2013-08-14T10:30:58-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 030306549 Helen Porter Nursing Home Inc HELE 8023884701 37 Porter Drive Middlebury VT 05753 James L Daily 8023884701 2013-08-13 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-13 2011 2016-02-25 16:41:14Z Helen Porter Healthcare & Rehab Center James L Daily 37 Porter Drive Middlebury VT 05753 9605607 0 X www.portermedical.org X 1986 VT Operation of 105 bed skilled nursing home 13 12 241 36 0 0 5494 120815 9202031 9484317 1780 475 0 0 9209305 9605607 0 0 0 0 6859278 6983280 0 0 0 2438211 2476256 9297489 9459536 -88184 146071 3361920 3430359 5867459 6027910 -2505539 -2597551 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 7648068 9484317 Operated long-term community oriented 105 bed skilled nursing home. The nursing home provided services to patients that totaled 36,088 resident days during the year ended 9/30/2012. 7648068 1 1 0 1 0 0 0 0 0 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 0 1 11 0 1 241 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 VT X Pearl AB Teague 8023884701 37 Porter Drive Middlebury VT 05753 James L Daily 40.00 X X 0 372595 120642 Betsy Gossens 1.00 X 0 0 0 Nicholas Clifford 1.00 X 0 0 0 Betsy Gleason 1.00 X 0 0 0 Linda Harmon 1.00 X X 0 0 0 Elizabeth Markowski 1.00 X X 0 0 0 Joe Sutton 1.00 X X 0 0 0 Ann Hanson 1.00 X 0 0 0 Lynn Coale 1.00 X 0 0 0 Diana Barnard MD 1.00 X 0 141979 5001 Mary Jane Broughton 1.00 X 0 0 0 Carole Cummings 1.00 X 0 0 0 Bill Townsend 1.00 X 0 0 0 Carrie Wulfman 1.00 X 0 0 0 Marilyn Olejnik 40.00 X 0 200145 30673 Neil Gruber 40.00 X 141497 0 9833 141497 714719 166149 1 0 1 0 0 120815 120815 Patient Revenue 623000 9440157 9440157 Other Revenue 623000 21007 21007 Lifeline Revenue 623000 9864 9864 Speech Therapy 623000 6863 6863 Cafeteria Revenue 623000 6426 6426 9484317 475 475 9605607 9484317 0 475 151330 151330 5232135 4978513 253622 212974 204207 8767 989537 918994 70543 397304 368091 29213 77532 77532 17700 17700 104541 104541 5825 5825 23397 23397 76153 76153 10866 10866 59853 59853 294236 294236 100108 100108 Medical Supplies 1178263 1178263 Medicare Provider Tax 516551 516551 Dues & Subscriptions 8320 8320 Miscellaneous Expense 2911 2911 9459536 7648068 1811468 0 1500 1500 404115 612596 1309874 1326042 26707 28146 24479 7260 5369920 4023747 1473377 1346173 119893 106945 1975 1697 3361920 3430359 811163 765004 3690000 3585000 12364 8193 741973 741973 611959 927740 5867459 6027910 X -2540649 -2688571 35110 91020 -2505539 -2597551 3361920 3430359 X 146071 -238083 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 580 580 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. 4383005 3414016 968989 788076 486827 301249 198839 122904 75935 1346173 Due to Affiliates 102765 Liability for Pension Benefits 824975 927740 9605607 9459536 146071 -238083 -238083 -92012 9367524 -238083 -238083 9605607 0 9605607 9459536 0 9459536 0 9459536 Part XI, Line 8 - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan -289,633. Equity Transfer from Affiliate 51,550. Total to Schedule D, Part XI, Line 8: -238,083. Part XII, Line 2d - Other Adjustments: Change in Net Assets to Recognize Funded Status of Pension Plan -289,633. Equity Transfer from Affiliate 51,550. X X X X 0 1 0 0 0 0 0 0 0 James L Daily 0 315089 0 0 0 57506 0 91450 0 29192 0 493237 0 0 Marilyn Olejnik 0 176398 0 20000 0 3747 0 5998 0 24675 0 230818 0 0 Neil Gruber 134649 0 0 0 6848 0 7440 0 2393 0 151330 0 0 0 Part I, Line 4b James Daily, President/CEO, participates in a 457(f) plan, and received $79,200 from the plan during FY 9/30/12. 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 5: Change in Net Assets to Recognize Funded Status of Pension Plan -289,633. Equity Transfer from Affiliate 51,550. Total to Form 990, Part XI, Line 5: -238,083. 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 1 0 1 0 0 0 0