COPLEY HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- COPLEY HOSPITAL INC (EIN 03-0179423)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-02-11
- IRS object ID
- 201100429349301225
- Schema version
- 2009v1.7
- 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 | 2011-02-11T13:32:56-06:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030179423 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COPL | NameControl |
| Phone | 8028884231 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Melvyn Patashnick | Name |
| Title | CEO | Title |
| Phone | 8028884231 | Phone |
| Date Signed | 2011-02-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Barbara J McGuan CPA | Name |
| Phone | 2077752387 | Phone |
| Date Prepared | 2011-02-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Melvyn Patashnick | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 72939153 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.copleyhealthsystems.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1934 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 481 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 364491 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 211733 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 67162450 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 72483009 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 214453 | InvestmentIncomePriorYear |
| Investment Income Current Year | 45023 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 95672 | OtherRevenuePriorYear |
| Other Revenue Current Year | 104609 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 67837066 | TotalRevenuePriorYear |
| Total Revenue Current Year | 72844374 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 191667 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 24402905 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 25305047 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 42972088 | OtherExpensePriorYear |
| Other Expenses Current Year | 46121165 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 67374993 | TotalExpensesPriorYear |
| Total Expenses Current Year | 71617879 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 462073 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1226495 | RevenuesLessExpensesCY |
| Total Assets BOY | 31112324 | TotalAssetsBOY |
| Total Assets EOY | 32180471 | TotalAssetsEOY |
| Total Liabilities BOY | 11902906 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11636406 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 19209418 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 20544065 | NetAssetsOrFundBalancesEOY |
| Mission Description | To oversee and coordinate the provision of services, to provide leadership in implementing the vision promoting wellness and to assure clear access to services regardless of ability to pay. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 67626250 | Expense |
| Grants | 191667 | Grants |
| Revenue | 72483009 | Revenue |
| Description | Copley Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement is critical to the hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Further, our mission is to serve the community with respect to providing healthcare services and healthcare education in keeping with the hospital's commitment to serve all members of its community. The Hospital offers free care and or subsidized care, care provided to persons covered by governmental programs at below cost, and health activities and programs to support the community and are considered where the need and/or individual's inability to pay coexists. These activities include a variety of services in the form of seminars, workshops, clinics, and screenings at minimal or no charge. | Description |
| Total Program Service Expense | 67626250 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | 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 |
| 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 | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | 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 | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 104 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 481 | 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 |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | 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 | 0 | 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 | Kevin Dorain | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8028884231 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Michael Alexander | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Bryce Breton | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Brian Coles | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Willa Farrell | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Elaine Nichols | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Nancy Putnam | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Elizabeth Rouse | |||||||
| Chair | 2.00 | X | 0 | 0 | 0 | X | |
| Jan Roy | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Judy Shanley | |||||||
| Trustee/Auxiliary Presid | 2.00 | X | 0 | 0 | 0 | ||
| Joel Silverstein MD | |||||||
| Trustee/Med. Staff Pres. | 2.00 | X | 17938 | 0 | 0 | ||
| Brian Smale MD | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| John Steel | |||||||
| Treasurer | 2.00 | X | 0 | 0 | 0 | X | |
| Anne Vitaletti-Coughlin | |||||||
| Secretary | 2.00 | X | 12000 | 0 | 0 | X | |
| Dana Wildes | |||||||
| Vice Chair | 2.00 | X | 0 | 0 | 0 | X | |
| Mark Woodward | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| David Yacovone | |||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | ||
| Melvyn Patashnick | |||||||
| President and CEO | 40.00 | X | 251101 | 0 | 27964 | X | |
| Rassoul Rangaviz | |||||||
| CFO | 40.00 | 159507 | 0 | 24547 | X | ||
| Bryan Huber MD | |||||||
| Physician | 40.00 | 462537 | 0 | 39839 | X | ||
| SG Neale MD | |||||||
| Physician | 40.00 | 432740 | 0 | 46946 | X | ||
| Eric Mullins MD | |||||||
| Physician | 40.00 | 450762 | 0 | 37695 | X | ||
