueIRS element (for citing)
Total Program Service Expense54918221TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109697NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees601NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Michael RogersBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8022570341TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line117 Belmont AvenueAddressLine1
CityBrattleboroCity
StateVTState
ZIP Code05301ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
John M Meyer
Secretary/Past Vice Chair1.001.00XX000
Carl Lynde
Chair/Past Secretary1.001.00XX000
Jill Zachary
Board Member1.001.00X000
Ben Taggard
Board Member1.001.00X000
Burton Tepfer MD
Board Member1.001.00X3857600
Peter Carvell
Vice Chair1.001.00XX000
Deborah Boyle
Board Member1.001.00X000
Leslie Morey
Past Board Member1.001.00X000
Denise Paasche MD
Board Member1.001.00X121400
Stephen Phillips
Board Member1.001.00X000
Patty O'Donnell
Board Member1.001.00X000
Kirsten Beske
Past Chair1.001.00XX000
Richard Carroll
Past Board Member1.001.00X000
Steven Gordon
President & CEO20.0020.00X029248017035
Michael Rogers
VP Finance, Treas. & CFO20.0020.00X019439939013
Mary Urquhart
VP Patient Care Services20.0020.00016471734299X
Teresa Fitzharris-Onyon MD
ER Physician40.00272179038039X
Christopher Schmidt MD
Medical Director-Emergency40.00295287037414X
Joseph Rosen MD
General Surgeon40.00267114038039X
Gregory Gadowski MD
General Surgeon40.00288517040816X
Thomas H Lewis MD
General Surgeon40.00280775038110X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1443662TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs651596TotalReportableCompFrmRltdOrgs
Total Other Compensation282765TotalOtherCompensation
Number Individuals GT100 K38NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Cummings HP Contruction Co
PO Box 269 5 High StreetWoodsvilleNH03785General Contractor3180425
Southern VT Health Services Corp
17 Belmont AvenueBrattleboroVT05301Management Fees1404001
Dartmouth Hitchcock Keene
599 Court StreetKeeneNH03431ER Provider Staffing895546
GPI Construction Inc
436 Canal Street Suite 101BrattleboroVT05301General Contractor777993
Anesthesia Physicians of Brattleboro
17 Belmont AvenueBrattleboroVT05301Medical Services710000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K17NumberOfContractorsGT100K
Related Organizations530950RelatedOrganizations
Government Grants241758GovernmentGrants
All Other Contributions365924AllOtherContributions
Total Contributions1138632TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenue621400128069069128069069
Miscellaneous Revenue90009913573051357305
Meaningful Use Revenue900099142850142850
Provision for Bad Debt621400-3974965-3974965
Contractual Allowances621400-55921344-55921344
FieldValueIRS element (for citing)
Total Program Service Revenue69672915TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column246099TotalRevenueColumn
Exclusion$246,099ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real224013Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real438718Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-214705Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-214705TotalRevenueColumn
Exclusion-$214,705ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities12835056Securities
Other9619Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities12304036Securities
Other7128Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities531020Securities
Other2491Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column533511TotalRevenueColumn
Exclusion$533,511ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column71376452TotalRevenueColumn
Related Or Exempt Function Income69672915RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$564,905ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total22135Total
Program Services22135ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total39790Total
Program Services39790ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total28197923Total
Program Services22751786ProgramServices
Management And General5446137ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1090295Total
Program Services880065ProgramServices
Management And General210230ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5960168Total
Program Services5009657ProgramServices
Management And General950511ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1444612Total
Program Services1166063ProgramServices
Management And General278549ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1404001Total
Program Services241000ProgramServices
Management And General1163001ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total35691Total
Management And General35691ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total69600Total
Management And General69600ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total44812Total
Management And General44812ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7775243Total
Program Services6497741ProgramServices
Management And General1277502ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total197640Total
Program Services107879ProgramServices
Management And General89761ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total746627Total
