Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 10-01-2014 , and ending 09-30-2015
BCheck if applicable:
CName of organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
130 FISHER ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BERLIN, VT05602
D Employer identification number

22-2547186
E Telephone number

G Gross receipts $ 183,113,973
F Name and address of principal officer:
Ms Judith Tarr Tartaglia
130 Fisher Road
Berlin,VT05602
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CVMC.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1963
M State of legal domicile: VT
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: WE WORK COLLABORATIVELY TO MEET THE NEEDS AND IMPROVE THE HEALTH AND IMPROVE THE HEALTH OF THE RESIDENTS OF CENTRAL VERMONT.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 1,819
6 Total number of volunteers (estimate if necessary) ............. 6 159
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,590,011 1,095,416
9 Program service revenue (Part VIII, line 2g) ......... 169,558,614 180,996,141
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,202,128 407,448
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 337,039 333,602
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 173,687,792 182,832,607
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 35,040 30,000
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 107,800,901 115,346,402
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet188,687    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 57,225,316 60,926,432
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 165,061,257 176,302,834
19 Revenue less expenses. Subtract line 18 from line 12....... 8,626,535 6,529,773
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 155,735,636 152,894,915
21 Total liabilities (Part X, line 26)............. 68,317,717 75,047,253
22 Net assets or fund balances. Subtract line 21 from line 20..... 87,417,919 77,847,662
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 116,960,605 including grants of $ 30,000 ) (Revenue $ 135,869,385 )
HOSPITAL SERVICES: INPATIENT, OUTPATIENT, AND 24/7 EMERGENCY DEPARTMENT SERVICES: CVMC HAS 122 LICENSED BEDS TO PROVIDE FOR A FULL SPECTRUM OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. 18,357 INPATIENT DAYS, MORE THAN 202,000 OUTPATIENT PROCEDURES, AND 24,784 EMERGENCY ROOM VISITS WERE RECORDED DURING FISCAL YEAR 2015. OUTPATIENT ANCILLARY SERVICE UNITS MAKE UP THE MAJORITY OF SERVICE VOLUME, INCLUDING 30,338 RADIOLOGY PROCEDURES, 480,341 LAB TESTS, 14,807 CARDIOLOGY TESTS, AND 127,368 UNITS OF PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. EMERGENCY DEPARTMENT: THE ER IS OPEN 24 HOURS A DAY 365 DAYS A YEAR. THE NUMBER OF PATIENTS SEEN IN THE ER IN FISCAL YEAR 15 WAS 24,784. THE CANCER TREATMENT CENTER PROVIDED 4,838 ONCOLOGY AND RADIATION TREATMENTS. THE HOSPITAL ALSO HAS BEEN ACTIVE IN ITS OUTREACH TO CENTRAL VERMONT'S UNINSURED AND UNDER INSURED RESIDENTS.
4b (Code:   ) (Expenses $ 33,600,257 including grants of $   ) (Revenue $ 30,586,788 )
MEDICAL GROUP PRACTICES: AT THE END OF THE FISCAL YEAR WE HAD 22 PRIMARY CARE, INFIRMARY, AND SPECIALTY PRACTICES. THIS INCLUDED 7 PRIMARY AND FAMILY CARE CLINICS, 2 PEDIATRIC CLINICS, AS WELL AS SPECIALTY CLINICS FOR UROLOGY, PODIATRY, RHEUMATOLOGY, ENDOCRINOLOGY, ORTHOPAEDICS, PSYCHOLOGY, AND OBSTETRICS/ GYNECOLOGY. THERE WERE A TOTAL OF 192,997 PRACTICE VISITS DURING FISCAL YEAR 2015.
4c (Code:   ) (Expenses $ 15,290,097 including grants of $   ) (Revenue $ 14,539,968 )
WOODRIDGE SKILLED NURSING FACILITY: CVMC ALSO OPERATES A 153 LICENSED BED SKILLED NURSING FACILITY. THE FACILITY CONCENTRATES ITS SERVICES TO PALLIATIVE CARE, REHABILITATION, PAIN MANAGEMENT, AND ADVANCED WOUND CARE. 43,955 PATIENT DAYS WERE RECORDED IN FISCAL YEAR 2015.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet165,850,959
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) .... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I.... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................ Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV
..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
82
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,819
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
VT
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJASON IRWIN CONTROLLER
130 FISHER RD
Berlin,VT05602 (802) 371-4225
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Mark Crane MD........................................................................
Trustee, Pres CVMC Med Staff
1.0
.......................0.0
X           57,650 0 0
(2) Stephen Martin........................................................................
Trustee until 12/11/14
1.0
.......................0.0
X           0 0 0
(3) Thomas Robbins........................................................................
Trustee, Immediate Past Chair
1.0
.......................2.0
X           0 0 0
(4) Marta Marble........................................................................
Trustee
1.0
.......................2.0
X           0 0 0
(5) Robin Nicholson........................................................................
Trustee
1.0
.......................2.0
X           0 0 0
(6) Judith Tarr Tartaglia........................................................................
Trustee, President/CEO
48.0
.......................2.0
X   X       467,091 0 27,201
(7) Mark Depman MD........................................................................
Trustee, Medical Director EMS
50.0
.......................0.0
X           378,396 0 24,112
(8) Michael Dellipriscoli........................................................................
TRUSTEE, Chair Elect
1.0
.......................2.0
X           0 0 0
(9) Laura Plude........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(10) Carol Welch........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(11) Greg Voorheis........................................................................
Trustee, Chair
1.0
.......................2.0
X           0 0 0
(12) Steven Shea........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
(13) Christopher Barbieri........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
(14) Heidi Pelletier........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
(15) Joseph Pekala MD........................................................................
Trustee until 12/11/14
1.0
.......................44.0
X           30,000 559,225 21,511
(16) John Brumsted MD........................................................................
Trustee
1.0
.......................49.0
X           0 1,498,888 154,551
(17) Joyce Judy........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
Form 990 (2014)
Form 990 (2014)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Dennis Minoli........................................................................
Trustee until 12/11/14
1.0
.......................0.0
X           0 0 0
(19) Donald Carpenter........................................................................
Trustee until 12/11/14
1.0
.......................0.0
X           0 0 0
(20) Sarah Field........................................................................
Trustee as of 12/2014
1.0
.......................0.0
X           0 0 0
(21) Cathy Palmer MD........................................................................
Trustee as of 12/2014
1.0
.......................44.0
X           0 259,648 35,557
(22) Thomas Golonka........................................................................
Trustee as of 12/2014
1.0
.......................0.0
X           0 0 0
(23) Nancy Lothian........................................................................
Chief Operating Officer
50.0
.......................0.0
    X       358,493 0 18,144
(24) Cheyenne Holland........................................................................
TREASURER, CFO/VP FISCAL SRVS
50.0
.......................0.0
    X       305,539 0 41,592
(25) Katherine Borne........................................................................
SECRETARY, EXECUTIVE ASSISTANT
50.0
.......................0.0
    X       89,246 0 19,675
(26) Philip Brown DO........................................................................
VP Medical Affairs
50.0
.......................0.0
      X     342,416 0 26,731
(27) Richard Morley........................................................................
VP Support Services
50.0
.......................0.0
      X     218,579 0 24,147
(28) Karin Morrow........................................................................
Chief Nursing Officer
50.0
.......................0.0
      X     176,544 0 7,870
(29) David Turner........................................................................
VP Physician Services
50.0
.......................0.0
      X     162,526 0 8,601
(30) Janusz Porowski MD........................................................................
Physician
50.0
.......................0.0
        X   324,698 0 18,422
(31) Mahlon Bradley MD........................................................................
Physician
50.0
.......................0.0
        X   489,955 0 34,451
(32) Peter Thomashow MD........................................................................
Physician
50.0
.......................0.0
        X   342,060 0 31,351
(33) John Braun MD........................................................................
PHYSICIAN
50.0
.......................0.0
        X   499,488 0 22,739
(34) Javad Mashkuri MD........................................................................
Physician
50.0
.......................0.0
        X   344,954 0 44,798
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,587,635 2,317,761 561,453
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet127
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
E F WALL ASSOCIATES INC,
131 SOUTH MAIN ST PO BOX 259
BARRE,VT05641
CONSTRUCTION CNTRCTR 1,772,043
WEATHERBY LOCUMS,
5352 NORTHWEST 21ST TERR
FORT LAUDERDALE,FL33309
PHYSICIAN STAFFING 676,941
CAPITOL EARTHMOVING,
131 SOUTH MAIN ST
BARRE,VT05641
GENERAL CONTRACTOR 672,672
BENOIT ELECTRIC,
254 INDUSTRIAL LN
BARRE,VT05641
ELECTRICAL CNTRCTR 562,976
J CRONAN SECURITY INVESTIGATIONS,
332 W LAKESHORE DRIVE
COLCHESTER,VT05446
SECURITY SERVICES 439,917
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet25
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 16,610
d Related organizations...1d  
e Government grants (contributions)1e 616,691
f All other contributions, gifts, grants, and
similar amounts not included above
1f
462,115
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 1,095,416
 Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 900099 169,472,810 169,472,810    
b REV FROM MANAGED CARE AND CAPITATED 900099 1,766,185 1,766,185    
c 340B CONTRACT PHARMACY REVENUE 900099 4,740,633 4,740,633    
d MEANINGFUL USE 900099 1,118,035 1,118,035    
e CAFETERIA REVENUE 900099 974,603 974,603    
f All other program service revenue . 2,923,875 2,923,875    
g Total. Add lines 2a–2f........MediumBullet 180,996,141
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 407,448     407,448
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 606,218  
b Less: rental expenses 270,117  
c Rental income or (loss) 336,101 0
d Net rental income or (loss).......MediumBullet 336,101     336,101
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$ 16,610
of contributions reported on line 1c). See Part IV, line 18 ..
a 8,750
b Less: direct expenses ...b 11,249
c Net income or (loss) from fundraising events..MediumBullet -2,499   -2,499
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 182,832,607 180,996,141   741,050
Form 990 (2014)
Form 990 (2014)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 30,000 30,000
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............ 0  
4 Benefits paid to or for members .... 0  
5 Compensation of current officers, directors, trustees, and key employees .... 4,413,087 2,281,194 2,131,893  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 36,569 36,569    
7 Other salaries and wages .... 87,538,216 84,341,842 3,047,431 148,943
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,716,607 5,507,870 199,010 9,727
9 Other employee benefits ....... 11,606,618 11,553,610 33,260 19,748
10 Payroll taxes ........... 6,035,305 5,698,823 326,213 10,269
11 Fees for services (non-employees):        
a Management ...... 174,250   174,250  
b Legal ......... 185,401   185,401  
c Accounting ........... 57,000   57,000  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 134,951 6,165 128,786  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 10,441,549 8,678,545 1,763,004  
12 Advertising and promotion .... 1,187,677 147,742 1,039,935  
13 Office expenses ....... 22,660,123 22,433,958 226,165  
14 Information technology ...... 1,836,676 1,763,727 72,949  
15 Royalties .. 0      
16 Occupancy ........... 6,003,197 5,880,499 122,698  
17 Travel ............ 132,867 95,582 37,285  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 525,437 487,494 37,943  
20 Interest ........... 1,042,882 1,042,882    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 9,770,913 9,770,913    
23 Insurance .............. 849,822 587,429 262,393  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a BAD DEBT EXPENSE 4,271,792 4,271,792    
b STATE NURSING BED TAX ASMNT 753,463 753,463    
c DUES & FEES 667,919 335,178 332,741  
d MISCELLANEOUS EXPENSE 230,513 145,682 84,831  
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 176,302,834 165,850,959 10,263,188 188,687
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 20,677,367 2 20,494,662
3 Pledges and grants receivable, net ........... 10,000 3 0
4 Accounts receivable, net ............. 15,913,054 4 17,370,365
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 1,486,230 7 1,219,958
8 Inventories for sale or use .............. 2,849,600 8 3,323,890
9 Prepaid expenses and deferred charges .......... 1,793,921 9 1,569,997
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 155,631,693
b Less: accumulated depreciation ..... 10b 87,517,308 70,070,774 10c 68,114,385
11 Investments—publicly traded securities .......... 41,396,088 11 39,270,169
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 1,538,602 15 1,531,489
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 155,735,636 16 152,894,915
Liabilities 17 Accounts payable and accrued expenses ......... 23,693,942 17 25,583,108
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 18,809,305 20 16,160,024
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 25,814,470 25 33,304,121
26 Total liabilities. Add lines 17 through 25......... 68,317,717 26 75,047,253
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 77,640,363 27 69,448,151
28 Temporarily restricted net assets ........... 6,676,250 28 5,073,037
29 Permanently restricted net assets ........... 3,101,306 29 3,326,474
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 87,417,919 33 77,847,662
34 Total liabilities and net assets/fund balances ........ 155,735,636 34 152,894,915
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
182,832,607
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
176,302,834
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
6,529,773
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
87,417,919
5
Net unrealized gains (losses) on investments ...............
5
-3,222,277
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-12,877,753
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
77,847,662
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? .................
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(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    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (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.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (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.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (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.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
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)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
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.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e))
 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))
 
