CARLOS G OTIS HEALTH CARE CENTER INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CARLOS G OTIS HEALTH CARE CENTER INC (EIN 03-0177161)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-09
- IRS object ID
- 201242229349301114
- Schema version
- 2010v3.4
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-09T12:58:43-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030177161 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlos G Otis Health Care Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARL | NameControl |
| Phone | 8023657920 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 216 | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 053530216 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Stephen A Brown | Name |
| Title | VP Finance/CFO | Title |
| Phone | 8023657920 | Phone |
| Date Signed | 2012-08-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Timothy R Hepburn CPA | Name |
| Phone | 2078792100 | Phone |
| Date Prepared | 2012-08-08 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Michael L Brant | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 216 | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 053530216 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 20071305 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.gracecottage.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1949 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | Provision of health care services | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 213 | TotalNbrEmployees |
| Total Nbr Volunteers | 95 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 431034 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 750710 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 19239545 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 18985022 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1262 | InvestmentIncomePriorYear |
| Investment Income Current Year | -954 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 392060 | OtherRevenuePriorYear |
| Other Revenue Current Year | 334281 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 20063901 | TotalRevenuePriorYear |
| Total Revenue Current Year | 20069059 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 50000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 50000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11966938 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12296999 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 299659 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8002170 | OtherExpensePriorYear |
| Other Expenses Current Year | 8209644 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20019108 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20556643 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 44793 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -487584 | RevenuesLessExpensesCY |
| Total Assets BOY | 12117111 | TotalAssetsBOY |
| Total Assets EOY | 12689832 | TotalAssetsEOY |
| Total Liabilities BOY | 4651223 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5767927 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7465888 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6921905 | NetAssetsOrFundBalancesEOY |
| Mission Description | The Otis Health Care Center promotes excellence in healthcare and well being, putting people first. It aims to be the standard for patient care. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17698552 | Expense |
| Grants | 50000 | Grants |
| Revenue | 19319303 | Revenue |
| Description | Grace Cottage Hospital is a critical access hospital offering 24-hour emergency services, inpatient acute and skilled care, 24 hour diagnostic imaging services, a full-service laboratory, a pharmacy, a variety of outpatient medical care services, including physical therapy, occupational therapy, and speech therapy, and a rural health clinic providing primary care and psychiatric services. | Description |
| Total Program Service Expense | 17698552 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 15 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 213 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stephen A Brown | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8023653601 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Grafton Road | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 05353 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Deborah Boyle | ||||||||
| President | 1.00 | X | X | 0 | 0 | 0 | ||
| Kathleen Ballantine | ||||||||
| Vice President | 1.00 | X | X | 0 | 0 | 0 | ||
| Kevin Meyer | ||||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | ||
| Gail Ann Fisher | ||||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | ||
| Roger Allbee | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Robert W Backus MD | ||||||||
| Former Trustee/Physician | 44.00 | 158686 | 0 | 19685 | X | |||
| Effie Chamberlin part year | ||||||||
| Trustee/Director of Quality | 1.00 | X | 420 | 0 | 13 | |||
| J Walter Corcoran | ||||||||
| Trustee (part year) | 1.00 | X | 0 | 0 | 0 | |||
| Edward Elliott MD | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Stanley Holt | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Stephan Morse | ||||||||
| Trustee (part year) | 1.00 | X | 0 | 0 | 0 | |||