| John Kaeding MD | |||||||
| Chief ER Physician | 40.00 | 274121 | 0 | 29278 | X | ||
| Neil Nigro MD | |||||||
| Physician | 40.00 | 239454 | 0 | 37119 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2300160 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 243388 | TotalOtherCompensation |
| Number Individuals GT100 K | 23 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HP Cummings Construction Co | |||||
| PO Box 269 | Woodsville | NH | 03785 | Building Contractor | 890225 |
| CPSG Inc | |||||
| 530 Washington Highway Suite 12 | Morrisville | VT | 05561 | Medical Services | 433450 |
| Fletcher Allen Health Care | |||||
| PO Box 1902 | Burlington | VT | 054021902 | Medical Services | 399709 |
| Bay View Funding | |||||
| PO Box 881774 | San Francisco | CA | 94188 | Contracted Labor | 343811 |
| Central VT Anesthesia | |||||
| PO Box 297 | Waitsfield | VT | 05673 | Medical Services | 262460 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Related Organizations | 211125 | RelatedOrganizations |
| All Other Contributions | 608 | AllOtherContributions |
| Noncash Contributions | 13428 | NoncashContributions |
| Total Contributions | 211733 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Outpatient Services | 621400 | 53742851 | 53742851 | |
| Inpatient Services | 621400 | 17668780 | 17668780 | |
| Skilled Nursing | 621400 | 489417 | 489417 | |
| Cafeteria Revenue | 900099 | 278734 | $278,734 | |
| Miscellaneous Revenue | 621400 | 189227 | $189,227 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 114000 | TotalRevenueColumn |
| Exclusion | $114,000 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 72483009 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 126204 | TotalRevenueColumn |
| Exclusion | $126,204 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 104609 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 104609 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 104609 | TotalRevenueColumn |
| Exclusion | $104,609 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 13598 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 94779 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -81181 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -81181 | TotalRevenueColumn |
| Exclusion | -$81,181 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72844374 | TotalRevenueColumn |
| Related Or Exempt Function Income | 71901048 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $731,593 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191667 | Total |
| Program Services | 191667 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 493057 | Total |
| Program Services | 29938 | ProgramServices |
| Management And General | 463119 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20027869 | Total |
| Program Services | 18482268 | ProgramServices |
| Management And General | 1545601 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 535720 | Total |
| Program Services | 497894 | ProgramServices |
| Management And General | 37826 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2855491 | Total |
| Program Services | 2616222 | ProgramServices |
| Management And General | 239269 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1392910 | Total |
| Program Services | 1259592 | ProgramServices |
| Management And General | 133318 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57163 | Total |
| Management And General | 57163 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47368 | Total |
| Management And General | 47368 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6161034 | Total |
| Program Services | 5631329 | ProgramServices |
| Management And General | 529705 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152039 | Total |
| Management And General | 152039 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6847996 | Total |
| Program Services | 6420072 | ProgramServices |
| Management And General | 427924 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1414229 | Total |
| Program Services | 1127927 | ProgramServices |
| Management And General | 286302 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83651 | Total |
| Program Services | 57892 | ProgramServices |
| Management And General | 25759 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60907 | Total |
| Program Services | 60907 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1715603 | Total |
| Program Services | 1715603 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 615175 | Total |
| Program Services | 568939 | ProgramServices |
| Management And General | 46236 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Contractual Allowances | 24582109 | 24582109 |
| Provider Tax Expense | 2047262 | 2047262 |
| Provision for Bad Debts | 1621408 | 1621408 |
| Charity Care | 715221 | 715221 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71617879 | Total |
| Program Services | 67626250 | ProgramServices |
| Management And General | 3991629 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 310277 | BOY |
| EOY | 2425 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10543874 | BOY |
| EOY | 9850724 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3037948 | BOY |
| EOY | 3453598 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1711478 | BOY |
| EOY | 1686877 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 743792 | BOY |
| EOY | 975034 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 30775566 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19146103 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10459119 | BOY |
| EOY | 11629463 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3674055 | BOY |
| EOY | 3782207 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65307 | BOY |
| EOY | 62121 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 566474 | BOY |
| EOY | 738022 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31112324 | BOY |
| EOY | 32180471 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6801081 | BOY |
| EOY | 5600873 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 503 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3865000 | BOY |