Program Services570137ProgramServices
Management And General176490ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1705912Total
Program Services1297777ProgramServices
Management And General408135ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total163289Total
Program Services118104ProgramServices
Management And General45185ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total254238Total
Program Services182109ProgramServices
Management And General72129ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total62773Total
Management And General62773ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3555368Total
Program Services2546686ProgramServices
Management And General1008682ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total660222Total
Program Services660222ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Provider Taxes39895063989506
Drugs35277873527787
Medical/Surgical Suppli33577203356901819
Lab Supplies110896711089670

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1807998Total
Program Services843909ProgramServices
Management And General964089ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total67222317Total
Program Services54918221ProgramServices
Management And General12304096ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY99947BOY
EOY3586EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6238648BOY
EOY6576524EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5834564BOY
EOY9519856EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1510932BOY
EOY2279058EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY354205BOY
EOY302414EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis62652435LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec34585524LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY22837674BOY
EOY28066911EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY25441707BOY
EOY24728422EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1053993BOY
EOY871759EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY63371670BOY
EOY72348530EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8351198BOY
EOY13002258EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY103080EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9845000BOY
EOY9425000EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY13693BOY
EOY8601EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6868845BOY
EOY6769733EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25078736BOY
EOY29308672EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY37834307BOY
EOY42586636EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY179682BOY
EOY174241EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY278945BOY
EOY278981EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38292934BOY
EOY43039858EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY63371670BOY
EOY72348530EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4154135ReconcilationRevenueExpenses
Reconciliation Unrealized Invest238048ReconciliationUnrealizedInvest
Reconcilation Other Changes354741ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$19,074OtherActivitiesAmount
Total Lobbying Expenditures IIB19074TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationBMH is a member of the VT 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 BMH and other member organizations in furtherance of their exempt purposes. BMH does not directly perform any lobbying activities.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis45499OtherCostOrOtherBasis
Book Value45499BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis37398216OtherCostOrOtherBasis
Depreciation17552207Depreciation
Book Value19846009BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis23122310OtherCostOrOtherBasis
Depreciation15894588Depreciation
Book Value7227722BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2086410OtherCostOrOtherBasis
Depreciation1138729Depreciation
Book Value947681BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings28066911TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Estimated third-party payor settlements$6,091,010
Interest Rate Swap$678,723
FieldValueIRS element (for citing)
Total Of Amounts6769733TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt71861656TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments238048NetUnrealizedGainsInvestments
Other Revenues354831OtherRevenues
Revenue Not Rptd F990592879RevenueNotRptdF990
Revenue Subtotal71268777RevenueSubtotal
Investment Expenses Not Included44812InvestmentExpensesNotIncluded
Other Revenues Not Included62863OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt107675RevenueNotRptdOnFinStmt
Total Revenue Per Form99071376452TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt67114732TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal67114732ExpensesSubtotal
Investment Expenses Not Included244812InvestmentExpensesNotIncluded2
Other Expenses Not Included62773OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt107585ExpensesNotRptdOnFinStmt
Total Expenses Per Form99067222317TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 2d - Other Adjustments:Unrealized Loss on Interest Rate Swap 354,831.
Part XI, Line 4b - Other Adjustments:Transfer to SVHSC 62,773. Change in Interest in SVHSC 90.