| John Nopper | ||||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |||
| Jane Robinsom | ||||||||
| Trustee (part year) | 1.00 | X | 0 | 0 | 0 | |||
| Timothy P Shafer MD | ||||||||
| Trustee/Family Physician | 57.50 | X | 206010 | 0 | 26477 | |||
| Michael L Brant | ||||||||
| CEO | 41.80 | X | 169208 | 0 | 20326 | |||
| Stephen A Brown | ||||||||
| V.P. Finance/CFO | 44.60 | X | 178665 | 0 | 25657 | |||
| Evan Ginsberg | ||||||||
| Family Physician | 45.00 | 202345 | 0 | 19210 | X | |||
| Maurice Geurts MD | ||||||||
| Family Physician | 55.00 | 195007 | 0 | 26022 | X | |||
| Carol Blackwood | ||||||||
| Family Physician | 45.00 | 188693 | 0 | 533 | X | |||
| Moss J Linder MD | ||||||||
| Family Physician | 50.00 | 169896 | 0 | 21295 | X | |||
| James S Heal | ||||||||
| Director of Pharmacy | 40.90 | 132577 | 0 | 27077 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1601507 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 186295 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 366850309 | Computer hardware/software support, bill | 144661 |
| MBA Health Group | |||||
| 55 Community Drive Suite 201 | South Burlington | VT | 05403 | Practice Management Services | 115448 |
| Southern VT Health Services Corp | |||||
| 17 Belmont Avenue | Brattleboro | VT | 05301 | VP Quality/Patient Safety | 111037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 536946 | RelatedOrganizations |
| Government Grants | 30437 | GovernmentGrants |
| All Other Contributions | 183327 | AllOtherContributions |
| Total Contributions | 750710 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenu | 900099 | 15439564 | 15439564 |
| Pharmacy revenue | 900099 | 3545458 | 3545458 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 18985022 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1292 | TotalRevenueColumn |
| Exclusion | $1,292 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2246 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -2246 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2246 | TotalRevenueColumn |
| Exclusion | -$2,246 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| GCF administration & o | 900099 | 255428 | 255428 |
| Miscellaneous revenue | 900099 | 78853 | 78853 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 334281 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20069059 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19319303 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$954 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50000 | Total |
| Program Services | 50000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 798966 | Total |
| Program Services | 382653 | ProgramServices |
| Management And General | 416313 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9023864 | Total |
| Program Services | 7815966 | ProgramServices |
| Management And General | 997425 | ManagementAndGeneral |
| Fundraising | 210473 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152991 | Total |
| Program Services | 129543 | ProgramServices |
| Management And General | 18041 | ManagementAndGeneral |
| Fundraising | 5407 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1633823 | Total |
| Program Services | 1341225 | ProgramServices |
| Management And General | 241541 | ManagementAndGeneral |
| Fundraising | 51057 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 687355 | Total |
| Program Services | 557802 | ProgramServices |
| Management And General | 114569 | ManagementAndGeneral |
| Fundraising | 14984 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24975 | Total |
| Management And General | 24975 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96118 | Total |
| Management And General | 96118 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276028 | Total |
| Program Services | 226589 | ProgramServices |
| Management And General | 49439 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125250 | Total |
| Program Services | 125250 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 742849 | Total |
| Program Services | 623965 | ProgramServices |
| Management And General | 112404 | ManagementAndGeneral |
| Fundraising | 6480 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 345907 | Total |
| Program Services | 115601 | ProgramServices |
| Management And General | 229946 | ManagementAndGeneral |
| Fundraising | 360 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391417 | Total |
| Program Services | 383601 | ProgramServices |
| Fundraising | 7816 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67107 | Total |
| Program Services | 44066 | ProgramServices |
| Management And General | 20474 | ManagementAndGeneral |
| Fundraising | 2567 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112284 | Total |
| Program Services | 72885 | ProgramServices |
| Management And General | 39399 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 624609 | Total |
| Program Services | 620588 | ProgramServices |
| Management And General | 4021 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261836 | Total |
| Program Services | 159720 | ProgramServices |
| Management And General | 102116 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Pharmacy & lab exp | 3826923 | 3813819 | 13104 | |
| Medicaid tax | 546257 | 546257 | ||
| Provision for bad debts | 462866 | 462866 | ||