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2014


Schedule C (Form 990 or 990-EZ) 2014
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
24,173
j
Total. Add lines 1c through 1i ...............................
24,173
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
LOBBYING ACTIVITY SCHEDULE C, PART II-B, LINE 1I CENTRAL VERMONT MEDICAL CENTER IS A MEMBER OF, AND PAYS DUES TO, THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SERVICE PROVIDERS AS WELL AS THE AMERICAN HOSPITAL ASSOCIATION, THE VERMONT HEALTH CARE ASSOCIATION, AND THE MEDICAL GROUP MANAGEMENT ASSOCIATION. A PORTION OF THE DUES IS USED FOR LOBBYING PURPOSES.
Schedule C (Form 990 or 990EZ) 2014

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 8,130,234 7,489,540 7,318,467 7,346,576 8,037,955
b Contributions ........         0
c Net investment earnings, gains, and losses -366,990 676,127 810,401 437,354 38,427
d Grants or scholarships .....         0
e Other expenditures for facilities
and programs ........
37,018 35,433 639,328 465,463 729,806
f Administrative expenses ....         0
g End of year balance ...... 7,726,226 8,130,234 7,489,540 7,318,467 7,346,576
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet43.000 %
c
Temporarily restricted endowment SchDMd Bullet57.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   5,510,000 5,510,000
b Buildings ................   52,866,209 28,481,216 24,384,993
c Leasehold improvements ............   21,867,559 11,162,000 10,705,559
d Equipment ................   69,397,844 44,769,570 24,628,274
e Other .................   5,990,081 3,104,522 2,885,559
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 68,114,385
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED PENSION LIABILITY 32,309,253
OTHER LIABILITIES 994,868







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 33,304,121
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 CVMC HAS ENDOWMENT INVESTMENTS AND SPENDING POLICIES THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING FOR CAPITAL AND OPERATIONAL PROGRAMS PERTAINING TO THE DELIVERY OF HOSPITAL AND SKILLED NURSING CARE SERVICES AS WELL AS INTERNAL MEDICINE, FAMILY AND SPECIALTY PHYSICIAN SERVICES IN ORDER TO MEET THE HEALTH CARE NEEDS OF THE CENTRAL VERMONT COMMUNITY.
ASC 740 DISCLOSURE SCHEDULE D, PART X, LINE 2 THE UNIVERSITY OF VERMONT HEALTH NETWORK ACCOUNTS FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC 740. NO PROVISION FOR UNCERTAIN TAX POSITIONS IS RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. CENTRAL VERMONT MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF THE UNIVERSITY OF VERMONT HEALTH NETWORK.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ
filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2014
Schedule G (Form 990 or 990-EZ) 2014
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF TOURNAMENT
(event type)
(b) Event #2

 
(event type)
(c) Other events

0
(total number)
(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 25,360     25,360
2 Less: Contributions . . 16,610     16,610
3 Gross income (line 1
minus line 2) . . .
8,750     8,750
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . . 8,309     8,309
7 Food and beverages . 336     336
8 Entertainment . . .        
9 Other direct expenses . 2,604     2,604
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 11,249
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow -2,499
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
%
%
%
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2014
Schedule G (Form 990 or 990-EZ) 2014
Page 3
11
Does the organization conduct gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activities conducted in:
a
The organization's facility ......................
13a
%
b
An outside facility ........................
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $  
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2014
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
 
No
b
If "Yes," did the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    909,647   909,647 0.530 %
b Medicaid (from Worksheet 3,
column a) ....
    41,983,045 29,421,944 12,561,101 7.300 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    42,892,692 29,421,944 13,470,748 7.830 %
Other Benefits
    49,670   49,670 0.030 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    322,201   322,201 0.190 %
g Subsidized health services
(from Worksheet 6) ..
    36,154,486 28,684,181 7,470,305 4.340 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    30,000   30,000 0.020 %
j Total. Other Benefits ..     36,556,357 28,684,181 7,872,176 4.580 %
k Total. Add lines 7d and 7j .     79,449,049 58,106,125 21,342,924 12.410 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,271,792
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
85,436
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
59,815,804
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
78,734,908
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-18,919,104
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 CENTRAL VERMONT MEDICAL CENTER
130 FISHER ROAD
BERLIN,VT05602
WWW.CVMC.ORG
470001
X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
CENTRAL VERMONT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10 Yes  
a If "Yes" (list url): SEE SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