| EOY | 3775000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1236825 | BOY |
| EOY | 2260030 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11902906 | BOY |
| EOY | 11636406 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15530363 | BOY |
| EOY | 16756858 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71020 | BOY |
| EOY | 91431 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3608035 | BOY |
| EOY | 3695776 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19209418 | BOY |
| EOY | 20544065 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31112324 | BOY |
| EOY | 32180471 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| 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 | $19,718 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 19718 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | A small percentage of dues paid to VAHHS include lobbying expenses. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 158876 | OtherCostOrOtherBasis |
| Book Value | 158876 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15394815 | OtherCostOrOtherBasis |
| Depreciation | 8666387 | Depreciation |
| Book Value | 6728428 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14501015 | OtherCostOrOtherBasis |
| Depreciation | 10098790 | Depreciation |
| Book Value | 4402225 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 720860 | OtherCostOrOtherBasis |
| Depreciation | 380926 | Depreciation |
| Book Value | 339934 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11629463 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Beneficial Interest in Net Assets of Copley Health Systems, Inc. | Description |
| Book Value | 3782207 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3782207 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Deferred Compensation | $680,722 |
| Estimated Third Party Payor Settlements | $1,579,308 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2260030 | TotalOfAmounts |
| Total Revenue | 72844374 | TotalRevenue |
| Total Expenses | 71617879 | TotalExpenses |
| Excess Or Deficit For Year | 1226495 | ExcessOrDeficitForYear |
| Other | $108,152 | OtherAmount |
| Total Adjustments | 108152 | TotalAdjustments |
| Excess Or Deficit Per FS | 1334647 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 47655196 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 108152 | OtherRevenues |
| Revenue Not Rptd F990 | 108152 | RevenueNotRptdF990 |
| Revenue Subtotal | 47547044 | RevenueSubtotal |
| Other Revenues Not Included | 25297330 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 25297330 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 72844374 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 46320549 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 46320549 | ExpensesSubtotal |
| Other Expenses Not Included | 25297330 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 25297330 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 71617879 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Change in beneficial interest in net assets of Copley Health Systems, Inc.: 108152. |
| Part XII, Line 2d - Other Adjustments: | Change in beneficial interest in net assets of Copley Health Systems, Inc.: 108152. |
| Part XII, Line 4b - Other Adjustments: | Contractual Allowances: 24582109. Charity Care: 715221. |
| Part XIII, Line 4b - Other Adjustments: | Contractual Allowances: 24582109. Charity Care: 715221. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 225.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2273 | PersonsServed |
| Total Community Benefit Expense | 414015 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 414015 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9643852 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5837607 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3806245 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05310 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2273 | PersonsServed |
| Total Community Benefit Expense | 10057867 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5837607 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4220260 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05890 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6210 | PersonsServed |
| Total Community Benefit Expense | 196037 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 63421 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 132616 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 9 | PersonsServed |
| Total Community Benefit Expense | 1705 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1705 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3238202 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2097839 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1140363 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01590 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 191990 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 191990 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6219 | PersonsServed |
| Total Community Benefit Expense | 3627934 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2161260 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1466674 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8492 | PersonsServed |