| Dues & subscriptions | 130876 | 87782 | 42579 | 515 |
| Equipment repair expens | 75881 | 75881 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98461 | Total |
| Program Services | 62493 | ProgramServices |
| Management And General | 35968 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20556643 | Total |
| Program Services | 17698552 | ProgramServices |
| Management And General | 2558432 | ManagementAndGeneral |
| Fundraising | 299659 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255907 | BOY |
| EOY | 251107 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135354 | BOY |
| EOY | 122754 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1491822 | BOY |
| EOY | 1574273 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28694 | BOY |
| EOY | 22295 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 852236 | BOY |
| EOY | 769304 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156620 | BOY |
| EOY | 150364 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11999501 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6986658 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3896522 | BOY |
| EOY | 5012843 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5299956 | BOY |
| EOY | 4786892 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12117111 | BOY |
| EOY | 12689832 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1307516 | BOY |
| EOY | 1971996 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1625000 | BOY |
| EOY | 1530000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1718707 | BOY |
| EOY | 2265931 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4651223 | BOY |
| EOY | 5767927 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5022863 | BOY |
| EOY | 4285101 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211191 | BOY |
| EOY | 482676 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2231834 | BOY |
| EOY | 2154128 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7465888 | BOY |
| EOY | 6921905 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12117111 | BOY |
| EOY | 12689832 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -487584 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -56399 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,850 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5850 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | Carlos G. Otis Health Care 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 Carlos G. Otis Health Care Center in furtherance of its exempt purpose. Carlos G. Otis Health Care Center does not directly perform any lobbying activities. AHA, portion of dues available for lobbying: $512 VAHHS, portion of dues available for lobbying: $5,338 | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2443026 | BeginningOfYearBalance |
| Contributions | 186971 | Contributions |
| Investment Earnings Or Losses | 25839 | InvestmentEarningsOrLosses |
| Other Expenditures | 19032 | OtherExpenditures |
| End Of Year Balance | 2636804 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2298260 | BeginningOfYearBalance |
| Contributions | 104897 | Contributions |
| Investment Earnings Or Losses | 39869 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2443026 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2513056 | BeginningOfYearBalance |
| Contributions | 24191 | Contributions |
| Investment Earnings Or Losses | -75026 | InvestmentEarningsOrLosses |
| Other Expenditures | 163961 | OtherExpenditures |
| End Of Year Balance | 2298260 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.16690 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.81690 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.01620 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30549 | OtherCostOrOtherBasis |
| Book Value | 30549 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5732596 | OtherCostOrOtherBasis |
| Depreciation | 3608612 | Depreciation |
| Book Value | 2123984 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4860628 | OtherCostOrOtherBasis |
| Depreciation | 3305896 | Depreciation |
| Book Value | 1554732 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1375728 | OtherCostOrOtherBasis |
| Depreciation | 72150 | Depreciation |
| Book Value | 1303578 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5012843 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Deferred financing costs & bond fees, net | 44226 |
| Estimated third-party payor settlements | 158813 |
| Beneficial interest in net assets of GCF | 4526863 |
| Bond interest reserve | 56990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4786892 | TotalBookValueOtherAssets |
| Total Revenue | 20069059 | TotalRevenue |
| Total Expenses | 20556643 | TotalExpenses |
| Excess Or Deficit For Year | -487584 | ExcessOrDeficitForYear |
| Other | -$56,399 | OtherAmount |
| Total Adjustments | -56399 | TotalAdjustments |
| Excess Or Deficit Per FS | -543983 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 19606193 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 19606193 | RevenueSubtotal |
| Other Revenues Not Included | 462866 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 462866 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 20069059 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20093777 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20093777 | ExpensesSubtotal |