CENTRAL VERMONT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

CENTRAL VERMONT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
PART V, LINE 5 CVMC INVITED A WIDE VARIETY OF PUBLIC HEALTH PROFESSIONALS, COMMUNITY LEADERS, HUMAN SERVICE PROVIDERS, AND CVMC STAFF MEMBERS TO SERVE AS A STEERING COMMITTEE THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. MEETINGS WERE HELD THROUGHOUT 2012 FOR THE COMMITTEE MEMBERS TO DELIBERATE OVER ALL COMMUNITY HEALTH CONCERNS AND REVIEW PERTINENT DATA AND INFORMATION. INPUT WAS PROVIDED BY: A. WASHINGTON COUNTY MENTAL HEALTH B. CENTRAL VERMONT HOME HEALTH & HOSPICE C. PEOPLES HEALTH AND WELLNESS D. U32 HIGH SCHOOL E. CENTRAL VERMONT COUNCIL ON AGING F. GREEN MOUNTAIN UNITED WAY G. VERMONT DEPARTMENT OF HEALTH H. CENTRAL VERMONT MEDICAL CENTER PART V, LINE 10A - Community Health Needs Assessment AND IMPLEMENTATION STRATEGY Website: http://www.cvmc.org/sites/default/files/documents/CVMC%20CHNA%202013.pdf PART V, LINE 11 AT CENTRAL VERMONT MEDICAL CENTER, WE COLLABORATE WITH OTHER NON-PROFITS, BUSINESSES, COMMUNITY LEADERS, AND GOVERNMENTAL AGENCIES TO PROVIDE A VARIETY OF PROGRAMS AND EDUCATIONAL OFFERINGS INTENDED TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. OUR AFFILIATION BEGINNING IN 2011 WITH THE UNIVERSITY OF VERMONT MEDICAL CENTER (FORMERLY FLETCHER ALLEN HEALTH CARE), CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, AND ELIZABETHTOWN COMMUNITY HOSPITAL UNDER THE UNIVERSITY OF VERMONT HEALTH NETWORK (FORMERLY FLETCHER ALLEN PARTNERS) HAS INCREASED OUR REACH AND CAPABILITIES AS THE PRIMARY MEDICAL CENTER IN CENTRAL VERMONT. THIS CONNECTION WITH THE UNIVERSITY OF VERMONT MEDICAL CENTER HAS BEEN A SIGNIFICANT STEP IN PROMOTING REGIONAL STRATEGIC PLANNING, IMPROVING ACCESS TO LOCAL CARE, ENHANCING INFORMATION TECHNOLOGY, AND ENCOURAGING JOINT QUALITY AND CLINICAL INITIATIVES. TOGETHER OUR ORGANIZATIONS HAVE WORKED TO ALIGN WITH THE STATE AND FEDERAL HEALTH CARE REFORM AGENDAS THAT PROMOTE ENHANCED INTEGRATION AND BUILD UPON OUR EXISTING CLINICAL PARTNERSHIPS. A NUMBER OF CVMC STAFF MEMBERS SERVE ON BOARDS OF OTHER MISSION RELATED COMMUNITY ORGANIZATIONS AND PLANNING GROUPS SUCH AS THE VERMONT BLUEPRINT FOR HEALTH, CENTRAL VERMONT HEALTH CARE COALITION, CENTRAL VERMONT SUBSTANCE ABUSE SERVICES, GREEN MOUNTAIN UNITED WAY, PEOPLE'S HEALTH & WELLNESS CLINIC, VERMONT DIETETIC ASSOCIATION, VERMONT ETHICS NETWORK, VERMONT MEDICAL SOCIETY BOARD, AND MANY MORE. THIS COMMUNITY INVOLVMENT HELPS TO SUPPORT THE VALUABLE WORK BEING DONE BY CVMC THROUGHOUT THE COUNTY TO ADDRESS COMMUNITY HEALTH. OUR STEERING COMMITTEE DISCUSSED REGIONAL STRATEGIES THAT ARE WORKING, GAPS THAT REMAIN, AND OPPORTUNITIES FOR IMPROVEMENT. FROM THIS POINT, WE HAVE DEVELOPED THE FOLLOWING MEASURES TO ADDRESS THOSE AREAS FOR IMPROVEMENT THAT REQUIRE MORE ATTENTION AND COLLABORATION: - PROMOTE HEALTHY LIFESTYLES Alcohol abuse, tobacco use, and marijuana use are barriers to improving the overall health of the CVMC community. In attending to these issues, CVMC will potentially decrease the number of chronic diseases developed down the road. CVMC is working with community partners including the Vermont Department of Health, local schools and area recreation departments to make it easier for people to make healthy choices and eliminate unhealthy habits. It is important that community members have knowledge of the resources that are currently available to them. o Tobacco Cessation Classes: Free 4-week sessions offered monthly at CVMC with special attention given to developing a quitting strategy, including dealing with weight control and managing stress. CVMC will continue to promote the start of a tobacco-free lifestyle by widely publicizing the workshop throughout the medical center and community. o Promote Healthy Lifestyles: Make community members aware of various types of exercises and places they can go to exercise, i.e. CVMC walking trail, parks, fitness classes, etc. Sponsor community activities that encourage physical fitness and exercise for families. o Health Care Share: In partnership with Vermont Youth Conservation Corps, CVMC provides freshly harvested, organic vegetables to families in need for 12 weeks. An educational newsletter with information on ways to prepare the vegetables is distributed along with the produce each week. o Continue CVMC's wellness initiative for employees. This program helps to build awareness and accountability for personal health via consistent medical and dental preventative care, and continuous assessment of health risks. o The addition of panel coordinators to our Primary Care Physician and National Committee for Quality Assurance certified practice locations will exponentially increase wellness and prevention efforts. This will be achieved through improved identification of patients who missed or are overdue for appointments, pre-visit planning (ensuring patient referrals, scheduled lab/diagnostic tests are acted upon and/or routine screening are identified in advance for the provider to have discussions with patient about) and overall coordination of care. Advance action o Engage practitioners: Informing adolescents on the dangers of alcohol and drug abuse to prevent habits from forming and developmental damage from taking place. Increase practitioner recommendation and referral for continued care of mental health and substance abuse issues. o Through promotion on hospital bulletins and media center, ensure that the public is aware of organizations such as Central Vermont Substance Abuse Services, and tools such as alcoholscreening.org made available through website links by the Vermont Department of Health.
- INCREASE IMMUNIZATION RATES Vaccines are one of today's most successful and cost-effective public health tools for preventing disease and death. Increasing immunization coverage will improve community healthy by preventing and reducing the spread of serious disease in children and adults. Several CVMC practices have been recognized by the State of Vermont for their work on ensuring that both adults and children receive recommended vaccines. However, Vermont has one of the highest rates in the country of children who are not vaccinated according to the schedule recommended by the Centers for Disease Control and Prevention. The percentage of 19-35 month old children who receive recommended vaccines (41%) is notably lower than the nationwide average (57%). CVMC is obliged to promote and educate our community on the benefits of vaccination. Implementation steps: o Associates in Pediatrics in Barre and Berlin and other CVMC practices to continue to reach out and send reminders to families who have missed or are overdue for vaccination appointments. Practices will focus on listening to the concerns and questions of parents and responding to help them understand that vaccination improves the health of everyone in the community. o Continue efforts with the Vermont Department of Health to increase completeness of reporting into the Vermont Immunization Registry. o Communication with Washington school system concerning enrolled students vaccination statuses o Associates in Pediatrics in Barre and Berlin have added "well child check" reminders to parents who have missed or are overdue for pediatric appointments. o CVMC plans to provide a link to the web-based public information campaign, It's OK to Ask, recently launched by the Vermont Department of Health. The website has research-based medical information and video discussions among Vermont moms to educate the public about childhood immunizations. o Include information on vaccines and their recommended schedules for newborns into the curriculum of CVMC's Childbirth and Prenatal Education classes. As Vermont allows exemption from vaccines due to philosophical and religious reasoning, it is especially important for CVMC staff to inform parents and guardians of the risks of not vaccinating children. - IMPROVE PRENATAL AND MATERNAL HEALTH Low birth weight babies born weighing less than 5.5 pounds are at a higher risk of preterm birth after less than 37 weeks of pregnancy, infant mortality, cognitive and developmental delays, respiratory conditions, and long-term health complications. Considering that smoking is the most preventable cause of low birth weight in babies, this is a definite area to be addressed. In previous years, Washington County had higher rates of low weight infants born than the statewide average. Our community has improved from this point and now the rate of low birth weight babies in Washington County is 16.4% lower than the Vermont statewide average. CVMC plans to continue on this path of improvement and increase the percentage of mothers who do not smoke during pregnancy (85.1%) to the Healthy Vermonters 2020 Goal (90%). The following implementation steps focus on preventing risk behaviors in pregnant women and increasing early prenatal care and counseling. Continue current initiatives o Encourage women to take part in Centering Pregnancy: Monthly group meetings offered at Central Vermont Women's Health. Physical and emotional issues important to expectant mothers are discussed, along with good health guidelines including diet, stress management, exercise, dangers of risk behaviors, and smoking cessation. o Childbirth Education Classes: On-going sessions of prenatal education and birthing classes offered at CVMC. Pregnant women are informed of the risks involved with tobacco, alcohol, and substance abuse.
o Prenatal Yoga: Classes held weekly at CVMC to ease the discomforts of pregnancy and prepare women physically and emotionally for birth. This programming at CVMC provides opportunity for pregnant women to engage in healthy behavior and relaxation. Advance action o Encourage utilization of and enrollment in Medicaid and Dr. Dynasaur program so that pregnant women have access to hospital services, health education, nutritious foods, nutritional counseling, breastfeeding support, and connections to other community resources. CVMC staff are aware of these programs and will inform patients of these programs when a need is identified. o Practitioners actively motivate pregnant women to quit smoking and take part in CVMC cessation classes or participate in statewide Vermont Quit Network program. - IMPROVE ACCESS TO TRANSPORTATION More than 90% of Washington County's land mass does not receive regular public transit service. CVMC believes we must be especially aware of low-income households, zero-vehicle households, adults 65 and older, and persons with disabilities in these areas. It is important that all people have the opportunity to utilize the resources at CVMC and other health care organizations in central Vermont. This is only possible if individuals and families feel comfortable and are easily able to get to and from these facilities. Implementation steps: Continue current initiatives o In December 2012, CVMC donated $10,000 to GMTA to support shuttle routes. As GMTA is the primary public transit provider and Medicaid broker for all of Washington County (including the three towns in Orange County), this money will ultimately work to ensure those who do not have their own