| Total Community Benefit Expense | 13685801 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7998867 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5686934 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07940 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $938,571 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10791537 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10931674 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -140137 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | 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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | 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. The ratio was derived from Worksheet 2. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to a physician clinic. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: Amount of bad debt expense included on Form 990, Part IX, Line 25 subtracted for purposes of calculating percentage: $1,621,408. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.The Organization utilized a cost to charge ratio as the costing methodology used to determine the amount of bad debt expense at cost. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The Organization used a cost report model as the costing methodology to determine the amount of allowable Medicare costs. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Financial Assistance is available to guarantors who meet the eligibility requirements. Income level, household size, residency status, etc, determine eligibility. Federal Poverty Level guidelines are utilized to determine the amount of assistance a household may be eligible for. For the patient's convenience, all statements have an abbreviated version of the Financial Assistance Application on the back. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Reaching out to the community to achieve meaningful public participation is integral to Copley's success and mission of meeting the healthcare needs of the community. Copley gathers and analyzes information about the greater Lamoille Valley community and its healthcare needs through various means, including:-Analyzing and responding to health trends in our patients and through aggregate data from our Workplace Wellness program. - Meeting with community leaders including town and state officials, health and community service providers, EMS providers, police and fire officials, school administrators and others who have knowledge of the community's health needs. Includes review of data of Vermonters' health, health practices and behavioral risks published by Vermont Department of Health, VITL, BISHCA and Federal Centers for Disease Control. -Hosting an annual Community Forum, an annual meeting and informal community needs assessment surveys in the community-Governance by a volunteer board of trustees comprised of local citizensrepresenting a cross section of the community served. -Copley Hospital maintains a strong level of involvement in the majority of community groups within our service area-Copley Hospital works collaboratively with other organizations to identify and meet community health needs. Our collaborations include but are not limited to: Blueprint for Health Community Activation and Support Work group, Friends of Lamoille Youth led by the United Way; 4-H; Lamoille Family Health Coalition with the Vermont Department of Health, Lamoille Valley Fit & Healthy Council, Lamoille Valley TobaccoTask Force, and Leadership Lamoille through the Chamber of Commerce. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Information about Copley's Charitable Care policy, which includes helping patients apply for assistance under federal, state or local government programs, is posted by each registration desk (Main Lobby and Emergency Department). It is also available, along with the application form, online on the Hospital's website in addition to the "Hospital Report Card" website of the Vermont Department of Banking, Insurance, Securities and Health Care Administration. Details are also included in the Patient Guide for inpatients, families and visitors. Copley's Charitable Care program is also promoted in our philanthropy efforts as many donors give to the program. All care providers may refer patients to the Hospital's Patient Financial Services counselors or to Patient and Family Services to connect them to assistance. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Copley Health Systems (CHS) is an essential health care resource in the rural greater Lamoille County area of Vermont. Our services include a 25-bed Critical Access community hospital, low-income elderly housing and an independent living facility. Copley Hospital's services include 24 hour/7 days a week emergency services, women's and children's services, general surgery, primary care including laboratory services and diagnostic imaging; and an excellent orthopaedic service given our proximity to major ski areas. Our patients are largely the elderly and low-income families in a rural area. Nearly a third are below 200% of poverty level. We serve all patients, regardless of ability to pay. Chronic health conditions impact many adults in our area; according to data from the Vermont Department of Health: 21% are obese; 30% have high cholesterol; 25% have asthma; 19% smoke; 18.5% binge drink. Copley provides services for residents whose next nearest hospital, in most cases, is an hour away in good weather. | CommunityInformation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Professional Services Group Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 530 Washington Highway No 12 | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 043358048 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 191667 | AmountOfCashGrant |
| Purpose Of Grant | Support obstetrics and gynecology services to residents of Lamoille County. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The Organization obtains financial information from the grantee to determine the amount of funds to be granted. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 | 1 | 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 | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Melvyn Patashnick | |||||||||||||
| 225715 | 0 | 0 | 0 | 25386 | 0 | 8747 | 0 | 19217 | 0 | 279065 | 0 | 0 | 0 |
| Rassoul Rangaviz | |||||||||||||
| 159231 | 0 | 0 | 0 | 276 | 0 | 6125 | 0 | 18422 | 0 | 184054 | 0 | 0 | 0 |
| Bryan Huber MD | |||||||||||||
| 398005 | 0 | 47491 | 0 | 17041 | 0 | 9800 | 0 | 30039 | 0 | 502376 | 0 | 0 | 0 |
| SG Neale MD | |||||||||||||
| 403914 | 0 | 11004 | 0 | 17822 | 0 | 9800 | 0 | 37146 | 0 | 479686 | 0 | 0 | 0 |
| Eric Mullins MD | |||||||||||||
| 429998 | 0 | 20428 | 0 | 336 | 0 | 9800 | 0 | 27895 | 0 | 488457 | 0 | 0 | 0 |