| Other Expenses Not Included | 462866 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 462866 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20556643 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | Assist in the provision of health care. |
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | The verbatim paragraph pertaining to FIN 48 in the consolidated audited financial statements for Carlos G. Otis Health Care Center, Inc. and Subsidiary ("The Organization") is as follows: The Organization adopted FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109, effective October 1, 2007. The Organization has evaluated its tax positions taken in accordance with FIN 48 and has determined that there is no impact on the Organization's current tax-exempt status, or financial position or results of operations for the years ended September 30, 2011 and 2010. With few exceptions, the Organization is no longer subject to income tax examination by the U.S. federal or state tax authorities for years prior to 2008. |
| Part XI, Line 8 - Other Adjustments: | Decrease in beneficial interest & unrestricted net assets of GCF -56,399. | |
| Part XII, Line 4b - Other Adjustments: | Bad debt provision 462,866. | |
| Part XIII, Line 4b - Other Adjustments: | Bad debt provision 462,866. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 247067 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 247067 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01230 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2338315 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1028095 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1310220 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06520 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2585382 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1028095 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1557287 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07750 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 151148 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21015 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 130133 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 73713 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 73713 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 224861 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21015 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 203846 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2810243 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1049110 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1761133 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08770 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 60 | PersonsServed |
| Total Community Building Expense | 50000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 50000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 60 | PersonsServed |
| Total Community Building Expense | 50000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 50000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $403,046 | BadDebtExpenseAmount |
| Amount Attributable To | 25051 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9731506 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9551193 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 180313 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Grafton Road | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 05353 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 0 | CHNAWidelyAvailable |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Messenger Valley Pharmacy | ||||
| 170 Grafton Road | Townshend | VT | 05353 | Pharmacy |
| Grace Cottage Family Health | ||||
| 185 Grafton Road | Townshend | VT | 05353 | Rural health clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: N/A | ||
| Part I, Line 6a: N/A | ||
| Part I, Line 7: The amounts reported for Charity Care and Means-Tested Government Programs were calculated using a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. | ||
| Part I, Line 7g: N/A | ||
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 462866. | ||
| Part II: Grace Cottage Hospital provided an operating subsidy of $50,000 to an Assisted Living Facility, Valley Cares, in Townshend. | ||
| Part III, Line 4: The cost of the Bad Debt expense reported on line 2 was calculated by applying the Ratio of Patient Care Cost-to-Charges (calculated on Worksheet 2) to the total Bad Debt expense. The amount of Bad Debt expense for accounts written off as bad debt is the account balance after all charity care discounts, contractual allowances, and insurance/patient payments have been applied. Any cash collected on accounts previously written off is included as an offset to bad debt expense.The amount of bad debt expense (at cost) attributable to patients eligible under our charity care policy reported on line 3 was estimated based on a review of accounts written off and identifying those that had charity care eligibility and/or Medicaid eligibility for dates of service in close proximity to the dates of service that were written off as bad debt. We feel that this estimate should actually be much higher because though we work hard to educate our patients regarding the charity care policy, including having a Resource Advocate to help them complete applications if they require assistance, many of the applications we distribute to patients are not returned. Knowing our patient population as we do, we feel it is primarily attributable to patients not wanting to share the income information. Footnote 1 to the Audited Consolidated Financial Statements of the Hospital contains the following to address bad debt: 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 the allowance for doubtful accounts based on its assessment of individual accounts and historical experience. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the allowance for doubtful accounts and a credit to accounts receivable. | ||