transportation have access to healthcare facilities. o In 2012, our Service Recovery Budget was $3,000. This fund provides patients in need with bus tokens, gas cards, and meal cards at CVMC. We take responsibility to ensure that patients with no means of transportation are able to return home safely. o Increase dispersion and frequency of media promotion throughout the CVMC campus to inform the public of GMTA transportation assistance programs. Discuss such promotion with other health care facilities on Barre Hospital Hill so that regular routes, as well as demand services are presented throughout the community. o Fortify communication with seniors, persons with disabilities, pregnant women/single mothers, and low-income advocacy groups to prevent major pitfalls in access to CVMC. o Identify populations that continue to struggle with current service (route location, frequency, and affordability) through survey conducted by CVMC. - FIGHT THE EPIDEMIC OF YOUTH OBESITY CVMC must continue to fight the epidemic of youth obesity to prevent development of chronic disease in the future. Over the past several decades, major societal changes have affected the nutritional habits and physical activity of the youth of Vermont. Washington County's youth obesity rates are below the national average but these levels are still too high. Our review of community data revealed physical activity and healthy diet with fruits and vegetables to be areas where our community can still improve. CVMC believes every effort put into assuring healthy lifestyles our youth will be repaid many times over in their health and success down the road in life. We resolve to work within central Vermont to increase access to healthy foods and nutritional education as well as encourage active lifestyles in the community. - Implementation steps: Continue current initiatives o Promote and advertise Healthy Living for Kids: CVMC programming offered as a fun way for families with children who struggle with weight issues to learn about healthy food choices and lifestyle changes. Each session includes private one-on-one time with a nurse practitioner and dietician. Meetings are held at CVMC medical practices throughout the year based on age and gender. o Increase the frequency of youth events like Food & Nutrition Story Time-Stone Soup: A fun and educational story hour for children and their care providers to learn about nutritious ingredients with a CVMC Registered Dietitian and enjoy vegetable soup prepared by CVMC chefs. o Registered Dieticians at CVMC Medical Group Practice locations will continue to work aggressively with patient referrals to address childhood obesity through diet and play. o Work with community groups to promote and ensure youth access to local parks, recreation spaces, and fitness events. Advertise outside programming throughout CVMC to endorse physical activity. o Increase participation in free and reduced school meal program. All school-aged children should have access to healthy food choices and daily physical activity during the school day. o Work with Associates in Pediatrics to focus on office visit goals for all children and adolescents: o Assess dietary and physical activity behaviors o Calculate and plot BMI once a year o Counsel families to help maintain or achieve healthy weight o Counsel families to develop healthy nutrition and physical activity behaviors
PART V, LINE 11 (continued) MENTAL HEALTH IS AN ISSUE THAT WAS IDENTIFIED IN THIS ASSESSMENT AS AN AREA OF NEED BUT WAS NOT PRIORITIZED OR INCLUDED IN OUR IMPLEMENTATION PLAN. WHEN WASHINGTON COUNTY YOUTH WERE SURVEYED THROUGH THE 2011 YOUTH RISK BEHAVIOR SURVEY, 23% OF STUDENTS REPORTED THAT THEY FELT SAD OR HOPELESS ALMOST EVERY DAY FOR TWO WEEKS OR MORE IN THE PAST 12 MONTHS. EVEN MORE TROUBLING IS THE STATISTIC THAT 11% OF WASHINGTON COUNTY STUDENTS REPORTED HAVING MADE A SUICIDE PLAN IN THE PAST 12 MONTHS. WITH THIS EVIDENCE AND MORE, WE RECOGNIZED COMMUNITY MENTAL HEALTH AS AN AREA WHERE IMPROVEMENT IS CERTAINLY NECESSARY BUT AS AN AREA MORE SUITED FOR COLLABORATIVE COMMUNITY AND STATE EFFORTS, WHERE CVMC DOES NOT INTEND TO IMPLEMENT INDEPENDENT IMMEDIATE ACTION. CURRENT AVAILABLE SOURCES OF CARE ARE WASHINGTON COUNTY MENTAL HEALTH SERVICE, CVMC FAMILY PSYCHIATRY ASSOCIATES, CVMC'S INPATIENT PSYCHIATRY DEPARTMENT, AND THE HEALTH CENTER IN PLAINFIELD. A SIGNIFICANT REASON WHY IMPLEMENTATION STEPS FOR MENTAL HEALTH ARE NOT INCLUDED IN THIS REPORT IS THAT A NEW 25-BED INTENSIVE-CARE PSYCHIATRIC HOSPITAL WAS CONSTRUCTED ADJACENT TO CVMC IN BERLIN. THIS $28.5 MILLION FACILITY IS PART OF A STATEWIDE NETWORK OF MENTAL HEALTH FACILITIES WHICH REPLACE THE VERMONT STATE HOSPITAL IN WATERBURY AND OPENED TO PATIENTS IN 2014. MENTAL HEALTH HAS BEEN ACKNOWLEDGED AS A PRESSING ISSUE STATEWIDE. OUR COMMUNITY HOPES THIS NEW FACILITY WILL CONTINUE TO ALLEVIATE SOME OF THE CURRENT DEMAND FOR INPATIENT CARE FOR SEVERE MENTAL HEALTH NEED. AS EXPECTED, OUR COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED ADDITIONAL DETERMINANTS OF HEALTH THAT FALL OUTSIDE THE REALM OF OUR CAPABILITIES AT CVMC. A PROMINENT NEED THAT WE ARE NOT DIRECTLY ADDRESSING IS ORAL HEALTH. SEVERAL OF OUR PHYSICIANS HAVE UNDERGONE FLUORIDE TREATMENT TRAINING, AND WILL BE ABLE TO PROVIDE THIS SERVICE FOR CHILDREN UP TO FOUR YEARS OF AGE WHO DO NOT HAVE ACCESS TO DENTAL CARE. HOWEVER, ONE OUT OF FOUR ADULTS IN WASHINGTON COUNTY HAS NOT VISITED A DENTIST IN THE LAST YEAR. AS A MEDICAL HOSPITAL, WE DO NOT HAVE THE FACILITIES OR EXPERTISE TO ADDRESS THIS NEED DIRECTLY. WITH THIS SAID, IT IS IMPORTANT THAT WE RECOGNIZE ALL FACTORS THAT MAY BE AFFECTING THE OVERALL HEALTH OF PATIENTS WALKING THROUGH OUR DOORS AT CVMC. WE INTEND TO CONTINUE COLLABORATION WITH COMMUNITY FACILITIES SUCH AS PLAINFIELD HEALTH CENTER THAT OFFER DENTAL CARE.
PART V, Line 16B - FAP APPLICATION WEBSITE http://www.cvmc.org/sites/default/files/documents/REVISED%20HAP%20APPLICAT ION%20April%202014.pdf PART V, LINE 16C - FAP PLAIN LANGUAGE SUMMARY http://www.cvmc.org/sites/default/files/documents/HAP%20Financial%20Aid%20 Policy.pdf PART V, LINE 16i IN ADDITION TO HAVING THE APPLICATION FOR FINANCIAL ASSISTANCE AS WELL AS THE SLIDING SCALE GRID OF HOW FINANCIAL ASSISTANCE IS AWARDED CVMC HAS COMPREHENSIVE INFORMATION ON THE WEBSITE ABOUT THE POLICY, MATERIALS REQUIRED TO APPLY AND CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS SO THAT INTERESTED INDIVIDUALS CAN APPLY. ADDITIONALLY, THERE IS REFERENCE MADE TO THE POLICY ON PATIENT'S BILLS AS WELL AS APPLICATIONS AND INFORMATION AVAILABLE IN REGISTRATION AREAS IN THE HOSPITAL AND CLINIC LOCATIONS. CVMC ALSO EMPLOYS A TEAM OF FINANCIAL COUNSELORS THAT WORK WITH PATIENTS THROUGHOUT THEIR VISIT TO ENSURE THAT WE COMMUNICATE WITH AS MANY ELIGIBLE INDIVIDUALS AS POSSIBLE. THESE FINANCIAL COUNSELORS ALSO WORK WITH PATIENTS TO EXPLORE THE OTHER OPPORTUNITIES AVAILABLE TO INDIVIDUALS IN NEED THROUGHOUT THE STATE OF VERMONT.
PART V, LINE 18E CVMC DID NOT INITIATE ANY OF THE ACTIONS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 18. HOWEVER, IF THE HOSPITAL HAD UNDERTAKEN ANY OF THE LISTED ACTIONS, IT WOULD HAVE FIRST NOTIFIED PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY ON ADMISSION, PRIOR TO DISCHARGE, AND IN COMMUNICATIONS WITH THE PATIENTS REGARDING THEIR BILLS. ADDITIONALLY, CVMC WOULD HAVE DOCUMENTED ITS DETERMINATION OF WHETHER PATIENTS WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY.
PART V, LINE 22D CVMC uses 75% of gross charges as a basis for billing FAP-eligible individuals. Sliding scale discounts are provided on this 75% of gross charges for FAP-eligible individuals. Senior leadership determined that this would be a reasonable basis for billing to ensure that FAP-eligible individuals are never charged more for emergency and other medically necessary care than the amounts billed to those who have insurance.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?24
Name and address Type of Facility (describe)
1 CVMC - WOODRIDGE NURSING HOME
130 FISHER ROAD
BERLIN,VT05602
SKILLED NURSING FACILITY
2 CVMC WOMEN'S HEALTH
130 FISHER ROAD SUITE 1-4
BERLIN,VT05602
MEDICAL GROUP PRACTICE
3 CVMC PEDIATRICS PRIMARY CARE - BERLIN
246 GRANGER ROAD SUITE 1
BERLIN,VT05602
MEDICAL GROUP PRACTICE
4 CVMC FAMILY MEDICINE - WATERBURY
130 SOUTH MAIN STREET
WATERBURY,VT05676
MEDICAL GROUP PRACTICE
5 CVMC ADULT PRIMARY CARE - BERLIN
195 HOSPITAL LOOP SUITE 3
BERLIN,VT05602
MEDICAL GROUP PRACTICE
6 CVMC INTEGRATIVE FAM MED - MONTPELIER
156 MAIN STREET
MONTPELIER,VT05602
MEDICAL GROUP PRACTICE
7 CVMC FAMILY MEDICINE - BERLIN
82 EAST VIEW LANE SUITE 3
BARRE,VT05641
MEDICAL GROUP PRACTICE
8 CVMC ADULT PRIMARY CARE - BARRE
225 SOUTH MAIN STREET
BARRE,VT05641
MEDICAL GROUP PRACTICE
9 CVMC CARDIOLOGY
130 FISHER ROAD SUITE 2-1
BERLIN,VT05602
MEDICAL GROUP PRACTICE
10 GREEN MOUNTAIN FAMILY PRACTICE
63 CRESCENT AVENUE
NORTHFIELD,VT05663
MEDICAL GROUP PRACTICE
11 CVMC PEDIATRICS PRIMARY CARE - BARRE
225 SOUTH MAIN STREET
BARRE,VT05641
MEDICAL GROUP PRACTICE
12 CVMC FAMILY PSYCHIATRY
77 VINE STREET
BARRE,VT05641
MEDICAL GROUP PRACTICE
13 CVMC FAMILY MEDICINE - MAD RIVER
859 OLD COUNTY ROAD
WAITSFIELD,VT05673
MEDICAL GROUP PRACTICE
14 CVMC UROLOGY
286 HOSPITAL LOOP SUITE 1
BERLIN,VT05602
MEDICAL GROUP PRACTICE
15 CVMC NEUROLOGY
130 FISHER ROAD
BERLIN,VT05602
MEDICAL GROUP PRACTICE
16 NORWICH INFIRMARY
63 CRESCENT AVENUE
NORTHFIELD,VT05663
MEDICAL INFIRMARY
17 CVMC ORTHOPEDICS & SPINE MEDICINE
244 GRANGER ROAD
BERLIN,VT05602
MEDICAL GROUP PRACTICE
18 CVMC ORTHOPEDICS & SPORTS MEDICINE
130 FISHER ROAD MOB-B SUITE 2-3
BERLIN,VT05602
MEDICAL GROUP PRACTICE
19 CVMC RHEUMATOLOGY
130 FISHER ROAD BLD B SUITE 2-3
BERLIN,VT05602
MEDICAL GROUP PRACTICE
20 CVMC EXPRESS CARE
1311 BARRE MONTPELIER ROAD SUITE 2
BERLIN,VT05602
MEDICAL GROUP PRACTICE
21 CVMC ORTHOPAEDICS - PODIATRY
130 FISHER ROAD MOB B SUITE 4
BERLIN,VT05602
MEDICAL GROUP PRACTICE
22 CVMC ENDOCRINOLOGY
130 FISHER ROAD MOB-C SUITE 1
BERLIN,VT05602
MEDICAL GROUP PRACTICE
23 CVMC WOUND CARE CENTER
1311 BARRE MONTPELIER ROAD
BERLIN,VT05602
MEDICAL GROUP PRACTICE
24 GRANITE CITY PRIMARY CARE
14 NORTH MAIN STREET SUITE 4002
BARRE,VT05641
MEDICAL GROUP PRACTICE
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