Part XII, Line 4b - Other Adjustments:Transfer to SVHSC 62,773.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage250.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1305046TotalCommunityBenefitExpense
Net Community Benefit Expense1305046NetCommunityBenefitExpense
Percent Of Total Expense0.01940PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense14792253TotalCommunityBenefitExpense
Direct Offsetting Revenue8811466DirectOffsettingRevenue
Net Community Benefit Expense5980787NetCommunityBenefitExpense
Percent Of Total Expense0.08900PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1134168TotalCommunityBenefitExpense
Direct Offsetting Revenue1306092DirectOffsettingRevenue
Net Community Benefit Expense-171924NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense17231467TotalCommunityBenefitExpense
Direct Offsetting Revenue10117558DirectOffsettingRevenue
Net Community Benefit Expense7113909NetCommunityBenefitExpense
Percent Of Total Expense0.10840PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense557890TotalCommunityBenefitExpense
Direct Offsetting Revenue406600DirectOffsettingRevenue
Net Community Benefit Expense151290NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense34135TotalCommunityBenefitExpense
Net Community Benefit Expense34135NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense592025TotalCommunityBenefitExpense
Direct Offsetting Revenue406600DirectOffsettingRevenue
Net Community Benefit Expense185425NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense17823492TotalCommunityBenefitExpense
Direct Offsetting Revenue10524158DirectOffsettingRevenue
Net Community Benefit Expense7299334NetCommunityBenefitExpense
Percent Of Total Expense0.11120PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,083,279BadDebtExpenseAmount
Amount Attributable To520771AmountAttributableTo
Amount Reimbursed By Medicare12415211AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17805987CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-5390776MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Brattleboro Memorial Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line117 Belmont AveAddressLine1
CityBrattleboroCity
StateVTState
ZIP Code05301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherCommunity HospitalOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Brattleboro Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted11NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent250.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent350.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 3c: Brattleboro Memorial Hospital's Free Care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. When making application for Free Care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veterans' Benefits or other governmental or public assistance programs. Free Care should always be the payor of last resort.A. Qualifications for Free Care:1. Free Care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by Free Care;2. Patients' family income must be at or below 250% of the current Federal Poverty Income Guidelines for their family size;3. Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate;4. Free Care applications will be processed within two weeks of the date of their receipt in our Business Office;5. Free Care applies only to those patient accounts still in active Accounts Receivable; no Free Care allowance may be applied against accounts that have been forwarded to a collection agency as Bad Debt.B. Patients will be notified in writing of their approval or denial status within 30 days of the date of receipt of the application and any required supporting documentation. All accounts written off to Free Care must be approved by the Director of Patient Financial Services or the Vice-President of Finance.
Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used.
Part II: 1.Health Fair 2.Director of the Community Health Team participates in community coalitions such as Fit & Health Kid's Coalition, Healthier Communities Coalition. The HCC coalition, of which the Director of the Community Health Team, is a member, has been instrumental in advocating for healthy nutrition, exercise, food security, Farm to School programming & advocating for improving the built environment & town policies to support health & wellness. Many of the health improvement needs identified by & advocated for by the coalition have been incorporated into the new town plan for Brattleboro. The HCC was recognized for its success & effectiveness. The HCC has conducted Community Healthier Living Index (CHLI) assessments at Green Street School and at BMH. This YMCA tool measures community organization support for physical activity & health eating. Mini grant money will be used to implement strategies for improvements in the areas of health nutrition and exercise. 3.Our Director of Nutrition Services supports local agriculture & has been recognized for BMH's level of support. 550 BMH employees benefit from local foods & healthy choices on our breakfast, lunch & dinner menus daily.
Part III, Line 4: A simple RCC was utilized to reduce charges to cost. The estimated bad debt that may be eligible for our charity care policy was based on a 25% eligibility rate.
Part III, Line 8: The Medicare shortfall should be considered a community benefit in its entirety.
Part III, Line 9b: Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate.
