TY 2017 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) JOHN GILMAN...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(2) MICHAEL NEWBOLD...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(3) LYNN PETERSON MD...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(4) HON DONNA SWEANEY...................................................................... VICE-CHAIR	1.00 .................	X	X	0	0	0
(5) STEVEN SMITH MD...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	183,126	114,455
(6) ALAN KEILLER...................................................................... CHAIR (FROM 12/2017)	1.00 .................	X	X	0	0	0
(7) MARIA PADIN MD...................................................................... DH REPRESENTATIVE	1.00 ................. 40.00	X		0	399,509	275,686
(8) VINCENT FUSCA III...................................................................... TREASURER	1.00 .................	X	X	0	0	0
(9) DEANNA S HOWARD...................................................................... DH REPRESENTATIVE	1.00 .................	X		0	0	0
(10) MATTHEW S HOUDE...................................................................... DH REPRESENTATIVE	1.00 ................. 40.00	X		0	194,397	34,795
(11) STEPHEN D SURGENOR MD...................................................................... DH REPRESENTATIVE	1.00 ................. 40.00	X		0	490,966	69,725
(12) JOHN TANSEY...................................................................... SECRETARY	1.00 .................	X	X	0	0	0
(13) GAY LANDSTROM...................................................................... INTERIM CEO (THRU 1/2017)	40.00 ................. 1.00	X	X	0	65,456	4,008
(14) JOSEPH PERRAS...................................................................... PRESIDENT & CEO (FROM 1/17	40.00 ................. 1.00	X	X	346,184	0	0
(15) PAMELA BROWN...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(16) PATRICK JORDAN...................................................................... DH REPRESENTATIVE	1.00 ................. 40.00	X		0	46,154	2,396
(17) WILLIAM PALMER MD...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	203,701	209,145

(A) Name and business address	(B) Description of services	(C) Compensation
DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL DRIVE LEBANON,NH03756	LEADERSHIP, PHYSICIANS AND MEDICAL SERVI	3,733,587
EMERGENCY SERVICES OF NEW ENGLAND PO BOX 12 CHESTER,VT05143	MEDICAL STAFF PROVIDERS FOR EMERGENCY RO	1,490,109
AHSA STAFFING PO BOX 945 TRAVERSE CITY,MI49685	TEMPORARY NURSING/CLINICAL STAFFING	1,038,954
SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH,PA15251	MNGMT & SUPPORT STAFF - ENVMMNTL SRVS	739,934
CERNER PO BOX 959156 ST LOUIS,MO63195	SUPPORT FOR EMR	678,169
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 32

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

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

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). 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

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) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization WINDSOR HOSPITAL CORPORATION

Part I Contributors	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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization WINDSOR HOSPITAL CORPORATION		Employer identification number 03-0183721

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization WINDSOR HOSPITAL CORPORATION			Employer identification number 03-0183721
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

12,969

Total. Add lines 1c through 1i ....................................................................................................

12,969

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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
PART II-B, LINE 1:	THE HOSPITAL PAID $10,620 IN THE FORM OF DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (VAHHS). VAHHS IS A MEMBER-OWNED ORGANIZATION DEVOTED TO IMPROVING THE HEALTH STATUS OF COMMUNITIES THROUGHOUT VERMONT THROUGH ACTIVITIES WHICH INCLUDE ADVOCACY, POLICY DEVELOPMENT, EDUCATION AND RESEARCH. THE HOSPITAL ALSO PAID $2,349 IN THE FORM OF DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA).

Return Reference

Explanation

PART II-B, LINE 1:

THE HOSPITAL PAID $10,620 IN THE FORM OF DUES TO THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (VAHHS). VAHHS IS A MEMBER-OWNED ORGANIZATION DEVOTED TO IMPROVING THE HEALTH STATUS OF COMMUNITIES THROUGHOUT VERMONT THROUGH ACTIVITIES WHICH INCLUDE ADVOCACY, POLICY DEVELOPMENT, EDUCATION AND RESEARCH. THE HOSPITAL ALSO PAID $2,349 IN THE FORM OF DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA).

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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 on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	4,958,242	4,667,571	4,431,980	4,759,330	4,645,093
b	Contributions ...
c	Net investment earnings, gains, and losses	289,494	475,456	420,076	-30,485	312,380
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	187,437	184,785	184,485	296,865	198,143
f	Administrative expenses ....
g	End of year balance ......	5,060,299	4,958,242	4,667,571	4,431,980	4,759,330

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

83.360 %

Term endowment SchDMd Bullet

16.640 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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" on 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 .....	410,000		410,000
b	Buildings ....	17,111,835	9,015,222	8,096,613
c	Leasehold improvements
d	Equipment ....	13,949,902	10,245,489	3,704,413
e	Other .....	13,159,823	7,285,607	5,874,216
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				18,085,242

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	18,171,742
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	56,458,700
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	192,916
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	682,050
e	Add lines 2a through 2d .....................			2e	874,966
3	Subtract line 2e from line 1..................			3	55,583,734
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	86,288
b	Other (Describe in Part XIII.) ...........	4b	-21,148
c	Add lines 4a and 4b....................			4c	65,140
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	55,648,874

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	53,449,229
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	21,148
e	Add lines 2a through 2d....................			2e	21,148
3	Subtract line 2e from line 1...................			3	53,428,081
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	86,288
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	86,288
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	53,514,369

