2011-08-12T14:02:33-05:00 2010-09-30 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2009-10-01 030183721 Windsor Hospital Corporation WIND 8026746711 289 County Road Windsor VT 05089 Wayne Bennett 8026746711 2011-08-09 1 Rachel Williamson CPA 6036697337 2011-08-09 2009 2016-02-24 21:20:13Z Mt Ascutney Hospital & Health Cente Wayne Bennett 289 County Road Windsor VT 05089 48384439 0 X www.mtascutneyhospital.org X 1933 VT To provide healthcare services. 20 17 555 150 0 0 459184 297511 45519332 47613164 157898 322946 1206222 78317 47342636 48311938 0 0 28535563 29468470 0 68203 18516542 19087745 47052105 48556215 290531 -244277 36057742 37681505 21320980 22218581 14736762 15462924 Mount Ascutney Hospital and Health Center's mission is to provide the highest quality healthcare in a fiscally responsible manner. 0 0 39750834 47613164 Mt. Ascutney Hospital and Health Center (MAHHC) operates a not-for-profit critical access hospital which provides primary and secondary health care. MAHHC's primary service area includes Windsor, Claremont, Woodstock, Hartland, Springfield, and Brownsville. The hospital provides essential healthcare services including emergency department, med/surg inpatient, med/surg outpatient, ancillary diagnostic tests, imaging/radiology procedures, and wellness/prevention services. MAHHC staffs a total of 25 acute med/surg beds, 10 acute rehabilitation beds, and 25 extended care beds. During the year there were 1,000 inpatient discharges, 600 outpatient surgeries, 65,000 outpatient lab tests, and 10,000 outpatient imaging procedures. MAHHC identified access to primary care as a central community need and is committed to providing the physician services of family practice, internal medicine and pediatrics in Windsor and Woodstock. During the year there were 36,500 primary care patient visits. MAHHC's service area includes a significant proportion of residents who are uninsured, underinsured, or dependant on Medicare/Medicaid benefits. MAHHC provides free care to patients who meet certain criteria. Foregone charges furnished under MAHHC's free care policy amounted to $636,000. 39750834 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 71 0 1 555 1 0 0 0 0 0 0 0 0 0 20 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Wayne Bennett 8026747240 289 County Road Windsor VT 05089 Harold Pyke 1.00 X X 0 0 0 Nancy Loux 1.00 X X 0 0 0 Susan Plausteiner 1.00 X X 0 0 0 Mary Bell 1.00 X 0 0 0 Paul Buff 1.00 X 0 0 0 Beach Conger MD 22.00 X 115894 0 25920 Larry Frazer 1.00 X X 0 0 0 Pastor David Jones 1.00 X 0 0 0 George Murray 1.00 X 0 0 0 Michael Newbold 1.00 X 0 0 0 Jane Osgood 1.00 X 0 0 0 Lynn Peterson MD 1.00 X 0 0 0 Alan Cummings 1.00 X 0 0 0 Catherine Schneider MD 16.00 X 165528 0 0 Shelley Seward 1.00 X 0 0 0 Nancy Formella 1.00 X 0 0 0 Diane Riley MD 40.00 X 369383 0 39252 David P Russo MD 40.00 X 175612 0 59709 Hon Donna Sweaney 1.00 X 0 0 0 Sikhar Banerjee MD 30.00 X 150328 0 22859 Richard Slusky 40.00 X 242124 0 40331 Michael Long 40.00 X 138646 0 22859 Kevin Donovan 40.00 X 0 0 0 Jeanne McNeil 40.00 X 0 0 0 Bennett Beres 40.00 X 127064 0 28516 Jill Lord 40.00 X 129610 0 859 Christopher Connor MD 40.00 X 339863 0 41777 Richard Meyer MD 40.00 X 255636 0 23548 Leonard Rudolf MD 40.00 X 412041 0 10975 Jennifer Keller MD 40.00 X 226706 0 19449 Marlene Sachs MD 40.00 X 219495 0 15952 3067930 0 352006 31 0 1 0 Emergency Services of New England Inc PO Box 12 Chester VT 05143 Physician assistance for Emergerncy Room 794922 Valley Regional Hospital 243 Elm Street Claremont NH 03743 Provide surgeons for Hospital 465376 Staffing Solutions of Vermont 2704 Church Hill Road Woodstock VT 05091 Provide agency nurses 426467 University of Vermont TSPIMF 280 East Avenue Burlington VT 05401 Maintenance services 123301 4 45538 251973 17711 297511 Net Patient Service Re 900099 46920173 46920173 Vermont Health Access 