REQUIRED DESCRIPTIONS SCHEDULE H, PART VI, LINE 1 THE ORGANIZATION'S REQUIRED SCHEDULE H SPECIFIC LINE ITEM DESCRIPTIONS ARE AS FOLLOWS: PART I, LINES 3A-C: CVMC HAS A SLIDING SCALE BASED ON INCOME AND ASSETS FOR DETERMINING FREE CARE AS WELL AS DISCOUNTED CARE. FOR INDIVIDUALS WITH INCOME UP TO 200% OF THE FEDERAL POVERTY LEVEL (FPL), FREE CARE IS PROVIDED. FOR INDIVIDUALS WITH INCOME UP FROM 201% TO 250% OF THE FPL, AN 85% DISCOUNT IS GIVEN, FOR INDIVIDUALS WITH INCOME FROM 251% TO 300% OF THE FPL, A DISCOUNT OF 75% IS GIVEN, FOR INDIVIDUALS WITH INCOME FROM 301% TO 350% OF THE FPL A 65% DISCOUNT IS GIVEN, AND FOR INDIVIDUALS WITH INCOME FROM 351% TO 400% OF THE FPL A 55% DISCOUNT IS GIVEN. ASSETS INCLUDING CASH, SAVINGS, CHECKING ACCOUNTS, MONEY MARKET ACCOUNTS, CERTIFICATES OF DEPOSIT, TERM CERTIFICATES, STOCKS, BONDS, MUTUAL FUNDS, OTHER LIQUID ASSETS, SECONDARY HOMES, AND RENTAL PROPERTIES MAY ALSO BE CONSIDERED IN THE FINANCIAL CALCULATION FOR INDIVIDUALS REQUESTING ASSISTANCE. PART I, LINE 7G: FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2015 CENTRAL VERMONT MEDICAL CENTER INCLUDED PHYSICIAN CLINIC EXPENSES IN SUBSIDIZED HEALTH SERVICES. CENTRAL VERMONT MEDICAL CENTER PHYSICIANS INCURRED $36,154,486 OF COSTS ASSOCIATED WITH PROVIDING OUTPATIENT CLINIC SERVICES. NEARLY ALL OF THE EXPENSES INCLUDED AS SUBSIDIZED HEALTH SERVICES ARE ATTRIBUTABLE TO PHYSICIAN CLINICS. AS A RESULT OF THE UNIQUE GEOGRAPHY AND POPULATION DENSITY OF THE COMMUNITY THAT CVMC SERVES, WE CONSIDER ALL OF THE PRIMARY AND SPECIALTY OUTPATIENT CARE PROVIDED BY OUR EMPLOYED GROUP OF PHYSICIANS TO BE SUBSIDIZED. IT HAS BEEN APPARENT OVER THE LAST 15 YEARS THAT THERE ARE NO NEW, UNAFFILIATED PROVIDERS COMING INTO THE CVMC SERVICE AREA AND STARTING PRACTICES. ADDITIONALLY THE MAJORITY OF THE INDEPENDENT PRACTICES THAT WERE ESTABLISHED IN THE CVMC SERVICE AREA HAVE JOINED CVMC DUE TO MANY REASONS INCLUDING ECONOMIC VIABILITY AND SUCCESSION PLANNING. AS A RESULT OF THIS SHIFT, WHICH IS COMMON NOT ONLY IN THE NORTHEAST BUT ACROSS THE UNITED STATES, CVMC'S EMPLOYED PHYSICIANS MAKE UP THE MAJORITY AND IN SOME CASES THE ENTIRETY OF THE OUTPATIENT CARE SERVICES IN OUR COMMUNITY. WERE CVMC TO CEASE THE PROVISION OF THESE SERVICES, THERE IS NO WAY THAT THE COMMUNITY AS IT EXISTS TODAY WOULD HAVE THE CAPACITY TO ABSORB THE PATIENTS AND PROVIDE THE NECESSARY CARE. GIVEN THE HISTORIC LACK OF PROVIDERS ESTABLISHING NEW PRACTICES IN THE AREA, THE PATIENTS CURRENTLY SERVED BY THESE SUBSIDIZED HEALTH SERVICES WOULD END UP RECEIVING CARE FROM THE FEDERALLY QUALIFIED HEALTH CENTER WITHIN OUR SERVICE AREA, THE CVMC EMERGENCY DEPARTMENT, OR RECEIVING CARE FROM PROVIDERS OF NEIGHBORING HOSPITALS AND HEALTH SERVICE AREAS. PART I, LINE 7, COLUMN F: THE PROVISION FOR BAD DEBT INCLUDED ON FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSE OF CALCULATING THE AMOUNT REPORTED ON LINE 7(F) IS $4,271,792. PART I, LINE 7: CVMC FOLLOWS THE IRS GUIDELINE FOR THE COMPLETION OF SCHEDULE H, PART I, LINES 7A-K, COLUMNS A-F. CVMC'S COST-TO-CHARGE RATIO IS USED FOR EACH OF THESE CALCULATIONS. PART III, LINE 2: BAD DEBT EXPENSE WAS CALCULATED BY TAKING THE CHARGES THAT WERE WRITTEN OFF TO ALLOWANCE TO BAD DEBT RESERVE AND REDUCING BY ANY RECOVERIES. THE BAD DEBT RESERVE IS BASED ON AN EVALUATION OF THE COLLECTABILITY OF ACCOUNTS RECEIVABLE. CVMC ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR CATEGORIES OF REVENUE TO ESTIMATE THE APPROPRIATE BAD DEBT RESERVE. MANAGEMENT REGULARLY REVIEWS ACCOUNTS RECEIVABLE DATA AND THE BAD DEBT RESERVE FOR REASONABLENESS. PART III, LINE 3: THE AMOUNT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE WAS CALCULATED USING A PERCENTAGE OF COLLECTION CASES WHEREBY THE COLLECTION AGENCY HAS, UPON FURTHER COLLECTION ACTIVITY BEEN INFORMED THAT THE PATIENT REQUESTED FINANCIAL ASSISTANCE WITH HIS/HER BILL. THIS PERCENTAGE IS APPROXIMATELY 2% OF ALL COLLECTION CALL ACTIVITY. THIS PERCENTAGE WAS CALCULATED FROM THE NUMBER OF CALLS WITH A REQUEST FOR FINANCIAL ASSISTANCE LISTED ON THE COLLECTION AGENCY'S LOG AS A PERCENTAGE OF THE TOTAL NUMBER OF CALLS THE COLLECTION AGENCY MADE. PART III, LINE 4: PLEASE REFERENCE FOOTNOTE NUMBER 17 ON PAGE 37 IN THE FISCAL YEAR 2015 AUDITED CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS SUCH AS MEDICARE IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD TO WHICH TAX-EXEMPT HOSPITALS ARE HELD. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. CVMC DETERMINES THE ALLOWABLE MEDICARE COSTS BY USING A COST TO CHARGE RATIO CALCULATION. PART III, LINE 9B: CVMC'S CREDIT AND COLLECTION POLICY FOR FINANCIAL ASSISTANCE STATES THAT CVMC WILL NOTIFY PATIENTS OF THE ASSISTANCE PROGRAM PRIOR TO SENDING ACCOUNTS TO COLLECTIONS. CVMC'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FREE CARE OR FINANCIAL ASSISTANCE. CVMC IS DILIGENT IN IDENTIFYING WHO QUALIFIES FOR FREE CARE AND/OR FINANCIAL ASSISTANCE. CVMC WILL NOT PURSUE COLLECTION FOR FREE CARE PATIENTS. ALSO, CVMC'S COLLECTION PRACTICES FOR FINANCIAL AID CASES INCLUDE MONITORING AND FOLLOWING UP TO ENSURE THAT THE PLAN IS CURRENT AND MATCHES THE PATIENT'S ECONOMIC NEEDS.
NEEDS ASSESSMENT PART VI, LINE 2 THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED USING BOTH QUALITATIVE AND QUANTITATIVE RESEARCH TECHNIQUES. INITIALLY, MEMBERS OF THE CVMC STEERING COMMITTEE GAVE VERBAL REPORTS ON THE ISSUES THEY BELIEVED TO BE THE MOST PRESSING IN THEIR ORGANIZATIONS OR IN THE GENERAL CENTRAL VERMONT COMMUNITY. FROM THERE, THE STEERING COMMITTEE REVIEWED THE RECOMMENDED LIST OF HEALTH AND SOCIOECONOMIC INDICATORS PROVIDED BY THE VERMONT DEPARTMENT OF HEALTH, AND GATHERED DATA PERTAINING TO POPULATION DEMOGRAPHICS, ACCESS TO HEALTH SERVICES, MATERNAL AND CHILD HEALTH, HEALTH STATUS AND PREVENTION, AND SOCIAL ENVIRONMENTAL MEASURES TO EVALUATE THESE CONCERNS. THIS SECONDARY RESEARCH COUPLED WITH THE STEERING COMMITTEE'S CONCERNS ALLOWED SIGNIFICANT CONCLUSIONS TO BE DRAWN AND CVMC'S PRIORITY HEALTH NEEDS TO BE SELECTED. IN ADDITION TO THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, CVMC REGULARY MONITORS THE HEALTH NEEDS OF THE CENTRAL VERMONT COMMUNITY, AND RESPONDS TO THOSE NEEDS AS SOON AS POSSIBLE WHEN DOING SO IS FEASIBLE. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEB ADDRESS: http://www.cvmc.org/documents/community-health-needs-assessment-2013
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 CVMC'S FINANCIAL ASSISTANCE POLICIES ARE POSTED IN ALL PATIENT ADMISSION PACKETS AND ON THE CVMC WEBSITE. CVMC ALSO PROVIDES CONSPICUOUS DISPLAYS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IN THE FACILITY. ALL PATIENT INVOICES LIST THE PHONE NUMBER FOR CONTACTING CVMC PATIENT FINANCIAL SERVICES FOR FINANCIAL ASSISTANCE IF PATIENTS ARE UNABLE TO PAY THEIR BILL. PATIENT FINANCIAL SERVICES HAS APPLICATIONS FOR ALL STATE FINANCIAL AID PROGRAMS ON FILE AND EMPLOYS THREE FINANCIAL COUNSELORS WHO WILL SIT DOWN WITH PATIENTS TO HELP THEM DETERMINE WHICH PROGRAMS THEY QUALIFY FOR, AS WELL AS HELP THEM FILL OUT THESE FORMS. PATIENT FINANCIAL SERVICES PROACTIVELY SCREENS PATIENT BILLING INFORMATION TO IDENTIFY INDIVIDUALS WHO MAY BE ELIGIBLE FOR STATE OR CVMC ASSISTANCE, AND WILL EITHER VISIT THAT PATIENT IN THE HOSPITAL, CALL THEM AT HOME, OR MAIL THEM THE INFORMATION.
COMMUNITY INFORMATION PART VI, LINE 4 CENTRAL VERMONT MEDICAL CENTER IS THE ONLY HOSPITAL LOCATED IN OUR IMMEDIATE SERVICE AREA OF WASHINGTON COUNTY AND PARTS OF ORANGE COUNTY. THIS SERVICE AREA CONSISTS OF 23 TOWNS WITH A TOTAL POPULATION OF APPROXIMATELY 64,239. INCLUDED IN THIS SERVICE AREA IS THE FEDERALLY DESIGNATED ORWELL TOWN MEDICALLY UNDERSERVED AREA. VITAL STATISTICS: 97.1% WHITE 68% RURAL 20% UNDER THE AGE OF 20 66% AGED 18 TO 64 14% OVER THE AGE OF 65 MEDIAN HOUSEHOLD INCOME OF $52,832 9.7% LIVE BELOW THE POVERTY LEVEL 6.1% NON ENGLISH SPEAKING HOUSEHOLDS ACCESS TO HEALTHCARE: 9.1% UNINSURED 16.1% MEDICAID (OR OTHER STATE PROGRAMS) RECIPIENTS 62.6% PRIVATE INSURANCE CHRONIC HEALTH CONDITIONS (ADULTS AGED 20+): 20% OBESITY RATE 6.9% LIVING WITH DIABETES 21% SMOKING RATE
PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 CENTRAL VERMONT MEDICAL CENTER IS THE ONLY HOSPITAL AND EMERGENCY CARE FACILITY LOCATED IN OUR IMMEDIATE SERVICE AREA. ALL OF ITS SERVICES, INCLUDING EMERGENCY CARE, ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. CENTRAL VERMONT MEDICAL CENTER (CVMC) IS THE ADMINISTRATIVE ENTITY FOR VERMONT BLUEPRINT FOR HEALTH MULTI-PAYER PRIMARY CARE PRACTICES (PATIENT CENTERED MEDICAL HOME) FOR THE BARRE HEALTH SERVICES AREA (HSA). THE GOAL OF THE VERMONT BLUEPRINT FOR HEALTH, PASSED BY THE VERMONT LEGISLATURE IN 2010, IS TO SUPPORT VERMONT'S EFFORTS TO DEVELOP A COMPREHENSIVE, PROACTIVE SYSTEM OF CARE THAT IMPROVES THE QUALITY OF LIFE FOR PEOPLE WITH, OR AT RISK FOR CHRONIC CONDITIONS. IN A PATIENT CENTERED MEDICAL HOME, PATIENTS RECEIVE CARE FROM A COMMUNITY HEALTH TEAM, WHICH CONSISTS OF A NURSE (CERTIFIED IN DIABETES EDUCATION), A DIETITIAN, A MEDICAL SOCIAL WORKER AND A HEALTH EDUCATOR. THIS TEAM WORKS WITH THE PATIENT TO HELP SET REALISTIC OUTCOMES, GOALS AND TIMELINES AND PROVIDES ONE-ON-ONE SUPPORT. THEY ALSO WORK WITH A BROAD BASE OF COMMUNITY SERVICES TO PROVIDE EACH PATIENT WITH INDIVIDUAL SUPPORT AND CARE. AT THE END OF 2012, THERE WERE 50 PRIMARY CARE PROVIDERS WHO ARE PARTICIPATING IN THE PCMH IN THE BARRE HSA CARING FOR OVER 60,000 PATIENTS. THERE ARE 9 COMMUNITY HEALTH TEAM MEMBERS IN THE CVMC PRACTICES. CVMC IS PROUD TO BE A PARTICIPANT IN THE VERMONT BLUEPRINT FOR HEALTH WITH THE PCMH. IN ADDITION TO FINANCIAL ASSISTANCE AND SLIDING SCALE DISCOUNTS (SEE SCHEDULE H, PART I, LINES 3A & B), CVMC OFFERS NO INTEREST MONTHLY PAYMENT PLANS FOR PATIENTS WHO CANNOT PAY THEIR OUTSTANDING BALANCE IN FULL BUT ARE ABLE TO PAY OVER TIME. CVMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. CVMC APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, SUCH AS NEW TECHNOLOGIES (MRI), FACILITIES AND SERVICES (A NEW THERAPEUTIC POOL AND WELLNESS FACILITY FOR AQUATIC AND OTHER REHAB THERAPY SERVICES). THE MAJORITY OF THE CVMC'S GOVERNING BODY (BOARD OF TRUSTEES) IS COMPRISED OF PERSONS WHO RESIDE IN CVMC'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS, NOR CONTRACTORS OF THE ORGANIZATION. CVMC ACTIVELY PARTNERS WITH MANY COMMUNITY ORGANIZATIONS, SUCH AS WASHINGTON COUNTY MENTAL HEALTH SERVICES, THE PEOPLE'S HEALTH AND WELLNESS CLINIC, CENTRAL VERMONT HOME HEALTH AND HOSPICE, AND GREEN MOUNTAIN UNITED WAY, TO IMPROVE THE HEALTH AND WELLBEING OF OUR COMMUNITY. ONE EXAMPLE IS OUR FREE WOMEN'S HEALTH CLINICS WITH FINANCIAL SUPPORT FROM THE SUSAN G. KOMEN FOR THE CURE THAT CVMC SPONSORS ALONG WITH THE PEOPLE'S HEALTH AND WELLNESS CLINIC. CVMC APPLIES SURPLUS FUNDS TO REVITALIZE FACILITIES, PURCHASE EQUIPMENT, AND TO ENHANCE PROGRAMS TO BETTER SERVE PATIENTS.
AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 AS OF OCTOBER 1, 2011, CENTRAL VERMONT MEDICAL CENTER, INC. (CVMC) AND THE UNIVERSITY OF VERMONT MEDICAL CENTER (FORMERLY FLETCHER ALLEN HEALTH CARE, INC.) BECAME MEMBERS OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (FORMERLY FLETCHER ALLEN PARTNERS, INC.), AN INTEGRATED SYSTEM OF CARE SERVING THE COMMUNITIES OF VERMONT AND NORTHERN NEW YORK. THE UNIVERSITY OF VERMONT HEALTH NETWORK IS CARRYING OUT CENTRALIZED ACTIVITIES FOR THE BENEFIT OF PATIENTS OF PARTNER ORGANIZATIONS, INCLUDING IMPROVING ACCESS TO LOCAL CARE, COST SAVINGS THROUGH GREATER JOINT PURCHASING POWER, ENHANCING INFORMATION TECHNOLOGY, INCREASING ACADEMIC OPPORTUNITIES FOR PHYSICIANS, ENGAGING IN REGIONAL STRATEGIC PLANNING, AND PARTICIPATING IN JOINT QUALITY AND CLINICAL INITIATIVES. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 VT
Schedule H (Form 990) 2014
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number
22-2547186
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) PEOPLES HEALTH AND WELLNESS CENTER
553 North Main St Suite 5
Barre,VT05641
03-0343290 501(c)(3) 20,000       HEALTH CARE FOR THE UNINSURED
(2) AREA HLTH EDU CNTRS PRM UNIV VT COL OF MED
UHC CMP Arnld 51 SPrpct
Brlngtn,VT05401
03-0179440 501(c)(3) 10,000       EDU LOAN RPMT TO HLTHCR PRFSNLS