| John Kaeding MD | |||||||||||||
| 256037 | 0 | 0 | 0 | 18084 | 0 | 9800 | 0 | 19478 | 0 | 303399 | 0 | 0 | 0 |
| Neil Nigro MD | |||||||||||||
| 239226 | 0 | 0 | 0 | 228 | 0 | 9352 | 0 | 27767 | 0 | 276573 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 5 | Bryan Huber, a highest compensated employee, received a bonus of $47,491. Eric Mullins, a highest compensated employee, received a bonus of $20,428. Glen Neale, a highly compensated employee, received a bonus of $11,004. Each of the individuals were paid an incentive bonus based upon the gross revenue they produced individually for the hospital. The bonus is triggered when the individual produces a certain level of revenue. The bonus is 20% of the excess revenue produced over that level. There is a cap on the amount of bonus the indivdual can receive. | |
| Part III | Form 990, Part VII, Line 5: Dr. Brian Smale, a member of the board of trustees is an owner of Green Mountain General Surgery. Copley Hospital paid Green Mountain General Surgery for surgical services that Dr. Smale provided through his Organization to the Hospital. Copley Hospital paid Green Mountain General Surgery $209,148 for these services. Dr. Smale's compensation for services rendered specifically to the Hospital was not available as Green Mountain General Surgery is an unrelated organization. | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Brian Smale MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Trustee of the Organization | Relationship |
| Amount Of Transaction | 209148 | AmountOfTransaction |
| Description Of Transaction | Independent Contractor Arrangement | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Copley Hospital, Inc. is a member organization whose sole corporate member is Copley Health Systems, Inc. Copley Health Systems, Inc. and the Hospital share the same board of trustees. | |
| Form 990, Part VI, Section A, line 7a | Copley Hospital, Inc. shares the same board as Copley Health Systems, Inc. Each year, the members of Copley Health Systems, Inc. will hold an annual meeting. The purposes of the annual meeting shall include the election of members to the Corporation, the election of Trustees to the Corporation's Board of Trustees, the election of the community member at large of the governance and bylaws committee, and the transaction of such other business as may properly come before the membership. The Board shall consist of up to twenty-one elected members, the Chief Executive Officer of the Corporation, the President of the Medical Staff of Copley Hospital, Inc., and the President of Copley Hospital Auxiliary, Inc., all as voting members. All Trustees must be members of the Corporation. | |
| Form 990, Part VI, Section B, line 11 | A subcommittee of both the finance and governance committees review the Form 990 prior to submission. A complete copy of the form is made available to all members of the governing body through the finance office. | |
| Form 990, Part VI, Section B, line 12c | The compliance officer reviews the completed conflict of interest statements and assesses the potential for conflicts of interest for each individual. Those individuals who receive a risk rating of moderate or above are retained on the monitoring list for five years. The CEO is informed of any individuals who receive such a rating. The compliance officer makes recommendations to the CEO and board chair as to actions to address any conflicts of interest. The Organization also annually asks trustees, foundation committee members, purchasing agents, senior directors, and employed physicians to complete a conflict of interest disclosure statement. Conflicts are then compiled in the conflict matrix and reviewed by the ethics committee. The conflict matrix is available for review by the public at both the annual meeting and by request. | |
| Form 990, Part VI, Section B, line 15 | The CEO's pay is determined through the use of the Millbrook Associates compensation data for Hospital CEOs. Senior leadership and other highly compensated individuals have their pay ranges determined through market data from Astron Solutions. The compensation for the CEO is then approved by the board of trustees. | |
| Form 990, Part VI, Section C, line 19 | The governing documents are made available upon request. The conflict of interest policy and Matrix are available at the annual meeting upon request. The financial statements are summarized in an annual report that is available to the public. The Hospital also submits both their budget and actual financial information to the State of Vermont's Department of Banking, Insurance, Securities & Health Care Administration. | |
| Form 990, Part XI, Line 2c: | The audit process has not changed from prior year. | Oversight of Audit |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|
| Lamoille Area Housing Corporation Copley Terrace Project | ||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030270255 | Subsidized Elderly Housing | VT | 501(c)(3) | Line 9 | Copley Health Systems Inc | |
| Copley Health Systems Inc | ||||||||||
| 528 Washington Highway | Morrisville | VT | 05661 | 030301457 | Support of Copley Hospital | VT | 501(c)(3) | Line 11b, II | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Health Center Building Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 528 Washington Highway | AddressLine1 |
| City | Morrisville | City |
| State | VT | State |
| ZIP Code | 05661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030220357 | EIN |
| Primary Activity | Office Building Rental | PrimaryActivity |
| Legal Domicile State | VT | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Copley Health Systems Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| 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 | 1 | 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 | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | 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 |
|---|---|
| Health Center Building | |
| K | 28500 |
| Health Center Building | |
| J | 57859 |
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