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
PART V, LINE 4:	IN GENERAL, THE AMOUNT OF THE ORIGINAL GIFT AND ANY REQUIRED ACCUMULATIONS BY THE DONOR ARE NOT EXPENDABLE. HOWEVER, THE MARKET VALUE OF THE FUND MAY FALL BELOW THAT AMOUNT DEPENDING ON CURRENT FINANCIAL CONDITIONS IN THE UNDERLYING INVESTMENTS. UNDER THE POLICY OF THE HOSPITAL, THE ENDOWMENT ASSETS ARE INVESTED MODERATELY WITH THE INTENT OF PROVIDING A PREDICTABLE STREAM OF FUNDING TO THE HOSPITAL. THE HOSPITAL INVESTS IN EQUITY FUNDS, BOND FUNDS AND MONEY MARKET INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN LIMITED RISK CONSTRAINTS. ACTUAL RETURNS IN ANY YEAR MAY VARY FROM BUDGETED AMOUNTS DUE TO MARKET FLUCTUATIONS.
PART X, LINE 2:	ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ADDRESSES THE ACCOUNTING UNCERTAINTY OF INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF "MORE-LIKELY-THAN-NOT" FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON MEASUREMENT CLASSIFICATION, INTEREST AND PENALTIES AND DISCLOSURE. THE ORGANIZATION HAS DETERMINED THAT THE PROVISIONS OF SUBTOPIC 740-10 DO NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATIONS FOR FISCAL YEARS PRIOR TO 2015.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	OTHER COMPONENTS OF NET PERIODIC BENEFIT COST 185,694. CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST-RETIREMENT PLANS 496,356.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES -21,148.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES 21,148.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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" on 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 arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

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?

YesNo

If "Yes," list the 10 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)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

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 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on 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)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	40,801	40,801
2	Less: Contributions . . . .
3	Gross income (line 1 minus line 2) . . . . . .	40,801	40,801

4	Cash prizes . . . . .
5	Noncash prizes . . . .	5,118	5,118
6	Rent/facility costs . . . .	2,448	2,448
7	Food and beverages . . .	7,363	7,363
8	Entertainment . . . .	1,209	1,209
9	Other direct expenses . . .	5,010	5,010
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		21,148
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		19,653

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

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? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

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

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 22500.0000000000 %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	400,697		400,697	0.750 %
b	Medicaid (from Worksheet 3, column a) . . . . .	6,587,826	2,573,564	4,014,262	7.500 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	6,988,523	2,573,564	4,414,959	8.250 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,583,963	910,713	673,250	1.260 %
f	Health professions education (from Worksheet 5) . . .	93,359		93,359	0.170 %
g	Subsidized health services (from Worksheet 6) . . . .	4,386,065	3,444,743	941,322	1.760 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,069		2,069	0 %
j	Total. Other Benefits . .	6,065,456	4,355,456	1,710,000	3.190 %
k	Total. Add lines 7d and 7j .	13,053,979	6,929,020	6,124,959	11.440 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

949,742

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

23,692,477

Enter Medicare allowable costs of care relating to payments on line 5.....

17,044,147

Subtract line 6 from line 5. This is the surplus (or shortfall)........

6,648,330

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2019

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?1Name, 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)						Other (describe)
1	WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR,VT05089	X	X	X	X	DISTINCT PART REHAB UNIT

Schedule H (Form 990) 2019

Page 4

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)

	WINDSOR HOSPITAL CORPORATION
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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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 .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

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. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SCHEDULE O

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE O

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	WINDSOR HOSPITAL CORPORATION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 225.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SCHEDULE O

The FAP application form was widely available on a website (list url):

SEE SCHEDULE O

A plain language summary of the FAP was widely available on a website (list url):
SEE SCHEDULE O

