2011-05-13T12:49:46-05:00 2010-09-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2009-10-01 030181058 Porter Hospital Inc PORT 8023884701 37 Porter Drive Middlebury VT 05753 Marilyn Olejnik 8023884701 2011-05-11 1 Barbara J McGuan CPA 2077752387 2011-05-11 2009 2016-02-24 21:20:13Z James Daily 37 Porter Drive Middlebury VT 05753 57146927 0 X www.portermedical.org X 1925 VT Critical Access Hospital 16 14 508 105 3353 1380 258237 115877 57316944 56666904 54643 197880 157320 66994 57787144 57047655 35000 0 31342161 32369152 0 0 24989167 26611534 56331328 59015686 1455816 -1968031 51071918 48872312 26597246 26159672 24474672 22712640 The Mission of Porter Medical Center, and its subsidiary companies, is to improve the health status of those served. The Organization will:1. Treat and care for the sick and injured;2. Provide, in cooperation with the community, as appropriate, a continuum of health services including out patient services, rehabilitation, long-term care, and wellness/prevention programs;3. Ensure the delivery of high quality care available to all without regard to their ability to pay;4. Serve as a leader and catalyst in helping to determine, and provide for, the health needs of the community, while remaining a financially healthy organization. 0 0 51793083 35000 56666904 Porter Hospital, Inc. ("Porter") operates a not-for-profit critical access hospital with patient care services including emergency department visits, maternity services, medical/surgical inpatient care, medical/surgical outpatient care, ancillary services tests and imaging/radiology procedures. As a critical access hospital, Porter staffs a total of 25 beds. Of the 25 beds, six beds are located in the maternity unit and three beds are located in the special care unit. The remaining beds are located on the patient wing. Porter recorded approximately 5,220 inpatient days during the year. Emergency Room visits total 15,001 for the year. Surgeries for the year totaled 3,822. Support services for both inpatients and outpatients include, but are not limited to, laboratory, imaging services, cardiac services and rehabilitation facilities. Imaging includes radiology, nuclear medicine, MRI, ultrasound and CT Scan. Porter provides outpatient facilities for physical therapy. Porter provides free care to patients who meet certain criteria. Foregone charges furnished under Porter's free care policy amounted to $1,100,000 for the fiscal year ending 9/30/10. Porter provides a number of community health outreach programs to the general public for free or at a minimal charge. The programs include, but are not limited to, tobacco cessation, memory screenings, diabetes education, lifeline, breast cancer screening, prenatal classes, breastfeeding classes and CPR courses. Porter provides services free of charge to the local Open Door Clinic. Finally, Porter has partnered with a local career center to provide clinical exposure to their students with the goal of developing future healthcare workers for the community. 