| Part III, Line 8: Medicare allowable costs reported in the Medicare Cost Report are reported in accordance with CMS Guidelines using the cost-to-charge ratio methodology. | ||
| Part III, Line 9b: N/A | ||
| Part V, Section B, Line 3: Grace Cottage Hospital conducts a community health needs assessment every three years, as required by Vermont statute. The 2010 survey was conducted by trained volunteers who made telephone calls to randomly selected members of communities in Grace Cottage Hospital's service area. The results of the survey showed that the community felt that Grace Cottage was on the right track towards providing improved access to diagnostic imaging services (X-ray, CT scan, ultrasound and bone density testing) and was doing well in providing improved access to wellness programs (osteoporosis prevention and exercise classes being the most needed) by the rapidly aging population/patients in rural, southern Vermont. Grace Cottage Hospital used this information in strategic planning during FY 2011. | Grace Cottage Hospital | |
| Part V, Section B, Line 6i: In 2011, Grace Cottage purchased and installed a 40-slice CT scanner, replacing the 4-slice CT scanner that had been purchased, used, in 2005. In order to provide more patient privacy and comfort, Grace Cottage added a 40' x 20' Diagnostic Imaging Suite, which included separate rooms for the bone densitometer, ultrasound, and digital X-ray, plus a patient bathroom and waiting room. In response to the community's request for an increased number and variety of wellness offerings, classes were added at Grace Cottage's Community Wellness Center, which is used extensively by a wide array of individuals of varying ages. Many of the classes held at the Community Wellness Center address the health needs of the elderly population in this rural, medically underserved area. The goal is to reduce the incidence of falls and broken bones, thereby potentially decreasing the incidence of institutionalization of this vulnerable population. Grace Cottage Hospital provides the health and wellness classes and events free of charge in some cases, or at a nominal cost. | Grace Cottage Hospital | |
| Part V, Section B, Line 19d: The Hospital charged standard facility rates as billed to all patient and insurers. Patients were eligible to apply for financial assistance based on policy. | Grace Cottage Hospital | |
| Part V, Section B, Line 21: As stated on line 19d, all charges billed were standard facility charges. | Grace Cottage Hospital | |
| Part VI, Line 2: Grace Cottage Hospital is such a small hospital in a rural, relatively sparsely populated area, so our community leaders, patients, and members of the public are quick to inform our administrators and our medical staff about how Grace Cottage serves the healthcare needs of the public. Because of Grace Cottage's small size, we can be responsive to community requests made via our website, e-mails to members of our staff, or informal face-to-face meetings with people in the communities we serve. | ||
| Part VI, Line 3: Although we are Vermont's smallest Critical Access Hospital, Grace Cottage Hospital believes that quality health care should be available to all, and that we all have a responsibility to help others in need, regardless of their ability to pay. Posters and brochures detailing the availability of help with billing, public programs and charity care are posted in high traffic areas throughout the hospital, rural health clinic and pharmacy, as well as listed on the Hospital's website. The staff reaches out to patients in a variety of ways to ensure that they are aware that help is available. The Hospital employs a Resource Advocate to help uninsured and underinsured patients locate and procure services for which they may qualify. The Resource Advocate's services are free of charge for community members between the ages of 18-64 years (those 65 and older are encouraged to contact Senior Solutions, formerly Southeastern Vermont Council on Aging, located on the Hospital premises). The Hospital's Resource Advocate has helped many people with a wide variety of resource issues, including helping to fill out necessary forms and making connections for patients with other federal, state and local resources. This employee is an expert in filling out reduced fee applications, finding sources for reduced-cost or free prescription medications, and locating other avenues of support. | ||