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	WINDSOR HOSPITAL CORPORATION
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	WINDSOR HOSPITAL CORPORATION
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 5: METHODS EMPLOYED IN THE ASSESSMENT INCLUDED A SURVEY OF AREA RESIDENTS MADE AVAILABLE THROUGH ELECTRONIC MAIL, PHYSICAL PRINTED SURVEYS DISTRIBUTED THROUGH THE COMMUNITIES AT APPROXIMATELY 72 SITES AND WEBSITE LINKS, A SURVEY OF KEY COMMUNITY STAKEHOLDERS WHO ARE AGENCY, MUNICIPAL OR COMMUNITY LEADERS, A SERIES OF COMMUNITY DISCUSSION GROUPS CONVENED IN THE MT. ASCUTNEY HOSPITAL SERVICE AREA, AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. AT THE BEGINNING OF THE SURVEY, RESPONDENTS WERE ASKED TO INDICATE THE REGION THEY PRIMARILY SERVE OR ARE MOST FAMILIAR WITH. A TOTAL OF 137 KEY STAKEHOLDER RESPONDENTS INDICATED THAT THEIR RESPONSES WERE REFLECTIVE OF THE GREATER WINDSOR SERVICE AREA. RESPONDENTS REPRESENTED THE FOLLOWING SECTORS:HUMAN SERVICE/SOCIAL SERVICE MENTAL /BEHAVIORAL HEALTH HOME HEALTH CARE PRIMARY HEALTH CAREMEDICAL SUBSPECIALTYPUBLIC SAFETY/FIRE EMERGENCY MEDICAL SERVICES EDUCATION/YOUTH SERVICES MUNICIPAL/COUNTY GOVERNMENT COMMUNITY MEMBER/VOLUNTEER
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 6A: OTHER FACILITIES WERE MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH), ALICE PECK DAY MEMORIAL HOSPITAL, NEW LONDON HOSPITAL AND VALLEY REGIONAL HOSPITAL. DURING JANUARY THROUGH JULY 2018, MAHHC COMPLETED OUR COMMUNITY NEEDS ASSESSMENT IN PARTNERSHIP WITH AFOREMENTIONED NEIGHBORING HOSPITALS INCLUDING THE VISITING NURSES AND HOSPICE OF VT AND NH, AS WELL AS MHMH, USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWING US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION.
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 6B: THROUGH JANUARY JULY 2018, MAHHC WORKED WITH MARY HITCHCOCK MEMORIAL HOSPITAL AND COMMUNITY PARTNERS (72 ORGANIZATIONS) TO DISSEMINATE SURVEYS, SERVE AT KEY INFORMANTS (137) AND TO PROVIDE OVERALL REVIEW AND FEEDBACK RE: FINDINGS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 7D: A BENEFIT REORT WAS PREPARED AND MADE AVAILABLE AND DISTRIBUTED THROUGH 5 COMMUNITY PRESENTATIONS, (INCLUDING 2 REGIONAL SUMMITS WITH OVER 100 PARTICIPANTS) CONDUCTED BY THE COMMUNITY BENEFIT STAFF, AS WELL AS A THOROUGH PRESENTATION MADE TO HOSPITAL'S BOARD OF TRUSTEES. THE MT. ASCUTNEY COMMUNITY HEALTH COMMITTEE, AS WELL AS THE WINDSOR AREA COMMUNITY PARTNERSHIP, AND WOODSTOCK HEALTH AND WELLNESS NETWORK, PARTICIPATED IN THE DISTRIBUTION OF THE REPORT. THE CHNA AND ALL INFORMATION IN THE NEEDS ASSESSMENT IS AVAILABLE FOR STAKEHOLDERS. THE CHNA IS ALSO AVAILABLE VIA PAPER COPY FOR PUBLIC INSPECTION UPON REQUEST, AT THE HOSPITAL'S MAIN INFORMATION DESK. IT IS ALSO AVAILABLE PROMINENTLY ON THE FOLLOWING WEBSITE, HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/FY2018%20MTA%20COMMUNITY%20HEALTH%20NEEDS%20ASSESSMENT%2010.3.18.PDF
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 11: THE MISSION OF MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) IS TO IMPROVE THE LIVES OF THOSE WE SERVE. TO ACCOMPLISH THIS, WE AND OUR COMMUNITY PARTNERS REGULARLY REACH OUT TO ENGAGE IN DIALOGUE WITH PEOPLE ACROSS OUR AREA ABOUT PRESSING HEALTH NEEDS. THE RESULT OF THIS WORK IS A COMPREHENSIVE LOCAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).*THIS ASSESSMENT IS DESIGNED TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES AND OPPORTUNITIES TO IMPROVE COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS.THE GEOGRAPHIC AREA COVERED BY THE ASSESSMENT IS 13 MUNICIPALITIES IN VERMONT AND NEW HAMPSHIRE THAT COMPRISE THE MT. ASCUTNEY HOSPITAL AND HEALTH CENTER SERVICE AREA.THE CHNA LEADS TO A LOCAL COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WITH STRATEGIES AND METRICS TO IMPROVE HEALTH AND REDUCE RISKS LEADING TO CHRONIC DISEASENOT ONLY FOR INDIVIDUALS, BUT FOR THE ENTIRE COMMUNITY.THIS CHNA-CHIP PROCESS, WHICH INCORPORATES INPUT FROM PEOPLE WHO REPRESENT THE COMMUNITY'S BROAD INTERESTS, IS AN ESSENTIAL PART OF CREATING AN ACCOUNTABLE COMMUNITY FOR HEALTH. IT'S THE LAW FOR TAX-EXEMPT HOSPITALS, AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. BUT IT'S ALSO SOUND MEDICINE. THE ASSESSMENT PROCESS FOSTERS ENGAGEMENT, AND THE RESULTS HELP US UNDERSTAND THE SPECIFIC ISSUES FACING OUR COMMUNITIES SO THAT WE CAN DEVELOP EFFECTIVE, COLLECTIVE SOLUTIONS.1. AL ALCOHOL AND DRUG MISUSE, INCLUDING HEROIN & PAIN MEDICATIONS THE