Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| REASON FOR PUBLIC CHARITY STATUS | SCHEDULE A, PART I THE UNIVERSITY OF VERMONT MEDICAL GROUP - NEW YORK ("UVM MEDICAL GROUP - NEW YORK") IS AN EXEMPT ORGANIZATION DESCRIBED IN IRC SECTION 509(a)(1) & 170 (B)(1)(A)(III). HOWEVER, IT DOES NOT OPERATE ANY FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL. IN FURTHERANCE OF UVM MEDICAL GROUP - NEW YORK AND UNIVERSITY OF VERMONT MEDICAL CENTER, INC.'S EXEMPT PURPOSE, UVM MEDICAL GROUP - NEW YORK RENDERS MEDICAL SERVICES TO PATIENTS AT VARIOUS HOSPITALS. AS A RESULT, UVM MEDICAL GROUP - NEW YORK IS APPROPRIATELY CATEGORIZED AS A HOSPITAL FOR SCHEDULE A PURPOSES, BUT IT IS NOT REQUIRED TO COMPLETE SCHEDULE H. |
| Software ID: | |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| MEMBERS OF STOCKHOLDERS | FORM 990, PART VI, QUESTIONS 6 AND 7A UVM MEDICAL GROUP - NEW YORK IS INCORPORATED AS A PROFESSIONAL SERVICES LIMITED LIABILITY COMPANY IN THE STATE OF NEW YORK. MEMBERS/MANAGERS OF UVM MEDICAL GROUP - NEW YORK MAY CONSIST OF: EMPLOYEES OF THE UVM MEDICAL GROUP - NEW YORK OR UNIVERSITY OF VERMONT MEDICAL GROUP, INC. ("UVMMG"), A RELATED ORGANIZATION, WHO ARE EITHER LICENSED TO PRACTICE IN THE STATE OF NEW YORK, OR INDIVIDUALS WHO HAVE BEEN ENGAGED IN THE PRACTICE OF MEDICINE ON BEHALF OF THE COMPANY AND ARE EMPLOYED BY UNIVERSITY OF VERMONT MEDICAL CENTER, INC. ("UVM MEDICAL CENTER"), A VERMONT NOT-FOR-PROFIT 501(C)(3) OR ITS WHOLLY OWNED TAX EXEMPT SUBSIDIARY, UVMMG. |
| MEETING DOCUMENTATION | FORM 990, PART VI, QUESTION 8B UVM MEDICAL GROUP - NEW YORK DOES NOT MAINTAIN COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990 REVIEW | FORM 990, PART VI, QUESTION 11B UVM MEDICAL GROUP - NEW YORK'S FORM 990 IS PREPARED BY A PAID PREPARER AND REVIEWED BY UVM MEDICAL CENTER'S (THE ORGANIZATION'S PARENT ORGANIZATION) INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, UVM MEDICAL CENTER'S INTERNAL MANAGEMENT PRESENTS THE FORM 990 TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF UVM MEDICAL GROUP - NEW YORK'S BOARD OF MANAGERS PRIOR TO THE FORM BEING FILED WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, QUESTION 12 THE ORGANIZATION IS SUBJECT TO THE CONFLICT OF INTEREST POLICY AND REQUIREMENTS OF UVM MEDICAL CENTER, ITS AFFILIATED ORGANIZATION. UVM MEDICAL CENTER REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. IN ACCORDANCE WITH THE POLICY, TRUSTEES, OFFICERS, KEY EMPLOYEES AND PHYSICIANS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE AND CERTIFICATION UPON HIRING, AND THEREAFTER AT LEAST ANNUALLY, PRIOR TO PARTICIPATING IN ANY DECISION THAT MAY BE AFFECTED BY A PERSONAL INTEREST, AND WHENEVER A POTENTIALLY CONFLICTING INTEREST FIRST ARISES. CONFLICT