| Part VI, Line 4: Grace Cottage Hospital plays a vital role in this rural, mountainous community. Its federal designation as a Critical Access Hospital recognizes its importance in providing health care to an otherwise medically underserved community. The Hospital's Emergency Department is especially vital to members of the community, who would otherwise have to travel many miles on winding mountainous highways to reach emergency medical care at another hospital. Grace Cottage Hospital is located in Windham County, in southeastern Vermont. According to the U.S. Census Bureau, Windham County has an estimated total of 44,513 residents. Grace Cottage Hospital's patient base is approximately 26,000 residents, mostly from 21 surrounding towns. The median household income of Windham County, Vermont, is $46,912, below the national average of $50,221 (U.S. Census Bureau "Quick Facts," updated 6-3-11). Income statistics for the total population served by Grace Cottage Hospital are not available because Grace Cottage only requires income information from patients requesting reduced fees or free care. | ||
| Part VI, Line 6: Grace Cottage Hospital is a Critical Access Hospital located in rural, mountainous Townshend, Vermont. The Hospital is served by a Board of Trustees consisting of local citizens active in community businesses and organizations. Only one of the eleven trustees, a physician, is a hospital employee. All trustees reside in the Hospital's service area and bring a wealth of community input to the Hospital's strategic planning process. The Hospital extends medical staff privileges to all qualified physicians in the community.Despite its small size, Grace Cottage Hospital is committed to giving back to the community to the greatest extent possible. Grace Cottage Hospital applies all surplus funds towards improving its ability to provide quality patient care and being an integral part of assuring the health and well being of the communities we serve. Area non-profit organizations providing health-related and emergency preparedness-related services to the community are provided with meeting and training space at the Hospital. In response to the last Community Health Needs Assessment, the Hospital has worked collaboratively with local schools and organizations to promote healthy, fun activities and provides opportunities that make the most of staying as healthy as possible. Community Wellness: In 2011, 682 people attended activities in the Community Wellness Center at Grace Cottage Hospital, with a total of 5,615 wellness visits. In 2011, wellness activities included Arthritis Support, Belly Dancing, Exercise for Better Balance, Meditation Circle, Relaxed Living, Strong Bones, Tobacco/Smoking Cessation Classes, Weight Control Programs, Yoga and Zumba. For the third year in a row, Grace Cottage Hospital employees organized and implemented a Community Health Fair. Over 30 area non-profit organizations and more than 300 members of the community attended the Health Fair on May 14, 2011. Grace Cottage also assisted in coordinating two community blood drives in conjunction with the American Red Cross.Grace Cottage Hospital plays a pivotal role in Emergency/Disaster Preparedness in this rural, mountainous area of Windham County, Vermont. The Hospital works collaboratively with:- the local town volunteer fire and first responder rescue departments; - the regional ambulance service, Rescue Inc.;- Windham County Regional Commission - the Local Emergency Planning Committee covering the towns that Grace Cottage serves;- The local Citizens Emergency Response Team (CERT); - The local Radio Amateur Civil Emergency Service (RACES) - West River Radio Club meets and stores equipment at Grace Cottage Hospital; - Vermont Association of Hospitals and Health Systems; - Vermont Department of Health. Grace Cottage Hospital houses the local non-profit transport ambulance service, Rescue Inc., free of charge, on the Hospital grounds. Rescue Inc. is based in Brattleboro, VT, 18 miles away. The branch that is located at Grace Cottage operates 24 hours a day, 365 days a year, and is known as Rescue Inc. Division Two. In 2011, this area had 582 Emergency Calls to 9-1-1; of these calls, 236 patients were transported to Grace Cottage Hospital's Emergency Department. Grace Cottage Hospital staff participates in onsite training for disaster preparedness as well as offsite training with other hospitals.On August 28, 2011 Tropical Storm Irene hit Vermont with 11" of rain that caused major flooding and infrastructure damage throughout the entire state. The Incident Command Center for the Town of Townshend was located at Grace Cottage Hospital. Grace Cottage never closed during Tropical Storm Irene, and remained fully staffed. | ||
| Part VI, Line 7: N/A | ||
| VT | Reports Filed With States | Part VI, Line 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Cares Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 341 | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 05353 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 201980713 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 50000 | AmountOfCashGrant |
| Purpose Of Grant | Operating subsidy for elderly housing/assisted living project | PurposeOfGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert W Backus MD | |||||||||||||
| 132774 | 0 | 19106 | 0 | 6806 | 0 | 4435 | 0 | 15250 | 0 | 178371 | 0 | 0 | 0 |