51793083 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 61 0 508 1 1 1 0 0 0 0 0 0 0 0 16 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Marilyn Olejnik 8023884701 37 Porter Drive Middlebury VT 05753 James L Daily 40.00 X X 0 368639 118950 Gerry Gossens 3.00 X 0 0 0 Ken Perine 3.00 X X 0 0 0 Edwin Grant 3.00 X X 0 0 0 Diana Barnard MD 3.00 X 0 0 0 Peter DeGraff 3.00 X 0 0 0 Ann Hanson 3.00 X 0 0 0 Mike Kiernan MD 3.00 X 0 0 0 Sherry Klinck 3.00 X 0 0 0 Fred Kniffin MD 40.00 X 227194 0 23448 Sue Ritter 3.00 X X 0 0 0 Benjamin Rosenberg MD 3.00 X 0 0 0 Robert Stetson 3.00 X 0 0 0 Joe Sutton 3.00 X 0 0 0 Steve Terry 3.00 X 0 0 0 Joan Donahue 3.00 X 0 0 0 Bill Townsend 3.00 X 0 0 0 Duncan Brines 40.00 X 0 166539 29111 Alan D Ayer 40.00 X 277650 0 26179 Robert D Pitts 40.00 X 200119 0 31639 Anders Holm 40.00 X 338817 0 33357 James A Malcolm 40.00 X 276378 0 26179 David B Turner 40.00 X 229447 0 29480 1549605 535178 318343 42 0 1 0 Fletcher Allen Health Care 111 Colchester Avenue Burlington VT 05402 Medical Testing 645588 American Health Centers 498 Essex Street Bangor ME 04401 MRI Testing 474169 Americus Sten-Tel 62 Wildfire Drive Warren VT 05674 Transcription Services 263697 AMN Healthcare 2735 Collection Center Drive Chicago IL 60693 Medical Testing 183397 American Red Cross 600 A Forest Point Circle Charlotte NC 28273 Medical Testing 171316 7 115877 115877 Patient Revenue 621110 54100971 54100971 Medicaid DSP 621110 1085929 1085929 Foundation Revenue 621110 495507 495507 Premium Revenue 621110 468693 468693 Miscellaneous Revenue 621110 237642 237642 278162 138996 3353 135813 56666904 235730 235730 66994 66994 66994 66994 61422 99272 61422 -99272 -37850 -37850 57047655 56527738 3353 400687 35000 35000 250642 250642 24533595 21503259 3030336 1052165 922553 129612 4852968 4257013 595955 1679782 1474203 205579 3168104 2780377 387727 110966 97385 13581 113710 99794 13916 116919 102610 14309 7792039 6834131 957908 2170340 1904724 265616 103659 90973 12686 223858 196462 27396 2980433 2615674 364759 1001211 878678 122533 Purchased Services 3244286 2847236 397050 Bad Debts 3102565 2722860 379705 Medicare Provider Tax 2483444 2179509 303935 59015686 51793083 7222603 0 4515 4315 9311446 7264772 7838664 7159094 53843 58455 819600 754471 227174 251569 40993254 14306350 27094245 26686904 2333233 2725355 2738616 3087530 154686 148674 495896 731173 51071918 48872312 5143545 5407202 202676 112592 14850000 14540000 1970960 2467948 4430065 3631930 26597246 26159672 X 21381994 19271048 432864 371505 2659814 3070087 24474672 22712640 51071918 48872312 X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 22511 22511 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 2130385 2130385 24277082 6167988 18109094 13132529 7490859 5641670 1453258 647503 805755 26686904 Beneficial Interest in Trusts 2952405 F Interest in Porter Medical Center 135125 F 3087530 Third Party Payor Settlements 600000 Deferred Compensation 302984 Due to Affiliate 310644 Liability for Pension Benefits 2418302 3631930 57047655 59015686 -1968031 89849 116150 205999 -1762032 57253654 89849 116150 205999 57047655 0 57047655 59015686 0 59015686 0 59015686 Part XI, Line 8 - Other Adjustments: Change in net assets to recognize funded status of pension plan: -377283. Change in net assets of Porter Medical Center, Inc.: 83160. Change in beneficial interest in perpetual trusts: 410273. Part XII, Line 2d - Other Adjustments: Change in net assets to recognize funded status of pension plan: -377283. Change in net assets of Porter Medical Center, Inc.: 83160. Change in beneficial interest in perpetual trusts: 410273. 1 1 1 X 1 X 1 1 0 1 1 780722 139940 640782 0.01150 11209431 6423839 4785592 0.08560 11990153 6563779 5426374 0.09710 1086787 186819 899968 0.01610 12665 0 12665 0.00020 741540 277022 464518 0.00830 35000 35000 0.00060 1875992 463841 1412151 0.02520 13866145 7027620 6838525 0.12230 1 1977226 30368 11683945 11990975 -307030 X 1 1 Porter Hospital Inc