Part V, Section B, Line 3: A Steering Committee was formed that represented a cross section of diverse community organizations and members that represented various community populations and age groups. Group forums, Steering Communitee meetings and various surveys were conducted during the time period from October 2011 and ending September 2012. The Needs Assessment was approved by the Board in December 2012.Brattleboro Memorial Hospital
Part V, Section B, Line 4: Brattleboro Memorial Hospital, Grace Cottage Hospital and The Brattleboro Retreat.Brattleboro Memorial Hospital
Part V, Section B, Line 7: Several needs emerged in the research findings that the participating health care organizations cannot fully address at this time. These unmet needs are as follows: Hepatitis C prevention, improved transportation, violence prevention and poverty reduction.The hospital is not addressing Hepatitis C prevention at this time due to other priority health care conditions being selected to focus on for the upcoming three-year period.While the hospital is not currently adressing the needs for improved transportation, violence prevention and poverty reduction they are supporting several community initiatives aimed at addressing these needs.Brattleboro Memorial Hospital
Part VI, Line 2: BMH conducted the December 2012 Community Health Needs Assessment. The needs assessment addressed health and wellness in Windham County, inclusive of lifestyle, access to care, maternal & child health, illness & death, and injury. Methodology included data analysis, on-line surveys, survey questionnaire distribution at public events, various focus groups, provider surveys and 7 formal Steering Committee meetings. Highest priority issues about healthcare & healthcare access were identified.Evaluations were given to all participants of the Community Health Needs Assessment. Participants are asked what health & wellness topics they would like to have presented. Each participant developed an implementation plan. These responses are compiled & prioritized. The committee for the calendar uses these priority requests to plan content of future calendars.
Part VI, Line 4: BMH serves a total service area that includes: 22 towns A population of 59,000 Compared to VT/US, residents of the service area tend to be: Older Similarly well off (MI), especially in the secondary service area Less at risk for obesityThe 65+ population will be the fastest growing segment, while the 0-17 and 18-44 age cohorts drop. VT is the second oldest state in the country (after Maine). Median age in the PSA & SSA is higher than Vermont overall & significantly higher than the US median. Brattleboro area employers, like Vermont employers generally, are small in size. The 3 largest employers are: C&S Wholesale, Entergy VT, and BMH. 11,474 people commute to Brattleboro to work.* The unemployment rate for Windham County as of April 2012 was 5.7%. The VT Department of Health publishes a comprehensive Health Status Report every 5 years. The most recent report is dated 2008. County data is compared to goals for VT. The indicators for Windham County for 2008 identified the following areas of concern. Access to health care - residents without a usual doctor; lack of health insurance Breast, Colon and Cervical Cancer screening rates are worse than in Vermont or less than the healthy Vermonter goal. Rates of Injury in Windham County were higher than Vermont in all age groups except 0-9 year olds.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1The Strolling of the Heifers IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1105 Partridge RoadAddressLine1
CityDummerstonCity
StateVTState
ZIP Code05346ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient020638820EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant6000AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation
Purpose Of GrantEvent promotionsPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule I, Part I, Line 2Identifier
ExplanationThe Organization makes contributions to small community events and no monitoring is deemed necessary.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Steven Gordon
President & CEO02569800355000000017035030951500
Michael Rogers
VP Finance, Treas. & CFO018000301000004396014099024914023341200
Mary Urquhart
VP Patient Care Services01547170100000008551025748019901600
Teresa Fitzharris-Onyon MD
ER Physician26289800092810131250249140310218000
Christopher Schmidt MD
Medical Director-Emergency285046000102410125000249140332701000
Joseph Rosen MD
General Surgeon242114025000000131250249140305153000
Gregory Gadowski MD
General Surgeon263517025000000125000283160329333000
Thomas H Lewis MD
General Surgeon26852805469067780131250249850318885000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 6ReturnReference
ExplanationThe bonuses paid in tax year 2012 are mostly contractual however the net earnings are a minor consideration in the senior leadership bonus amounts.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Vermont Educational and Health Building Financing AgencyBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN237154467IssuerEIN
CUSIP Number924166BQ3CUSIPNumber
Date Issued2008-02-01DateIssued
Issue Price11180000IssuePrice
Description Of PurposeAdvance refund of previously issued bondsDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired1755000AmountRetired
Total Proceeds11180000TotalProceeds
Issuance Costs From Proceeds145933IssuanceCostsFromProceeds
Capital Expenditures11034067CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed1Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1Duetsche BankBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge15.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action1ProcToUndertkCorrectiveAction

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonJoAnne RogersNamePerson
FieldValueIRS element (for citing)
RelationshipSpouse of Michael Rogers, VP of Finance, Treasurer & CFORelationship
Amount Of Transaction37079AmountOfTransaction
Description Of TransactionJoAnne Rogers works as the Volunteer Coordinator and Lobby Cafe Manager for an average of 35 hours per week.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The sole member of the Hospital shall be Southern Vermont Health Services Corporation, a Vermont not-for-profit corporation.