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Description of Organization's Procedures for Monitoring the Use of Grants Schedule I, Part I, Line 2 CENTRAL VERMONT MEDICAL CENTER OCCASIONALLY GRANTS FUNDS TO ORGANIZATIONS THAT SUPPORT CVMC'S EXEMPT PURPOSE OF SERVING THE HEALTHCARE NEEDS OF CENTRAL VERMONT RESIDENTS. GRANT FUNDS ARE APPROVED AND OVERSEEN BY THE BOARD.
Schedule I (Form 990) 2014


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Philip Brown DOVP Medical Affairs (i)
(ii)
323,879
...............................
0
13,866
...............................
0
4,671
...............................
0
0
...............................
0
26,731
...............................
0
369,147
...............................
0
0
...............................
0
2Nancy LothianChief Operating Officer (i)
(ii)
296,397
...............................
0
43,122
...............................
0
18,974
...............................
0
0
...............................
0
18,144
...............................
0
376,637
...............................
0
0
...............................
0
3Cheyenne HollandTREASURER, CFO/VP FISCAL SRVS (i)
(ii)
256,807
...............................
0
35,644
...............................
0
13,088
...............................
0
14,721
...............................
0
26,871
...............................
0
347,131
...............................
0
0
...............................
0
4Richard MorleyVP Support Services (i)
(ii)
201,039
...............................
0
13,961
...............................
0
3,579
...............................
0
0
...............................
0
24,147
...............................
0
242,726
...............................
0
0
...............................
0
5Judith Tarr TartagliaTrustee, President/CEO (i)
(ii)
411,351
...............................
0
30,669
...............................
0
25,071
...............................
0
0
...............................
0
27,201
...............................
0
494,292
...............................
0
0
...............................
0
6Janusz Porowski MDPhysician (i)
(ii)
293,629
...............................
0
10,095
...............................
0
20,974
...............................
0
0
...............................
0
18,422
...............................
0
343,120
...............................
0
0
...............................
0
7Mark Depman MDTrustee, Medical Director EMS (i)
(ii)
329,081
...............................
0
30,020
...............................
0
19,295
...............................
0
0
...............................
0
24,112
...............................
0
402,508
...............................
0
0
...............................
0
8Mahlon Bradley MDPhysician (i)
(ii)
478,389
...............................
0
9,804
...............................
0
1,762
...............................
0
6,696
...............................
0
27,755
...............................
0
524,406
...............................
0
0
...............................
0
9Peter Thomashow MDPhysician (i)
(ii)
336,163
...............................
0
0
...............................
0
5,897
...............................
0
0
...............................
0
31,351
...............................
0
373,411
...............................
0
0
...............................
0
10John Braun MDPHYSICIAN (i)
(ii)
492,841
...............................
0
6,647
...............................
0
0
...............................
0
19,816
...............................
0
2,923
...............................
0
522,227
...............................
0
0
...............................
0
11Joseph Pekala MDTrustee until 12/11/14 (i)
(ii)
30,000
...............................
499,930
0
...............................
0
0
...............................
59,295
0
...............................
18,200
0
...............................
3,311
30,000
...............................
580,736
0
...............................
0
12John Brumsted MDTrustee (i)
(ii)
0
...............................
982,343
0
...............................
361,620
0
...............................
154,925
0
...............................
129,600
0
...............................
24,951
0
...............................
1,653,439
0
...............................
0
13Javad Mashkuri MDPhysician (i)
(ii)
307,091
...............................
0
20,363
...............................
0
17,500
...............................
0
19,237
...............................
0
25,561
...............................
0
389,752
...............................
0
0
...............................
0
14Cathy Palmer MDTrustee as of 12/2014 (i)
(ii)
0
...............................
215,214
0
...............................
0
0
...............................
44,434
0
...............................
11,000
0
...............................
24,557
0
...............................
295,205
0
...............................
0
15Karin MorrowChief Nursing Officer (i)
(ii)
176,544
...............................
0
0
...............................
0
0
...............................
0
0
...............................
0
7,870
...............................
0
184,414
...............................
0
0
...............................
0
16David TurnerVP Physician Services (i)
(ii)
162,177
...............................
0
0
...............................
0
349
...............................
0
6,452
...............................
0
2,149
...............................
0
171,127
...............................
0
0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
SUPPLEMENTAL RETIREMENT BENEFIT PLAN (SRP) SCHEDULE J, PART I, LINE 4B DURING CALENDAR YEAR 2012, UNIVERSITY OF VERMONT MEDICAL CENTER, INC. (UVM MEDICAL CENTER) ENTERED INTO A SUPPLEMENTAL RETIREMENT BENEFIT PLAN (SRP) WITH ITS PRESIDENT, DR. BRUMSTED. UNDER THE SRP, UVM MEDICAL CENTER MAKES ANNUAL DEFERRALS EQUAL TO 10% OF THE PRESIDENT'S BASE SALARY FOR EACH YEAR THROUGH THE PLAN YEAR ENDING SEPTEMBER 30, 2015. THIS AMOUNT IS INCLUDED IN SCHEDULE J, PART II, COLUMN C. AMOUNTS DEFERRED ARE SUBJECT TO FORFEITURE IF CERTAIN CONDITIONS ARE NOT MET. The CEO of CVMC participates in a split dollar life insurance arrangement. The value of the premium is included in her taxable compensation in Schedule J, Part II, column (B)(iii).
Schedule J (Form 990) 2014