INTERDISCIPLINARY CHRONIC PAIN CONSULT TEAM MET ON A MONTHLY BASIS TO PROVIDE SUPPORT FOR MANAGING CHALLENGING CHRONIC PAIN PATIENTS THE BLUEPRINT SELF MANAGEMENT PROGRAM ALSO CONVENED TWO CHRONIC PAIN SELF MANAGEMENT CLASSES THIS REPORTING PERIOD. MAHHC IMPLEMENTED MEDICATION ASSISTED THERAPY "SPOKE" PROGRAMS IN 4 SITES, MAHHC, OTTAUQUECHEE HEALTH CENTER, CONNECTICUT VALLEY RECOVERY SERVICES AND BRADFORD PSYCHIATRIC ASSOCIATION SERVING OVER 200 PATIENTS EACH QUARTER PURCHASED MICHIGAN MODEL (SUBSTANCE MISUSE PREVENTION CURRICULA) FOR WINDSOR, HARTLAND, AND WEATHERSFIELD SCHOOLS FOR 2018/2019 SCHOOL YEAR IMPLEMENTATION MAHHC AND THE WINDSOR AREA DRUG TASK FORCE CONVENED "BEYOND NALOXONE: PREVENTION OF OPIATE DEATHS SUMMIT". THE FIRST WAS HELD IN JUNE AND THE SECOND IN SEPTEMBER 2018 MAHHC AND THE WINDSOR AREA DRUG TASK FORCE CONVENED A SUMMIT TO REVIEW DATA, SHARE CONCERNS, AND CREATE SOLUTIONS FOR YOUTH SUBSTANCE MISUSE AND CREATED 2 RESOURCE GUIDES RELATING TO YOUTH PREVENTION INTERVENTION AND TREATMENT SERVICES. EXPANDED REGIONAL APPROACH BY CONTRACTING WITH GIFFORD HEALTH CARE AND LITTLE RIVERS HEALTHCARE TO PARTICIPATE IN PREVENTION EFFORTS. DESIGNED AND IMPLEMENTED MARIJUANA LAW COMMUNITY SURVEY TO GAUGE UNDERSTANDING AND IDENTIFY MARIJUANA EDUCATION NEEDS. 602 RESPONSES COLLECTED ACROSS WINDSOR COUNTY. WORKGROUP CONVENED TO CREATE TWO RESOURCE GUIDES: PREVENTION ACTIVITIES & YOUTH SUBSTANCE MISUSE TREATMENT PROGRAMS2. ACCESS TO MENTAL HEALTH SERVICES WELLNESS RECOVERY ACTION PLAN (WRAP) WORKSHOPS DELIVERED FOR SKILL BUILDING AND SELF-MANAGEMENT SUPPORT FOR ANXIETY, DEPRESSION AND GENERAL MENTAL HEALTH EXPANSION OF AN HCRS EMBEDDED LADC TO 4 DAYS A WEEK IN PATIENT-CENTERED MEDICAL HOME (PCMH), SUPPORTED BY SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) GRANT PSYCHIATRIST EMBEDDED IN PATIENT CENTERED MEDICAL HOME MENTAL HEALTH COUNSELING SESSIONS AT WINDSOR CONNECTION RESOURCE CENTER INCREASED FROM 336 IN 2017 TO 776 IN 20183. ACCESS TO DENTAL CARE WORKING WITH NORTHEAST DELTA DENTAL AND ALICE PECK DAY COMMUNITY HEALTH, MAHHC ORGANIZED A DENTAL CLINIC IN THE WINDSOR ELEMENTARY SCHOOL CALLED WINDSOR SMILES PROGRAM IN 2018, THE WINDSOR COMMUNITY HEALTH CLINIC SUPPLIED 12 DENTAL VOUCHERS WHICH TOTALED $6,701.25 WORTH OF SERVICES4. ACCESS TO AFFORDABLE HEALTH INSURANCE AND PRESCRIPTION MEDICATION M THE WINDSOR COMMUNITY HEALTH CLINIC ASSISTS CLIENTS WITH VT HEALTH CONNECT, MEDICARE, AND MEDICAID APPLICATIONS.ALSO HELPS PATIENTS COMPLETE APPLICATIONS FOR REDUCED PRICE MEDICATIONS FROM PHARMACEUTICAL COMPANIES. IN 2018, 5 MEDICAL DOCTORS, 5 REGISTERED NURSES, 2 MENTAL HEALTH PROFESSIONALS, 8 MID-LEVEL NURSING PROVIDERS, AND 1 LICENSED CLINICAL SOCIAL WORKER DONATED THEIR TIME TO SUPPORT THE CLINIC. A TOTAL OF $852,318 OF IN-KIND SUPPORT WAS OFFERED, WITH PAID PROGRAM EXPENSES BEING $78,464. A TOTAL OF $8,396 WAS SPENT ON MEDICATION VOUCHERS IN 2018E5. HEALTH CARE FOR SENIORS ESTABLISHED A REGIONAL, COMMUNITY-BASED FALLS PREVENTION BEST PRACTICE PROGRAM INVOLVING EMS IN WOODSTOCK AND WINDSOR, HISTORIC HOMES OF RUNNEMEDE, OLD WINDSOR VILLAGE, RETIRED SENIORS VOLUNTEER PROGRAM (RSVP), PATIENT- CENTERED MEDICAL HOME, MAHHC PHYSICAL THERAPY; ADOPTION OF FALLS FREE STATEWIDE PROGRAM (STEDI SYSTEM); DEVELOPED EMS PROTOCOL; PROVIDED TRAINING; PROMOTED REFERRALS TO PT AND COMMUNITY-BASED SKILLS TRAINING; AND PROVIDED BALANCE AND STRENGTH TRAINING FOR SENIORS. INTERAGENCY CARE MANAGEMENT AND CARE COORDINATION THROUGH THE COMMUNITY HEALTH TEAM FOR HIGH-RISK CHRONIC CARE ELDERS. LEADERSHIP AND BOARD PARTICIPATION FOR THE CREATION OF SCOTLAND HOUSE ADULT DAY HEALTH AND WELLNESS PROGRAM. SUPPORT AND SERVICES AT HOME (SASH) WELLNESS NURSE SERVED OVER 100 PATIENTS WITH ASSESSMENTS, EDUCATION, MONITORING AND CARE COORDINATION. INVOLVED IN 2 QUALITY INITIATIVES WITH MAHHC PATIENT-CENTERED MEDICAL HOME INCLUDING HYPERTENSION AND DIABETES QUALITY INITIATIVES. HOUSING AND SUPPORTIVE SERVICES (HASS) COORDINATOR WORKED TO DECREASE SOCIAL ISOLATION BY PROVIDING ONE- ON-ONE VISITING FOR 31 RESIDENTS, WITH CLASSES AND EVENTS INCLUDING GARDENING, BOOK CLUBS, CRAFTS, ART AND MUSIC. LEADERSHIP AND BOARD PARTICIPATION FOR THE CREATION OF SCOTLAND HOUSE ADULT DAY HEALTH AND WELLNESS PROGRAM. SUPPORT AND SERVICES AT HOME (SASH) WELLNESS NURSE SERVED OVER 100 PATIENTS WITH ASSESSMENTS, EDUCATION, MONITORING AND CARE COORDINATION. INVOLVED IN 2 QUALITY INITIATIVES WITH MAHHC PATIENT-CENTERED MEDICAL HOME INCLUDING HYPERTENSION AND DIABETES