Form 990, Part VI, Section A, line 7aThe Board of Directors of the Hospital shall consist of eleven persons elected by Southern Vermont Health Service Corporation (sole member) from among membership of the sole member, plus the President and Medical Staff President ex officio but without the power to vote. Directors shall be elected annually by the sole member to hold office for three years and until their successors have been elected and qualified or until thier death or resignation. Elected directors may serve for a maximum of three consective three-year terms.
Form 990, Part VI, Section A, line 7bThe Board of Directors may not take any of the following actions without the prior approval of Southern Vermont Health Service Corporation (sole member): a) Adopt any annual or long-term capital or operating budget of the Hospital; b) Authorize the Hospital to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operating budget of the Hospital approved by the sole member, where the amount involved exceeds an amount as determined from time to time by the sole member; c) Authorize the Hospital to transfer funds or other assets to any other organization or corporation, where the amount involved exceeds an amount as determined from time to time by the sole member; d) Authorized the Hospital to engage in, or enter into, any transaction involving the borrowing of funds, incurring of debt, and/or guaranteeing, pledging, or collateralizing of any of its assets in connection therewith; e) Adopt any new, or any changes to the existing, long-range or master plans or the Hospital; or f) Organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the Hospital.
Form 990, Part VI, Section B, line 11The role of the Hospital's Audit Committee includes review of the 990. The Audit Committee engages the auditors and receives the audit and a complete copy of the Form 990, including all schedules. The Audit Committee will report to the Board that the 990 review has occurred. The Board accepts the the Audit Committee reports and the 990. All members of the Board will have access to the 990 prior to filing.
Form 990, Part VI, Section B, line 12cEach December, Board Members are required to complete a Conflict of Interest Statement. Beginning FY 2010, these statements were reviewed by outside counsel and reported back to the Board of Directors along with recommendations for action.
Form 990, Part VI, Section B, line 15The Executive Compensation Committe (ECC) of the Board of Directors (BOD) engages an outside compensation consultant to review executive compensation policies, procedures and conduct an independent regional and national market survey for senior leadership positions. The ECC sets the CEO's compensation and reviews the CEO's recommendations for other senior leadership compensation. The actions of the ECC are reviewed and approved by the BOD.
Form 990, Part VI, Section C, line 19Financial statements are published on our website. Our governing documents and conflict of interest policies are not made available to the public.
Form 990, Part IX, line 11gContract Services & Consultant: Program service expenses 5,174,624. Management and general expenses 773,304. Fundraising expenses 0. Total expenses 5,947,928. Contract Temp.: Program service expenses 279,718. Management and general expenses 0. Fundraising expenses 0. Total expenses 279,718. Service Contracts: Program service expenses 1,043,399. Management and general expenses 504,198. Fundraising expenses 0. Total expenses 1,547,597.Other Fees
Form 990, Part XI, line 9:Unrealized Loss on Interest Rate Swap 354,831. Change in Interest in SVHSC -90.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Southern Vermont Health Services CorpBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line117 Belmont AveAddressLine1
CityBrattleboroCity
StateVTState
ZIP Code05301ZIPCode
FieldValueIRS element (for citing)
EIN222564588EIN
Primary ActivitiesProvide Health Management ServicesPrimaryActivities
Legal Domicile StateVTLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity StatusLine 7PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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