Additional Data


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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number
22-2547186
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A VT Educational & Health Bldgs Finance Authority
 
23-7154467   05-13-2009 21,023,997 SEE SCH K, PART VI   X   X X  
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 11,303,348      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 21,028,838      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 144,996      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 8,000,000      
11 Other spent proceeds . . . . . . . . . . . . . . 12,879,001      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . .
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X            
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . . X              
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K, PART I, LINE A, COLUMN F DESCRIPTION OF PURPOSE THE VEHBFA 2009 SERIES A&B BOND ISSUANCE WAS ISSUED ON 5/13/2009 TO SATISFY (REFINANCE) 2005 DEBT WITH VEHBFA. THE 2005 DEBT FINANCED THE CONSTRUCTION AND EQUIPMENT OF A RENOVATION AND MODERNIZATION PROJECT. $12,879,001 OF THE VEHBFA 2009 SERIES A&B BOND ISSUANCE WAS USED TO REFUND THE 2005 DEBT. THE REFUND OCCURRED ON MAY 31, 2009. THE REMAINDER WAS USED TO CONSTRUCT AND EQUIP A CANCER TREATMENT CENTER. SCHEDULE K, PART IV, COLUMN A, LINE 2C REBATE COMPUTATION DATE A REBATE COMPUTATION WAS PERFORMED IN AUGUST, 2014.
Schedule K (Form 990) 2014

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2014
Schedule L (Form 990 or 990-EZ) 2014
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Matt Tarr See Schedule L, Part V 36,569 Wages & Benefits   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
SCHEDULE L, PART IV, COLUMN B RELATIONSHIP BETWEEN PARTIES: MATT TARR IS AN EMPLOYEE OF CVMC AND IS THE SON OF JUDITH TARR TARTAGLIA, AN OFFICER OF THE ORGANIZATION.
Schedule L (Form 990 or 990-EZ) 2014