900099 311483 311483 Purchase Discounts 900099 116375 116375 Cafeteria & Dietary Se 900099 101543 101543 Miscellaneous Revenue 900099 62160 62160 101430 101430 47613164 325520 325520 56463 56463 56463 56463 40271 9930 52775 -12504 9930 -2574 -2574 41580 19726 21854 21854 48311938 47613164 0 401263 1453644 1453644 21356513 18100044 3214299 42170 1500438 1274165 226273 3593304 3570329 22975 1564571 1328627 235944 51130 51130 125118 125118 25942 25942 52851 589 48068 4194 3407565 3185412 220227 1926 976929 317189 659725 15 64313 46848 17465 459 459 399496 399496 1962508 1962508 397027 118455 278572 Contracted Services 3458764 2483554 962780 12430 Physician Fees 1913404 1913404 Bad Debts 1578846 1578846 Taxes & Licenses 1439635 1439635 Minor Equipment 1330202 797182 529707 3313 1903556 1234551 665309 3696 48556215 39750834 8737178 68203 1224 1563 2414825 4473870 47952 5626 6877460 6383142 99957 8775 63938 580698 596225 558325 539577 28217404 15707469 13745313 12509935 8342679 9334400 1713764 1800789 1666770 1972440 36057742 37681505 4414414 4715059 9651056 9477506 7255510 8026016 21320980 22218581 X 8650109 9260218 447219 491962 5639434 5710744 14736762 15462924 36057742 37681505 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20101 20101 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The Hospital paid $17,992 in the form of dues to the Vermont Association of Hospitals and Health Systems (VAHHS). VAHHS is a member-owned organization devoted to improving the health status of communities throughout Vermont through activities which include advocacy, policy development, education and research. The Hospital also paid $2,109 in the form of dues to the American Hospital Association (AHA). 5710296 76719 5787015 5634030 76266 5710296 0.98680 0.01320 0 0 75418 75418 18700471 9496606 9203865 8252601 5697384 2555217 1188914 513479 675435 12509935 Deposits 5560 Other Assets 272398 Deferred Financing Costs, net 117455 Equity in Subsidiary 1577027 1972440 Other Liabilities 215481 Pension Liability 6167680 Interest Rate Swap 712607 Estimated Settlements with Third Parties 930248 8026016 48311938 48556215 -244277 740211 230228 970439 726162 49188233 740211 911833 1652044 47536189 25942 749807 775749 48311938 48462071 19726 19726 48442345 25942 87928 113870 48556215 Part V, Line 4: Description of Intended Use of Endowment Funds: In general, the amount of the original gift and any required accumulations by the donor are not expendable. However, the market value of the fund may fall below that amount depending on current financial conditions in the underlying investments. Under the policy of the Hospital, the endowment assets are invested moderately with the intent of providing a predictable stream of funding to the Hospital. The Hospital invests in equity funds, bond funds and money market investments to achieve its long-term return objectives within limited risk constraints. Actual returns in any year may vary from budgeted amounts due to market fluctuations. Part XI, Line 8 - Other Adjustments: Loss on Extinguishment of Debt: -137390. Unrealized Loss on Interest Rate Swap: -524489. Equity in Income of Subsidiaries: 255170. Change in Funded Status of Pension Plan: 549910. Unrealized Appreciation in Charitable Remainder Trust: 15717. Unrealized Appreciation in Beneficial Interest in Perpetual Trusts: 71310. Part XII, Line 2d - Other Adjustments: Equity in Income of Subsidiaries: 255170. Change in Funded Status of Pension Plan: 549910. Unrealized Appreciation in Charitable Remainder Trust: 15717. Unrealized Appreciation in Beneficial Interest in Perpetual Trusts: 71310. Fundraising Expenses: 19726. Part XII, Line 4b - Other Adjustments: Loss on Extinguishment of Debt: 137390. Unrealized Loss on Interest Rate Swap: 524489. Development Department Expense: 87928. Part XIII, Line 2d - Other Adjustments: Fundraising Expenses: 19726. Part XIII, Line 4b - Other Adjustments: Development Department Expense: 87928. Golf Tournament 41580 41580 399 9933 7375 2019 41580 41580 399 9933 7375 2019 19726 21854 1 1 1 X 1 X 1 1 1 0 1 1 426186 426186 0.00910 6549553 4066294 2483259 0.05290 6975739 4066294 2909445 0.06200 195807 195807 0.00420 34058 34058 0.00070 8510857 7662915 847942 0.01810 14100 14100 0.00030 8754822 7662915 1091907 0.02330 15730561 11729209 4001352 0.08530 1 1057196 0 18028907 17916634 112273 X 1 1 Windsor Hospital Corporation