37 Porter Drive Middlebury VT 05753

X X X X Porter Internal Medicine

116 Porter Drive Middlebury VT 05753

Physician Clinic Neshobe Family Medicine

61 Court Drive Brandon VT 05733

Family Physician Clinic Bristol Internal Medicine

6 Park St Bristol VT 05443

Physician Clinic Tapestry Midwifery

20 Armory Lane Vergennes VT 05491

Physician Clinic Porter Cardiology

115 Porter Drive Middlebury VT 05753

Physician Clinic Middlebury Pediatric & Adolescent Med

1330 Exchange Street 201 Middlebury VT 05753

Physician Clinic Little City Family Practice

10 North Street Vergennes VT 05491

Family Physician Clinic Addison Associates in OBGYN

116 Porter Drive Middlebury VT 05753

OB/GYN Addison Family Medicine

82 Catamount Park Middlebury VT 05753

Family Physician Clinic Partners in Palliative & Home Care

108 Porter Drive Middlebury VT 05753

Physician Clinic Porter Ear Nose & Throat

1330 Exchange Street 202 Middlebury VT 05753

Physician Clinic Part I, Line 6a: The annual community benefit report is prepared by Porter Medical Center, the parent Company of Porter Hospital, Inc. Part I, Line 7: Amount of Bad Debt expense removed for purposes of calculating the amount reported on Line 7f: $3,102,565The Organization used a cost-to-charge ratio as its methodology for calculating amounts on Lines 7a & 7b. An actual costing methodology was used to calculate the amounts on lines 7e, 7f, 7g & 7i. Part I, Line 7g: The Organization included as subsidized health services costs attributable to Partners in Pallative Care, a physician clinic. Total costs related to this physician clinic are $741,540. Part III, Line 4: An allowance is provided for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Accounts are considered delinquent and subsequently written off as uncollectible based on individual credit evaluation and specific circumstances of the account.The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense. Part III, Line 9b: Porter Hospital, Inc. recognizes that it has a responsibility to provide care to all patients regardless of their ability to pay and make available financial assistance for those patients that have been identified as financially needy through written documentation. Information regarding financial assistance is made available upon request. Part VI, Line 8: Porter Medical Center files an Annual Report to the Community in the State of Vermont on behalf of its wholly owned subsidiary, Porter Hospital, Inc. Part VI, Line 2: Porter Hospital, Inc. maintains an active list of Quality Improvement Projects and Initiatives that are identified by our clinical staff in response to either internal or external assessments of how we can implement "best practices" for our patients. The list of projects and initiatives is updated annually as part of the State of Vermont's Act 53. Porter Hospital's Community Advisory Committee assess community needs biennially. The results of the assessment are posted on Porter Medical Center's Web Site. Part VI, Line 3: A "Notice of Availability of Free Care" is posted on the Porter Medical Center Web Site. In addition, all patients receive a brochure entitled "Important Information About your rights and responsibilities as a patient". The brochure states that the patient has the right to receive the most appropriate medical treatment available regardless of ability to pay and receive information about financial assistance. Part VI, Line 4: Porter Hospital, Inc. is the major provider of health care in Addison County, Vermont. Porter Hospital, Inc. also provides services to residents of northern Rutland County (Vermont), Essex County (Vermont), New York and elsewhere in this region. Part VI, Line 5: Porter Hospital, Inc. provides annual financial support, rent free clinic space and vouchers for no-cost ancillary services to the local Open Door Clinic in its role as a catalyst in the delivery of health care services to its entire community.Porter Hospital, Inc. offers free and low cost community education programs on health care topics including memory loss, dementia, breast cancer screening, basic diabetes, CPR, smoking cessation, parenting, prenatal exercise and breast feeding.A majority of the governing body is comprised of persons who reside in its service area and who are neither employees nor contractors of Porter Hospital, Inc. nor family members thereof. Medical staff privileges are extended to all qualified physicians in the community.Surplus funds are invested in technology, facilities and programs. Porter Hospital and the local Career Center collaborate on a new Health Careers Education program. Part VI, Line 7: Porter Hospital, Inc. and Helen Porter Nursing Home, Inc. are wholly owned subsidiaries of Porter Medical Center. Through its subsidiaries, Porter Medical Center provides a continuum of health services including in-patient care, out-patient care, short-term rehabilitation, long-term rehabilitation, long-term care, dementia care, wellness programs and prevention programs. 