| Timothy P Shafer MD | |||||||||||||
| 202665 | 0 | 0 | 0 | 3345 | 0 | 6180 | 0 | 20297 | 0 | 232487 | 0 | 0 | 0 |
| Michael L Brant | |||||||||||||
| 166400 | 0 | 0 | 0 | 2808 | 0 | 5076 | 0 | 15250 | 0 | 189534 | 0 | 0 | 0 |
| Stephen A Brown | |||||||||||||
| 161027 | 0 | 0 | 0 | 17638 | 0 | 5360 | 0 | 20297 | 0 | 204322 | 0 | 0 | 0 |
| Evan Ginsberg | |||||||||||||
| 200000 | 0 | 0 | 0 | 2345 | 0 | 0 | 0 | 19210 | 0 | 221555 | 0 | 0 | 0 |
| Maurice Geurts MD | |||||||||||||
| 186362 | 0 | 6000 | 0 | 2645 | 0 | 5725 | 0 | 20297 | 0 | 221029 | 0 | 0 | 0 |
| Carol Blackwood | |||||||||||||
| 185000 | 0 | 0 | 0 | 3693 | 0 | 0 | 0 | 533 | 0 | 189226 | 0 | 0 | 0 |
| Moss J Linder MD | |||||||||||||
| 166986 | 0 | 0 | 0 | 2910 | 0 | 998 | 0 | 20297 | 0 | 191191 | 0 | 0 | 0 |
| James S Heal | |||||||||||||
| 128006 | 0 | 0 | 0 | 4571 | 0 | 3780 | 0 | 23297 | 0 | 159654 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 7 | ReturnReference |
| Explanation | Physician contracts are being re-written at renewal to be productivity based. Contracts provide the opportunity for physicians to receive additional payments for productivity above minimum thresholds. For the period reported, two physicians listed in Part VII were under such a contract: Dr. Maurice Geurts, who received an incentive compensation payment of $6,000 and Dr. Robert Backus, who received an incentive compensation payment of $19,106. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Edward Elliott MD | |||
| Trustee who is also President of Windham Radiology Associates, Inc. | 13079 | Windham Radiology Associates, Inc. was reimbursed a total of $13,079 in the fiscal year ended 9/30/11 for the amounts they paid on OHCC'S behalf to Virtual Radiologic Corporation. | 0 |
| Laura D Brant | |||
| Spouse of CEO | 40714 | Ms. Brant is the spouse of Michael L. Brant, who is OHCC'S CEO and listed in Part VII. Ms. Brant is compensated as an employee of OHCC (as the Director of Diagnostic Imaging through May, 2011 and then as a per diem radiology technician through the end of the fiscal year). The W-2 compensation paid is in accordance with OHCC'S standard employment practices and policies. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Deborah Boyle is married to Kathleen Ballantine's brother. | |
| Form 990, Part VI, Section B, line 11 | A draft of the Form 990 is initially reviewed in detail by Carlos G. Otis Health Care Center's key finance employees. Thereafter, the final draft is provided to the full Board for review prior to filing with the IRS. | |
| A copy of the conflict of interest policy is distributed annually to the Board of Trustees and each trustee signs to confirm that they have thoroughly read, understand and agree to comply with the conflict of interest policy. | Form 990, Part VI, Section B, line 12c | |
| CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted and voted on by the full board annually. The Board used external market compensation data to determine the CEO's initial compensation when hired and annually uses such data to compare OHCC's CEO compensation with that of other hospital executives in the Northeast region. The CEO is excused from Board discussion and voting on issues surrounding CEO compensation and benefits. Compensation of other hospital employees: The CEO reviews the salaries of employees annually and determines compensation based on performance and salary ranges, using regional salary range data for comparison. | Form 990, Part VI, Section B, line 15 | |
| Upon request, Carlos G. Otis Health Care Center, Inc. makes its governing documents, conflict of interest policy, or financial statements available to the public. | Form 990, Part VI, Section C, line 19 | |
| Reportable compensation for services as employees | The 2010 compensation reported for Effie Chamberlin, Dr. Robert Backus, and Dr. Timothy Shafer was for their services as a per diem employee in the quality department, full-time physician, and full-time physician respectively. They were not compensated for their services as members of OHCC's Board of Trustees. | Form 990, Part VII, Section A, Column D |
| Changes in Net Assets or Fund Balances: | Decrease in beneficial interest & unrestricted net assets of GCF -56,399. Total to Form 990, Part XI, Line 5: -56,399. | Form 990, Part XI, line 5: |
| Audit Review Process | The Finance and Audit Committee oversees the audit process for the Carlos G. Otis Health Care Center, Inc. and Grace Cottage Foundation, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for both fiscal years. | Form 990, Part XI, Line 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grace Cottage Foundation Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1 | AddressLine1 |
| City | Townshend | City |
| State | VT | State |
| ZIP Code | 05353 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030343282 | EIN |
| Primary Activities | Solicit contributions for the funding of health care services by OHCC | PrimaryActivities |
| Legal Domicile State | VT | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 509(a)(3) Type I | PublicCharityStatus |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Grace Cottage Foundation Inc | ||
| P | 255428 | Actual per books |
| Grace Cottage Foundation Inc | ||
| C | 536946 | Actual per books |