QUALITY INITIATIVES. HOUSING AND SUPPORTIVE SERVICES (HASS) COORDINATOR WORKED TO DECREASE SOCIAL ISOLATION BY PROVIDING ONE- ON-ONE VISITING FOR 31 RESIDENTS, WITH CLASSES AND EVENTS INCLUDING GARDENING, BOOK CLUBS, CRAFTS, ART AND MUSIC.6. NUTRITION / ACCESS TO AFFORDABLE, HEALTHY FOOD HOSTED VT FOOD BANK'S "VEGGIEVANGO" EVERY MONTH (DELIVERY OF FREE VEGETABLES TO THE COMMUNITY). SERVES 90 TO 215 FAMILIES EACH MONTH. MAHHC MEDICAL PROVIDERS GIVE "PRESCRIPTIONS" FOR VEGETABLES AND "VEGGIEVANGO PREVENT TYPE 2 DIABETES SUPPORT GROUP WORKSHOPS WERE HELD ON A MONTHLY BASIS FROM JANUARY THROUGH SEPTEMBER. NEW TOPICS WERE REVIEWED UNDER THE GUIDANCE OF EXPERTS IN DIABETES AND RELATED FIELDS ORGANIZED SUMMER PICNIC SERIES. SERVED DAILY, FREE LUNCH TO CHILDREN ACROSS THE SCHOOL DISTRICT. THREE LOCATIONS SERVED OVER AN 8-WEEK PERIOD TO ABOUT 70 CHILDREN PER DAY, FOR A TOTAL OF ABOUT 2,800 LUNCHES SERVED. PEDIATRIC CLINIC SCREENED FOR FOOD INSUFFICIENCY AND PROVIDED REFERALS TO THE COMMUNITY HEALTH TEAM FOR THOSE AT RISK. MAHHC REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR PROVIDED NUTRITIONAL COUNSELING ON AN ONGOING BASIS ORGANIZED A LEARNING KITCHEN CLASS FOR RESIDENTS LIVING IN LOCAL SUBSIDIZED HOUSING UNITS.7. PHYSICAL ACTIVITY AND OBESITY IN JULY 2018, MAHHC JOINED THE FIRST COHORT OF 6 HOSPITALS EXPANDING THE RISEVT PROGRAM STATEWIDE. THE PROGRAM INCREASES OUR CAPACITY FOR MORE OPPORTUNITIES RELATED TO PHYSICAL ACTIVITY AND ADDRESSES FOOD INSECURITY/NUTRITION IN WSESU TOWNS. ORGANIZED A 20-MEMBER, CROSS-SECTOR STEERING COMMITTEE TO HELP SHAPE PLAN FOR 2019 MT. ASCUTNEY PREVENTION PARTNERSHIP (MAPP) CONDUCTED READINESS ASSESSMENTS FOR TOWN HEALTH & WELLNESS COMMITTEES IN WINDSOR, WOODSTOCK, AND WEATHERSFIELD. COMMUNITY OUTREACH RELATED TO INCREASING PHYSICAL ACTIVITY THROUGH THE VERMONT 3-4-50 CAMPAIGN RESULTED IN OVER 2,000 CONTACTS. MAHHC IS AT THE 3-4-50 WORKSITE WELLNESS "GOLD" LEVEL FOR HOSTING A MYRIAD OF WELLNESS INCENTIVES AND EXERCISE OFFERINGS.8. INCOME POVERTY AND FAMILY STRESS FAMILY WELLNESS PROGRAM IS EMBEDDED IN THE PEDIATRIC CLINIC AND EMPLOYS THE VERMONT FAMILY-BASED APPROACH METHODOLOGY. PARENT TRAINING IN COLLABORATIVE PROBLEM-SOLVING (CPS). WINDSOR BECAME A PROMISE COMMUNITY TO PROMOTE KINDERGARTEN READINESS AND EMOTIONAL-SOCIAL COMPETENCE OF CHILDREN AND FAMILIES. MAHHC PROVIDED BACKBONE SUPPORT TO A CROSS-SECTOR STEERING COMMITTEE. PROJECT ACTIVITIES INCLUDED TRAINING FOR EARLY CHILDHOOD EDUCATORS, ESTABLISHING FREE TAKE-A-BOOK BOXES IN 4 TOWNS, AND CREATING A FAMILY-FRIENDLY ACTIVITY SPACE AT THE WINDSOR CONNECTION RESOURCE CENTER. PATCH SERVICES AT THE WINDSOR CONNECTION RESOURCE CENTER INCLUDE ECONOMIC SERVICES, MENTAL HEALTH COUNSELING AND VISITS FOR EMPLOYMENT COUNSELING.(SEE CONTINUED EXPLANATION ON SCHEDULE O)
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 13B: PATIENTS WHOSE FAMILY INCOME EXCEEDS 300% OF FPL MAY BE ELIGIBLE TO RECEIVE A DISCOUNT BASED ON THE SELF-PAY BALANCE. DISCOUNTS WILL BE GRANTED SUCH THAT THE TOTAL SELF-PAY BILL DOES NOT EXCEED 10% OF 2 YEARS GROSS INCOME, PLUS 10% OF ASSETS IN EXCESS OF THE SHELTERED ASSET CALCULATION DESCRIBED EARLIER IN THE POLICY. ANY DISCOUNTS OTHER THAN THOSE DESCRIBED ABOVE MUST BE APPROVED BY THE FINANCIAL ASSISTANCE APPEALS COMMITTEE BASED ON A WRITTEN APPEAL FROM THE PATIENT OR RESPONSIBLE PARTY.
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 13H: MAHHC APPLIES A DISCOUNT TO THE FAP ELIGIBLE PATIENT'S GROSS CHARGES TO ALL BALANCES WHERE THERE IS NO INSURANCE, OR TO MEDICALLY NECESSARY SERVICES PROCESSED BY INSURANCE CARRIERS RESULTING IN A BALANCE, WHICH THE PATIENT IS EXPECTED TO PAY. THE DISCOUNT IS CALCULATED ANNUALLY. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN GENERALLY BILLED TO PATIENTS WITH INSURANCE.
WINDSOR HOSPITAL CORPORATION	PART V, SECTION B, LINE 16J: THE MAHHC FINANCIAL ASSISTANCE POLICY IS POSTED ON MAHHC WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY VERSION. MAHHC PROVIDES THE PATIENT FRIENDLY BROCHURE VERSION OF THE POLICY TO ALL UNINSURED PATIENTS. MAHHC ALSO NOTIFIES PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABILITY. ADDITIONALLY, MAHHC POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITY INCLUDING ADMISSION OFFICES. MAHHC SCREENS UNINSURED PATIENTS AND A REPRESENTATIVE FROM THE WINDSOR COMMUNITY HEALTH DEPARTMENT (1 FULLTIME EMPLOYEE) CONNECTS WITH THE PATIENT TO ASSIST IN GETTING THEM SIGNED UP ON HEALTH PLANS OR APPLY FOR FINANCIAL ASSISTANCE.