OF INTEREST DISCLOSURES AND CERTIFICATION MAY BE MADE ONLINE OR IN WRITING AND ARE REGULARLY REVIEWED BY THE GENERAL COUNSEL OF UVM MEDICAL CENTER. THE CONFLICT OF INTEREST POLICY IS ENFORCED BY THE OFFICE OF GENERAL COUNSEL OF UVM MEDICAL CENTER AND OVERSEEN BY A FIVE-PERSON CONFLICT OF INTEREST COMMITTEE OF THE UVM MEDICAL CENTER BOARD OF TRUSTEES. THE GENERAL COUNSEL REPORTS AT LEAST QUARTERLY ON CONFLICT OF INTEREST ISSUES TO THE UVM MEDICAL CENTER AUDIT COMMITTEE OF THE BOARD OF TRUSTEES. CONFLICTS OF INTEREST ARE MANAGED IN ACCORDANCE WITH THE POLICY, WHICH PROVIDES FOR A VARIETY OF REMEDIES TO ADDRESS CONFLICTS OF INTEREST. IN ADDITION, "DISQUALIFIED PERSONS", CONSISTING OF TRUSTEES, OFFICERS AND KEY EMPLOYEES ARE SUBJECT TO SPECIAL PROCEDURES TO COMPLY WITH THE INTERMEDIATE SANCTION RULES, AS OUTLINED IN THE CONFLICT OF INTEREST POLICY. |
| COMPENSATION DETERMINATION | FORM 990, PART VI, QUESTION 15 UVM MEDICAL GROUP - NEW YORK RELIED ON UVM MEDICAL CENTER, ITS AFFILIATED ORGANIZATION, TO ESTABLISH ITS MEMBER/MANAGER'S COMPENSATION. THE BOARD OF MEMBER/MANAGERS OF UVM MEDICAL GROUP - NEW YORK HAS ADOPTED A PHYSICIAN COMPENSATION PLAN THAT PROVIDES IN PART AS FOLLOWS: "THE TOTAL COMPENSATION PAID TO A PHYSICIAN SHALL NOT BE IN EXCESS OF REASONABLE COMPENSATION NOR INCONSISTENT WITH THE FAIR MARKET VALUE OF THE PHYSICIAN'S SERVICES, MEASURED BY APPROPRIATE INDUSTRY BENCHMARKS." THE COMPENSATION PLAN HAS BEEN APPROVED BY THE BOARD OF TRUSTEES OF UVM MEDICAL CENTER, AN AFFILIATED ORGANIZATION OF UVM MEDICAL GROUP - NEW YORK. UVM MEDICAL CENTER'S COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES HIRED AN EXTERNAL INDEPENDENT CONSULTING FIRM, INTEGRATED HEALTHCARE STRATEGIES, TO ASSIST THE COMMITTEE IN ESTABLISHING THE TOTAL COMPENSATION. AIDED BY INTEGRATED HEALTHCARE STRATEGIES, THE COMPENSATION COMMITTEE HAS ESTABLISHED, AND THE BOARD HAS APPROVED, A COMPENSATION PHILOSOPHY FOR THE ORGANIZATION WHICH DEFINES A PEER GROUP OF ORGANIZATIONS ACROSS THE COUNTRY AND INCLUDES ORGANIZATIONS OF SIMILAR SIZE, SCOPE, COMPLEXITY AND MANAGEMENT CHALLENGE; IT HAS ALSO ESTABLISHED THE COMPETITIVE LEVEL AT WHICH THE COMMITTEE WANTS TO COMPENSATE EXECUTIVES COMPARED TO THE PEER GROUP ORGANIZATIONS. INTEGRATED HEALTHCARE STRATEGIES BENCHMARKED AND ANALYZED THE TOTAL COMPENSATION FOR THESE EMPLOYEES USING PROPRIETARY HEALTH CARE EXECUTIVE COMPENSATION SURVEYS AND OTHER COMPARATIVE MARKET PAY DATA TO ENSURE THAT THIS COMPENSATION IS COMPETITIVE, EQUITABLE AND MEETS ALL REASONABLENESS STANDARDS. DUE TO THE COMPLEXITY OF THIS REVIEW, CALENDAR YEAR ENDS ARE SOMETIMES SPANNED AND THE PROCESS DOES NOT COME TO CLOSURE EACH AND EVERY FISCAL YEAR. THE MOST RECENT PROCESS BEGAN IN FY13 AND ENDED IN FY14. INTEGRATED HEALTHCARE STRATEGIES CONDUCTS REASONABLENESS TESTING TO ENSURE THAT THE COMPENSATION PAID TO THESE EMPLOYEES IS CONSISTENT WITH BOARD POLICIES AND IRS REGULATIONS. |