Additional Data


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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Return Reference Explanation
DESCRIPTION OF THE ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 CENTRAL VERMONT MEDICAL CENTER TRUSTEES AND ITS STAFF ARE COMMITTED TO PROVIDING EXCELLENT CARE TO CENTRAL VERMONTERS. TO STAY ABREAST OF BEST PRACTICES, CVMC COLLABORATES WITH MANY HEALTHCARE ENTITIES TO ENSURE THIS COMMITMENT. PARTICIPATING IN THE JOINT COMMISSION ACCREDITATIONS PROCESS IS ONE MEASURE OF HOW CVMC CONTINUOUSLY STRIVES TO IMPROVE THE SAFETY AND QUALITY OF CARE PROVIDED TO ITS PATIENTS. THE HOSPITAL AND THE PHYSICIAN PRACTICE GROUPS (CVMGP, CENTRAL VERMONT MEDICAL GROUP PRACTICES) WERE ACCREDITED IN JANUARY 2013 FOR A THREE YEAR PERIOD. JOINT COMMISSION ACCREDITATION IS THE EQUIVALENT OF THE GOOD HOUSEKEEPING "SEAL OF APPROVAL" FOR MEDICAL CENTERS. THE JOINT COMMISSION EVALUATES THE QUALITY AND SAFETY OF CARE PROVIDED BY HEALTH CARE ORGANIZATIONS. TO EARN AND MAINTAIN ACCREDITATION, ORGANIZATIONS MUST HAVE AN EXTENSIVE ON-SITE REVIEW BY A TEAM OF JOINT COMMISSION HEALTH CARE PROFESSIONALS AT LEAST ONCE EVERY THREE YEARS. THE PURPOSE OF THE REVIEW IS TO EVALUATE THE ORGANIZATION'S PERFORMANCE IN AREAS THAT AFFECT PATIENT CARE. ACCREDITATION IS AWARDED BASED ON HOW WELL THE ORGANIZATION MEETS THE JOINT COMMISSION STANDARDS. CVMC PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. ALL OF CVMC'S SERVICES, INCLUDING EMERGENCY CARE, ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part VI, Line 6 THE UNIVERSITY OF VERMONT HEALTH NETWORK IS THE SOLE MEMBER AND PARENT CORPORATION OF CENTRAL VERMONT MEDICAL CENTER, INC. (CVMC). THE UNIVERSITY OF VERMONT HEALTH NETWORK IS A VERMONT NON-PROFIT CORPORATION WHICH HAS BEEN RECOGNIZED BY THE IRS AS A 501(C)(3) ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION.
ELECTION OF GOVERNING BODY & GOVERNANCE DECISIONS Form 990, Part VI, Line 7a & 7b THE UNIVERSITY OF VERMONT HEALTH NETWORK HOLDS THE POWER TO ELECT CVMC'S BOARD OF TRUSTEES AND TO APPROVE SIGNIFICANT CORPORATE ACTIONS, INCLUDING ANNUAL OPERATING AND CAPITAL BUDGETS, STRATEGIC PLANS, THE APPOINTMENT OF THE CEO, THE INCURRENCE OF LONG-TERM INDEBTEDNESS, AND AMENDMENTS TO CVMC'S BYLAWS AND ARTICLES OF ORGANIZATION.
DESCRIPTION OF PROCESS USED BY MGMNT &/OR GOVERNING BODY TO REVIEW 990 Form 990, Part VI, Line 11b THE FORM 990 IS PREPARED BY THE CONTROLLER AND REVIEWED IN DETAIL BY CVMC'S OUTSIDE TAX ADVISORS BEFORE BEING REVIEWED BY THE OFFICERS OF THE CORPORATION AND BY THE OTHER MEMBERS OF THE SENIOR MANAGEMENT TEAM. THE CONTROLLER PROVIDES REGULATORY UPDATES REGARDING THE FORM 990 TO THE FINANCE COMMITTEE AND MAKES AVAILABLE TO THE FINANCE COMMITTEE THE FORM 990 ALONG WITH HIGHLIGHTS OF ALL SIGNIFICANT PARTS OF THE FORM 990. THE BOARD OF TRUSTEES IS ALSO PROVIDED VIA EMAIL A COPY OF THE "AS FILED" FORM 990 BEFORE IT IS FILED WITH THE IRS. THE FORM 990 IS ALSO AVAILABLE IN HARD COPY FOR THOSE THAT DO NOT HAVE ACCESS TO EMAIL.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C THE COMPLIANCE OFFICER FOR CVMC MAINTAINS THE CONFLICT OF INTEREST STATEMENTS AND REGULARLY MONITORS THEM AS WELL AS ANY OTHER ACTIVITIES THAT MAY CONSTITUTE A CONFLICT OF INTEREST. THE ORGANIZATION'S PRACTICE IS TO SEND OUT ANNUAL DISCLOSURE QUESTIONNAIRES TO BOARD OF TRUSTEE MEMBERS, SENIOR OFFICERS, AND DIRECTORS OF THE ORGANIZATION OR OTHER INDIVIDUALS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION WHO HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST, AS DEFINED BELOW, AS AN "INTERESTED PERSON." THIS DEFINITION SHALL ALSO INCLUDE MEMBERS OF THE ORGANIZATION'S LEADERSHIP GROUP, MEDICAL DIRECTORS AND ANY EMPLOYEES INVOLVED WITH RECOMMENDING OR PURCHASING PRODUCTS/SERVICES. THE RESPONSES ARE TAKEN TO THE GOVERNANCE AND HUMAN RESOURCES COMMITTEE OF THE BOARD OF TRUSTEES TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE GOVERNANCE AND HUMAN RESOURCES COMMITTEE SHALL MAINTAIN A LIST OF INDIVIDUALS WHO MAY BE CONSIDERED DISQUALIFIED PERSONS UNDER IRS REGULATIONS. THE GOVERNANCE AND HUMAN RESOURCES COMMITTEE SHALL REPORT THE RESULTS OF ITS REVIEW ANNUALLY TO THE BOARD OF TRUSTEES. IF THERE IS ANY POSSIBILITY OF FINANCIAL GAIN BY A TRUSTEE AND OR EMPLOYEE FROM ANY DECISION THAT IS TO BE DELIBERATED ON, THEN THAT TRUSTEE/EMPLOYEE MAY MAKE A PRESENTATION, BUT IS THEN REMOVED FROM THOSE DISCUSSIONS TO ENSURE THAT THE TRUSTEE/EMPLOYEE WILL NOT TAKE PART IN ANY DELIBERATIONS THAT HE OR SHE MIGHT PERSONALLY GAIN FROM. THE TRUSTEE/EMPLOYEE OPERATING UNDER A CONFLICT IS PROHIBITED FROM VOTING ON ANY MATTER TO WHICH THE CONFLICT RELATES.
WHISTLEBLOWER & DOCUMENT RETENTION - DESTRUCTION POLICIES FORM 990, PART VI, LINES 13 & 14 CVMC HAS BOTH A WHISTLEBLOWER AND A DOCUMENT RETENTION - DESTRUCTION POLICY. THESE POLICIES ARE EFFECTIVE WITHOUT FORMAL BOARD APPROVAL.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A & 15B THE PROCESS FOR DETERMINING COMPENSATION FOR THE ORGANIZATION'S CEO, CFO, AND COO INCLUDES A REVIEW AND APPROVAL BY THE BOARD OF TRUSTEES. AN INDEPENDENT COMPENSATION STUDY IS ALSO PERIODICALLY PERFORMED. THE MOST RECENT STUDY WAS PERFORMED IN 2013. THIS STUDY INCLUDED COMPENSATION DATA FOR CHIEF EXECUTIVE OFFICERS AND VICE PRESIDENTS. INDEPENDENT RESEARCH IS COMPLEMENTED BY A MARKET STUDY ANALYSIS PERFORMED BY THE HUMAN RESOURCES DEPARTMENT AND REVIEWED BY THE BOARD OF TRUSTEES. MARKET STUDY DATA COMES FROM, BUT IS NOT LIMITED TO, HFMA, VAHHS, NEAH, AHA, INDUSTRY SPECIFIC COMPENSATION SURVEYS AND OTHER HEALTHCARE SOURCES. THE COMPENSATION OF OTHER KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED THROUGH MARKET STUDY ANALYSIS PERFORMED BY THE HUMAN RESOURCES DEPARTMENT AND REVIEWED BY THE BOARD OF TRUSTEES IF NECESSARY.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC UPON REQUEST. WITHIN THE ANNUAL PUBLICATION OF THE ORGANIZATION'S ANNUAL REPORT THERE ARE HIGHLIGHTS OF THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ANNUAL REPORT IS ALSO AVAILABLE IN A PDF FORMAT ON THE ORGANIZATION'S WEBSITE. COMPENSATION OF TRUSTEES FORM 990, PART VII Two physicians serving as Board members, Dr. Pekala, and Dr. Crane, receive compensation from the Organization for their services as physicians. This compensation is not related to their participation as members of the Board of Trustees.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: CHANGE IN MINIMUM PENSION LIABILITY ($11,804,221) FUNDS RELEASED FROM THE CVMC ENDOWMENT ($1,073,533) -------------- TOTAL: ($12,877,754)
CIRCULAR A-133 AUDIT FORM 990, PART XII, LINE 3B: DURING FY15, CVMC DID NOT REACH THE LEVEL REQUIRED TO WARRANT AN AUDIT UNDER OMB CIRCULAR A-133. HOWEVER, BECAUSE OF CVMC'S AFFILIATION WITH THE UNIVERSITY OF VERMONT MEDICAL CENTER, CVMC WAS INCLUDED IN THE A-133 THAT WAS PERFORMED FOR THE UNIVERSITY OF VERMONT MEDICAL CENTER.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC
 
Employer identification number

22-2547186
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1) University of Vermont Medical CenterInc
111 Colchester Ave

Burlington,VT05401
03-0219309
Hospital VT 501(c)(3) 3 UVMHN
 
Yes
 
(2) Univ of Vermont Health Network Inc
111 Colchester Ave

Burlington,VT05401
45-2880726
Holding Co VT 501(c)(3) 11a NA
 
 
No
(3) Univ of Vermont Medical Group - New York
183 Park Street

Malone,NY12953
20-3905216
PHYS SVCS NY 501(c)(3) 3 UVMMG
 
Yes
 
(4) University of Vermont Medical Group
111 Colchester Ave

Burlington,VT05401
03-0225105
PHYS SVCS VT 501(c)(3) 11a UVMMC
 
Yes
 
(5) Univ of Vermont Medical Ctr Fdn inc
111 Colchester Ave

Burlington,VT05401
26-3159849
Fundraising VT 501(c)(3) 11a UVMMC
 
Yes
 
(6) Central Vermont Hospital Auxiliary
130 Fisher Rd

Berlin,VT05602
03-0264240
Service VT 501(c)(3) 11d NA
 
 
No
(7) Community Providers Inc
75 Beekman St

Plattsburgh,NY12901
22-2544844
Hlth Svc Coor NY 501(c)(3) 11a UVMHN
 
Yes
 
(8) Champlain Valley Physicians Hospital
75 Beekman St

Plattsburgh,NY12901
14-1338471
HOSPITAL NY 501(c)(3) 3 CPI
 
Yes
 
(9) Elizabethtown Community Hospital
75 Park Street

Elizabethtown,NY12932
14-1364513
Hospital NY 501(c)(3) 3 CPI
 
Yes
 
(10) Emergency Medical Transport of CVPH Inc
75 Beekman St

Plattsburgh,NY12901
06-1718419
Ambulance Svc NY 501(c)(3) 11b CPI
 
Yes
 
(11) CVPH Medical Center Foundation
75 Beekman St

Plattsburgh,NY12901
14-1727048
Health Svc Su NY 501(c)(3) 11B CVPH
 
Yes
 
(12) University Medical Education Association
89 Beaumont Ave

Burlington,VT05405
23-7107832
Educational VT 501(c)(3) 9 UVMMG
 
Yes
 
(13) University Health Center
111 Colchester Ave

Burlington,VT05401
03-0229931
Hospital VT 501(c)(3) 11c UVMMG
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) ONECARE VERMONT ACCOUNTABLE CA

 
 
45-5399218
ACCOUNTABLE C VT NA
 
N/A                
(2) ADIRONDACKS ACO LLC

 
 
46-2840926
ACCOUNTABLE C NY NA
 
N/A                
(3) OBNET SERVICES LLC

 
 
04-3746287
HEALTH RESEAR NH NA
 
N/A                








Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Charitable Irrevocable Trust (7)

 
 
Support VT UVMMCCVMC
 
Trust       Yes  
(2) UNIV OF VT MED CTR HEALTH VENT INC

111 Colchester Ave
Burlington,VT05401
04-3380045
Holding Company VT NA
 
C Corp       Yes  
(3) VMC Indemnity Company LTD

PO BOX HM 3103 25 Church St HM F
Hamilton   HM FX FR
BD
99-9999999
Captive Insurance BD NA
 
C Corp       Yes  
(4) Vermont Managed Care

111 Colchester Ave
Burlington,VT05401
03-0333056
Managed Care VT NA
 
C Corp       Yes  
(5) Charitable Remainder Trust (5)

 
 
Support VT UVMMCCVMC
 
Trust       Yes  
(6) Perpetual Trust (4)

 
 
Support VT NA
 
Trust       Yes  
(7) CHAMPLAIN VALLEY HEALTH NETWORK

75 BEEKMAN STREET
PLATTSBURGH,NY12901
16-1586102
ADMIN SERVICE NY NA
 
C CORP       Yes  
(8) MEDQUEST INC

PO BOX 1656
PLATTSBURGH,NY12901
14-1663061
MED. OFFICE LEASE NY NA
 
C CORP       Yes  
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) UNIVERSITY OF VERMONT MEDICAL CENTER

IJMOQ 2,683,281 FMV





Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R, Part IV, Line 1 University of Vermont Medical Center, Inc. (UVM Medical Center) has a beneficial interest in four of these trusts. CVMC has a beneficial interest in three of these trusts.
Schedule R, Part V, Transaction K UVM Medical Center leases and shares facilities, equipment, and other assets with CVMC. The value of these transactions is indeterminable.
Schedule R (Form 990) 2014
Additional Data


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