Schedule H (Form 990) 2019

Page 9

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

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
PART I, LINE 7:	A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. A COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENTS SEGMENTS. A COST-TO-CHARGE RATIO WAS USED.
PART I, LINE 7G:	PHYSICIAN CLINIC COSTS INCLUDED WITHIN SUBSIDIZED HEALTH SERVICES ARE $6,245,064 OF THE TOTAL COMMUNITY BENEFIT EXPENSES AND $9,844,453 OF THE DIRECT OFFSETTING REVENUE.
PART III, LINE 2:	BAD DEBT EXPENSE IS DERIVED FROM THE WRITE OFF OF PATIENT ACCOUNTS AFTER THEY HAVE BEEN SENT 4 STATEMENTS OVER A COURSE OF 120 DAYS. ALSO, BAD DEBT EXPENSE CONTAINS ESTIMATES FOR FUTURE WRITE-OFFS BASED ON MANAGEMENT'S JUDGEMENTS AND FINANCIAL MODELS.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. BALANCES STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE PROVISION FOR DOUBTFUL ACCOUNTS AND A CREDIT TO ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR DOUBTFUL ACCOUNTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR DOUBTFUL ACCOUNTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR DOUBTFUL ACCOUNTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACTUAL WRITE-OFFS ARE CHARGED AGAINST THE PROVISION FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	THE SHORTFALL REPRESENTS THE PPS REIMBURSEMENT DIFFERENCE ON THE REHAB UNITS. SINCE THE REIMBURSEMENT DOES NOT COVER THE COSTS OF THESE UNITS, A SUBSIDY IS CREATED. BECAUSE THE HOSPITAL DETERMINED THAT THESE SERVICES ARE IMPORTANT TO OUR SERVICE AREA, THE HOSPITAL COVERS THE SUBSIDY. THE COSTING METHODOLOGY USED ABOVE WAS THE COST TO CHARGE RATIO.
PART III, LINE 9B:	MAHHC'S COLLECTION POLICY AND CHARITABLE CARE POLICIES ARE CONSISTENTLY APPLIED TO ALL PATIENTS. OUR COLLECTION POLICY APPLIES TO ANY BALANCE OWED BY THE PATIENT WHETHER IT IS A BALANCE AFTER INSURANCE, A BALANCE WITH NO INSURANCE, OR A BALANCE AFTER AN ADJUSTMENT FOR PARTIAL CHARITABLE CARE. STATEMENTS, AND WRITE-OFF CRITERIA ARE THE SAME FOR ALL LIKE BALANCES, REGARDLESS OF THE REASON FOR THE BALANCE AND REGARDLESS OF WHETHER IT IS A BALANCE AFTER CHARITABLE CARE OR NOT. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE THE APPROPRIATE ADJUSTMENT ON THEIR BILL. IF A BALANCE REMAINS AFTER THAT ADJUSTMENT, THEY ARE BILLED ACCORDING TO THE COLLECTION POLICY, FOR THE REMAINDER.
PART VI, LINE 2:	IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE NEEDS OF THE COMMUNITY ARE ASSESSED THROUGH ONGOING REVIEW OF HEALTH INDICATORS SUCH AS THE YOUTH RISK BEHAVIOR SURVEY, BRFSS, QUALITY INDICATORS FROM BOTH THE HOSPITAL AND EXTERNAL EVALUATIONS SUCH AS ONE CARE VERMONT AND THE THAT PRACTICE PROFILES. COMMUNITY HEALTH NEEDS ARE ALSO ASSESSED THROUGH PATIENT SATISFACTION SURVEYS AND THE PATIENT COMPLAINT PROCESS. THE HOSPITAL ALSO HAS A COMMUNITY HEALTH TEAM EMBEDDED IN OUR PATIENT CENTERED MEDICAL HOME WHO RESPOND TO THE NEEDS OF PATIENTS WITH COMPLEX CHRONIC CARE NEEDS.
PART VI, LINE 3:	WINDSOR COMMUNITY HEALTH CLINIC (A DEPARTMENT WITHIN THE HOSPITAL) PROVIDES INFORMATION AND ONE-ON-ONE ASSISTANCE WITH ANY INDIVIDUAL THAT IS IDENTIFIED WITHOUT INSURANCE. THIS BEGINS AT THE TIME THAT A PATIENT PRESENTS FOR THEIR HEALTH CARE APPOINTMENT; THE REGISTRATION STAFF MAKE THE INTRODUCTION AND PROVIDE INFORMATION TO THE PATIENT ON THE SERVICES. ALSO, A REFERRAL FROM THE PHYSICIAN/PROVIDER MAY DIRECT A PATIENT TO THIS DEPARTMENT. THE STAFF OF THIS DEPARTMENT ASSIST PATIENTS IN APPLYING FOR HEALTH INSURANCE, WHETHER ON THE COMMERCIAL "EXCHANGE", OR IN GOVERNMENTAL INSURERS. THEY ALSO PROVIDE INFORMATION ON AND THE APPLICATION FOR FINANCIAL ASSISTANCE; OFTEN TIME, ASSISTING PATIENTS WITH COMPLETING THE APPLICATION. THIS IS A DEDICATED STAFF THAT IS ON SITE DURING THE NORMAL BUSINESS HOURS WHEN THE MAJORITY OF PATIENTS WOULD BE SEEKING CARE.
PART VI, LINE 4:	MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, HARTLAND, WOODSTOCK, SPRINGFIELD, WEATHERSFIELD, BROWNSVILLE, VT AND CORNISH, AND CLAREMONT, NH. MAHHC IS THE LARGEST EMPLOYER IN THE TOWN OF WINDSOR, WITH MANY OF ITS RESIDENTS HAVING LOWER THAN AVERAGE PAYING JOBS AND STRUGGLE WITH FINANCIAL STABILITY; INCLUDING TRANSPORTATION DIFFICULTIES.