1 Open Door Clinic 812 Exchange Street Suite 2 Middlebury VT 05753 030359531 501(c)(3) 10000 Operational assistance Patricia Hannaford Career Center 51 Charles Avenue Middlebury VT 05753 201189236 25000 Operational assistance 1 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Open Door Clinic When the Open Door Clinic (Clinic) makes its annual solicitation of support to Porter Hospital, Inc., the Clinic includes a report detailing the uses of funds for the prior year. The report includes the number of patients served by the Clinic and the types of services provided by the Clinic. Patricia A. Hannaford Career Center Porter Hospital, Inc.'s (Porter) assistance to the Patricia A. Hannaford Career Center (Center) is intended to support the Health Career program at the Center. The assistance enables the Center to provide training to their students in an actual health care setting. Porter can monitor the success of its financial assistance to the Health Career program directly when the students from the Center come to Porter for shadowing or cooperative education opportunities in various clinical areas. X X X X 0 1 0 0 0 0 0 0 0 James L Daily 0 368639 0 0 0 0 0 91450 0 27500 0 487589 0 0 Fred Kniffin MD 227194 0 0 0 0 0 6887 0 16561 0 250642 0 0 0 Duncan Brines 0 166539 0 0 0 0 0 10275 0 18836 0 195650 0 0 Alan D Ayer 267650 0 10000 0 0 0 7350 0 18829 0 303829 0 0 0 Robert D Pitts 200119 0 0 0 0 0 8191 0 23448 0 231758 0 0 0 Anders Holm 323317 0 0 0 15500 0 7350 0 26007 0 372174 0 0 0 James A Malcolm 266378 0 10000 0 0 0 7350 0 18829 0 302557 0 0 0 David B Turner 229447 0 0 0 0 0 6995 0 22485 0 258927 0 0 0 Part I, Line 4a James Daily, President & CEO, participates in a 457(f) plan, but did not receive any funds from the plan for FY 9/30/10. Vermont Educational and Health Buildings Financing Agency 237154467 9241607X6 2005-06-17 15430000 Funding for new Construction 0 0 15430000 4974901 207863 170152 10077084 2005 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 1 Form 990, Part VI, Section A, line 6 Porter Medical Center, Inc. is the parent holding company and sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to appoint Hospital directors. Form 990, Part VI, Section A, line 7b Porter Medical Center, Inc., the parent holding company and sole corporate member of the Organization, has the right to approve major hospital expenditures and approve hospital long-term borrowings. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by management and the finance committee before filing. Form 990, Part VI, Section B, line 12c The Organization's CFO is responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. When bids are solicited to include the business of a Board member, those bids are reviewed by the Board of Directors to assure adherence to the Hospital's lowest bid policy. When an issue comes up to a vote and it is connected, in any way, to the business of a Board member, the member must recuse him/herself from the vote. Form 990, Part VI, Section B, line 15a The Organization's executive committee reviews comparative data prepared by a consultant prior to referral of compensation to the board of directors. The board of directors review the findings of the consultant and vote to approve the salary of the CEO. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, Line 2c: Oversight of Audit The audit process has not changed from prior years. Form 990, Part I, Lines 8-18: Prior year numbers have been restated to present revenue at net amounts. Porter Real Estate Holdings LLC 37 Porter Drive Middlebury VT 05753 261585746 Real Estate Holdings VT 0 0 Porter Medical Center Inc Porter Medical Center Inc 37 Porter Drive Middlebury VT 05753 030310862 Holding Company for Subsidiaries VT 501(c)(3) Line 11b, II N/A Porter Management Services Inc 37 Porter Drive Middlebury VT 05753 030308242 Management Services VT 501(c)(3) Line 11b, II Porter Medical Center Inc Helen Porter Nursing Home Inc DBA Helen Porter Healthcare & Rehab Center 37 Porter Drive Middlebury VT 05753 030306549 Nursing Home VT 501(c)(3) Line 3 Porter Medical Center Inc Auxiliary of Porter Medical Center 37 Porter Drive Middlebury VT 05753 237363227 Supporting Organization VT 501(c)(3) Line 11b, II Porter Medical Center Inc 0 0 0 1 1 0 0 0 0 1 1 1 0 1 0 0 0 0