289 County Road Windsor VT 05089

X X X X Skilled nursing facility Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. Part III, Line 4: 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 accounts receivable. The costing methodology used above was the cost to charge ratio. Part VI, Line 3: The Hospital posts its charity care policy on its website. Part VI, Line 4: MAHHC's primary service area includes Windsor, Claremont, Woodstock, Hartland, Springfield, and Brownsville. Part VI, Line 6: The Windsor Community Health Clinic at Mt. Ascutney Hospital was established to serve members of our community who are not covered by Medicaid, VHAP, and private insurance, and who do not have the financial resources to pay for healthcare services. The Clinic offers free clinic appointments to members who have no insurance, or are under-insured and meet certain income requirements. X X X X 0 0 0 0 0 0 0 0 0 Catherine Schneider MD 165528 0 0 0 0 0 0 0 0 0 165528 0 0 0 Diane Riley MD 297450 0 71694 0 239 0 9800 0 29452 0 408635 0 0 0 David P Russo MD 175612 0 0 0 0 0 0 0 59709 0 235321 0 0 0 Sikhar Banerjee MD 149604 0 0 0 724 0 0 0 22859 0 173187 0 0 0 Richard Slusky 228941 0 0 0 13183 0 0 0 40331 0 282455 0 0 0 Michael Long 132758 0 0 0 5888 0 0 0 22859 0 161505 0 0 0 Bennett Beres 126861 0 0 0 203 0 5114 0 23402 0 155580 0 0 0 Christopher Connor MD 296924 0 42693 0 246 0 9800 0 31977 0 381640 0 0 0 Richard Meyer MD 254654 0 0 0 982 0 9800 0 13748 0 279184 0 0 0 Leonard Rudolf MD 399233 0 12522 0 286 0 9800 0 1175 0 423016 0 0 0 Jennifer Keller MD 226486 0 0 0 220 0 9102 0 10347 0 246155 0 0 0 Marlene Sachs MD 166848 0 39056 0 13591 0 0 0 15952 0 235447 0 0 0 Vermont Educational and Health Buildings Financing Agency 237154467 2010-02-05 9244000 Refinancing of 2004 and 2005 Bonds 0 0 9244000 128133 1 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 Form 990, Part VI, Section B, line 11 Prior to filing, the Form 990 is reviewed and approved by the Finance Committee of the Board. The Board receives a copy of the final version, prior to filing, and it is discussed at the Board meeting. Form 990, Part VI, Section B, line 12c The Finance and Audit Committees monitor and report to the Board of Directors. Form 990, Part VI, Section B, line 15 The Executive Committee of the Board meets annually to review compensation for the CEO, using independent surveys of area compensation for executives of various sized hospitals. Other officers and key employees salaries are determined, by the HR department, using comparable market data. Form 990, Part VI, Section C, line 19 All internal policies, governing documents, and financial statements are made available upon request Form 990, Part XI, Line 2c The Organization did not change its process of either oversight or selection of the independent accountants. Historic Homes of Runnemede 40 Maxwell Perkins Lane Windsor VT 050891206 237396147 Providing Services for the Aging VT 501(c)(3) Supported Windsor Hospital Corporation Mount Ascutney Hospital Community Health Foundation Inc 289 County Road Windsor VT 05089 030300481 To provide healthcare services to the Windor, Vermont community VT 501(c)(3) Service Organization Windsor Hospital Corporation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Mt Ascutney Hospital Community Health Foundation Inc P 95676 Historic Homes of Runnemede Inc P 81915