| DOCUMENT DISCLOSURE | FORM 990, PART VI, QUESTION 19 GOVERNANCE DOCUMENTS CONSIST OF THE ARTICLES OF ORGANIZATION, OPERATING AGREEMENT AND MEMBERSHIP AGREEMENT. THE ARTICLES OF ORGANIZATION ARE FILED WITH THE NEW YORK SECRETARY OF STATE AND PUBLICLY AVAILABLE THROUGH THAT OFFICE. THE OPERATING AGREEMENT AND MEMBERSHIP AGREEMENT ARE NOT PUBLICLY POSTED, BUT A COPY WOULD BE FURNISHED TO ANY MEMBER OF THE PUBLIC WHO REQUESTS ONE. CONFLICT OF INTEREST POLICY IS NOT PUBLICLY POSTED, BUT A COPY WOULD BE FURNISHED TO ANY MEMBER OF THE PUBLIC WHO REQUESTS ONE. WITH THE ENACTMENT OF VERMONT'S ACT 48 IN MAY 2011, THE GREEN MOUNTAIN CARE BOARD ("GMCB") BECAME THE REGULATORY BODY OVERSEEING HOSPITALS IN THE STATE OF VERMONT. AS A RESULT, THE BUDGET OF UVM MEDICAL CENTER (OF WHICH UVM MEDICAL GROUP - NEW YORK IS A SUBSIDIARY) IS SUBJECT TO REVIEW BY THE GMCB ON AN ANNUAL BASIS. ONGOING DISCLOSURE OF OPERATING RESULTS IS ALSO REQUIRED AND UVM MEDICAL CENTER SUBMITS ITS FINANCIAL STATEMENTS REGULARLY THROUGHOUT THE YEAR. UVM MEDICAL CENTER ALSO REGULARLY DISCLOSES ITS FINANCIAL RESULTS ON ITS WEBSITE AND SUBMITS PRESS RELEASES RELATING TO PERFORMANCE ON A REGULAR BASIS TO LOCAL NEWS ORGANIZATIONS. THE ANNUAL EXTERNAL AUDIT OF THE UVM HEALTH NETWORK IS ALSO POSTED ON THE WEB SITE AND ATTACHED TO THE CURRENT YEAR'S FORM 990. FORM 990, PART VII MANAGERS OF UVMMG-NY WERE COMPENSATED FOR THEIR ROLES AS PHYSICIANS, NOT FOR THEIR ROLES AS MEMBERS OF THE BOARD. (1) IN ADDITION TO COMPENSATION PAID BY UVM MEDICAL GROUP - NY AND REFLECTED ON ITS FORM 990, THE REFERENCED INDIVIDUALS RECEIVE ADDITIONAL COMPENSATION FROM UNIVERSITY OF VERMONT (UVM) AN UNRELATED ORGANIZATION AND NOT REPORTED ON THE UVM MEDICAL GROUP-NY RETURN. A PORTION OF SUCH COMPENSATION FROM UVM MAY BE REIMBURSED BY THE UVM MEDICAL CENTER TO UVM AS ACADEMIC SUPPORT PURSUANT TO THE AFFILIATION AGREEMENT BETWEEN UVM AND UVM MEDICAL CENTER. FORM 990, PART XI, LINE 9 OTHER CHANGE IN NET ASSETS REPRESENTS A TRANSFER OF NET ASSETS IN THE AMOUNT OF $705,520 FROM AN AFFILIATED ORGANIZATION. |
| AUDIT COMMITTEE | FORM 990, PART XII, QUESTION 2C THE UNIVERSITY OF VERMONT HEALTH NETWORK, INC.'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT, AS WELL AS THE CHOICE OF AN INDEPENDENT ACCOUNTANT. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:118124 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAUNDRY & LINENS TOTAL FEES:265 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER SERVICES TOTAL FEES:604172 |
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