PART VI, LINE 5:	THE HOSPITAL HAS ESTABLISHED A DIRECTOR OF COMMUNITY HEALTH, A PREVENTION EDUCATION AND HEALTH PROMOTION DEPARTMENT AND A COMMUNITY HEALTH COMMITTEE WHICH IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES. OUR STAFF ORGANIZE, LEAD AND IMPLEMENT HEALTH PROMOTION AND PREVENTION PROGRAMS FOR HIGH RISK BEHAVIORS SUCH AS ALCOHOL, TOBACCO AND DRUG MISUSE. WE PROMOTE EXERCISE AND NUTRITION PROGRAMS IN A WELL-ESTABLISHED CAMPAIGN WORKING WITH THE VERMONT DEPARTMENT OF HEALTH IN THE 3-4-50 CAMPAIGN. THIS CAMPAIGN INVOLVES OUTREACH AND ENGAGEMENT TO AND WITH THE COMMUNITY TO DECREASE THE THREE BEHAVIORS OF TOBACCO USE, LACK OF EXERCISE AND POOR NUTRITION THAT ARE RELATED TO THE FOUR CONDITIONS OF HEART DISEASE AND STROKE, DIABETES, CANCER AND RESPIRATORY DISEASES THAT ACCOUNT FOR OVER 50% OF THE DEATHS IN VERMONT. THIS YEAR OUR OUTREACH IMPACTED OVER 1000 PEOPLE. WE SERVE AS AN INTEGRATOR AND LEADER OF COMMUNITY HEALTH BY CHAIRING AND LEADING THE FOLLOWING COMMUNITY PARTNERSHIPS; WINDSOR AREA COMMUNITY PARTNERSHIP, WINDSOR PA TCH TEAM, BLUEPRINT FOR HEALTH EXTENDED TEAM, WINDSOR HSA COMMUNITY COLLABORATIVE AND WINDSOR DRUG TASK FORCE. MISSION STATEMENTS AND MINUTES ARE AVAILABLE PER REQUEST.
PART VI, LINE 6:	THE HOSPITAL COMMUNITY BENEFIT STAFF IS AN ACTIVE PARTICIPANT IN REGIONAL COMMUNITY HEALTH COMMITTEE, WHICH IS LEAD AND ORGANIZED BY DARTMOUTH-HITCHCOCK. THE HOSPITAL IS AFFILIATED, FORMALLY, WITH DARTMOUTH-HITCHCOCK. AS ARE OTHER LOCAL HOSPITALS, ALICE PECK DAY MEMORIAL HOSPITAL AND NEW LONDON HOSPITAL. VALLEY REGIONAL HOSPITAL IS ALSO PART OF THE REGIONAL COMMUNITY HEALTH COMMITTEE. THE PARTICIPANTS COLLABORATE, COMPARE SOLUTIONS AND OFFER SUPPORT TO EACH OTHER AS ALL ARE SERVING OVERLAPPING SERVICE AREAS.
PART VI, LINE 2	DURING THE PERIOD JANUARY THROUGH JULY 2018, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED BY MT. ASCUTNEY HOSPITAL AND HEALTH CENTER IN PARTNERSHIP WITH DARTMOUTH-HITCHCOCK, ALICE PECK DAY MEMORIAL HOSPITAL, VALLEY REGIONAL HEALTHCARE, NEW LONDON HOSPITAL AND VISITING NURSE AND HOSPICE FOR VT AND NH, AND THE NEW HAMPSHIRE COMMUNITY HEALTH INSTITUTE. THE PURPOSE OF THE ASSESSMENT WAS TO IDENTIFY COMMUNITY HEALTH CONCERNS, PRIORITIES AND OPPORTUNITIES FOR COMMUNITY HEALTH AND HEALTH CARE DELIVERY SYSTEMS IMPROVEMENT. FOR THE PURPOSE OF THE ASSESSMENT, THE GEOGRAPHIC AREA OF INTEREST WAS 13 MUNICIPALITIES IN VERMONT AND NEW HAMPSHIRE COMPRISING THE MT. ASCUTNEY HOSPITAL AND HEALTH CENTER SERVICE AREA WITH A TOTAL RESIDENT POPULATION OF 44,035 PEOPLE. METHODS EMPLOYED IN THE ASSESSMENT INCLUDED SURVEYS OF COMMUNITY RESIDENTS MADE AVAILABLE ON-LINE AND PAPER SURVEYS PLACED IN NUMEROUS LOCATIONS THROUGHOUT THE REGION; A DIRECT EMAIL SURVEY OF KEY STAKEHOLDERS AND COMMUNITY LEADERS REPRESENTING MULTIPLE COMMUNITY SECTORS; A SET OF COMMUNITY DISCUSSION GROUPS; COMPILATION OF RESULTS FROM ASSESSMENT ACTIVITIES FOCUSED SPECIFICALLY ON BEHAVIORAL HEALTH NEEDS AND GAPS; AND A REVIEW OF AVAILABLE POPULATION DEMOGRAPHICS AND HEALTH STATUS INDICATORS. ALL INFORMATION COLLECTION ACTIVITIES AND ANALYSES SOUGHT TO FOCUS ASSESSMENT ACTIVITIES ON VULNERABLE AND DISPROPORTIONATELY SERVED POPULATIONS IN THE REGION INCLUDING POPULATIONS THAT COULD EXPERIENCE LIMITED ACCESS TO HEALTH-RELATED SERVICES OR RESOURCES DUE TOINCOME, AGE, DISABILITY, AND SOCIAL OR PHYSICAL ISOLATION. HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/COMMUNITY-SERVICES/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS
PART VI, LINE 3	UNINSURED PATIENTS, ARE PRO-ACTIVELY SCREENED TO IDENTIFY FOR POTENTIAL QUALIFICATION FOR OTHER FEDERAL, STATE OR OTHER LOCAL PROGRAMS. A FULL-TIME EMPLOYEE, WHO IS DEDICATED TO SERVING THIS POPULATION GETS IN CONTACT WITH THE PATIENT TO HELP THEM COMPLETE THE APPLICATIONS, INCLUDING MAHHC FINANCIAL ASSISTANCE PROGRAM. THIS WORK IS THE SINGLE FOCUS OF HER JOB, AND SHE MAKES HERSELF AVAILABLE TO THE PATIENT IN PERSON, BY PHONE OR EMAIL.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

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 on Line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1STEVEN SMITH MD TRUSTEE	(i) (ii)	0 ------------- 182,352	0 ------------- 0	0 ------------- 774	0 ------------- 95,090	0 ------------- 19,365	0 ------------- 297,581	0 ------------- 0
2MARIA PADIN MD DH REPRESENTATIVE	(i) (ii)	0 ------------- 386,729	0 ------------- 0	0 ------------- 12,780	0 ------------- 253,282	0 ------------- 22,404	0 ------------- 675,195	0 ------------- 0
3MATTHEW S HOUDE DH REPRESENTATIVE	(i) (ii)	0 ------------- 194,397	0 ------------- 0	0 ------------- 0	0 ------------- 13,795	0 ------------- 21,000	0 ------------- 229,192	0 ------------- 0
4STEPHEN D SURGENOR MD DH REPRESENTATIVE	(i) (ii)	0 ------------- 450,673	0 ------------- 0	0 ------------- 40,293	0 ------------- 49,762	0 ------------- 19,963	0 ------------- 560,691	0 ------------- 0
5JOSEPH PERRAS PRESIDENT & CEO (FROM 1/17	(i) (ii)	346,184 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	346,184 ------------- 0	0 ------------- 0
6WILLIAM PALMER MD TRUSTEE	(i) (ii)	0 ------------- 202,513	0 ------------- 0	0 ------------- 1,188	0 ------------- 196,234	0 ------------- 12,911	0 ------------- 412,846	0 ------------- 0
7DAVID SANVILLE CFO	(i) (ii)	181,809 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	20,699 ------------- 0	202,508 ------------- 0	0 ------------- 0
8MARY JOYCE PHYSICIAN	(i) (ii)	249,664 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	20,699 ------------- 0	270,363 ------------- 0	0 ------------- 0
9CHRISTOPHER CONNOR PHYSICIAN	(i) (ii)	315,647 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	10,000 ------------- 0	325,647 ------------- 0	0 ------------- 0
10HEIDI CRUZ PHYSICIAN	(i) (ii)	238,721 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	20,689 ------------- 0	259,410 ------------- 0	0 ------------- 0
11DENNIS HEIBEIN PHYSICIAN	(i) (ii)	244,242 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	10,000 ------------- 0	254,242 ------------- 0	0 ------------- 0
12PETER RAUERT PHYSICIAN	(i) (ii)	407,201 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	18,140 ------------- 0	425,341 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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
PART I, LINE 3	THE INTERIM CEO WAS PAID BY MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION.
PART I, LINE 4B	THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): DARTMOUTH-HITCHCOCK CLINIC, A RELATED ORGANIZATION, PAID MARIA PADIN $10,686 AND STEPHEN D SURGENOR $37,218. MARY HITCHCOCK MEMORIAL HOSPITAL, A RELATED ORGANIZATION PAID GAY LANDSTROM $29,011.
PART I, LINE 7	CONNOR RECEIVED A BONUS. THE BONUS WAS AWARDED EITHER DUE TO MEETING RVU GOALS OR BASED ON QUALITY AND CITIZENSHIP.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER IS A PART OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM, WHICH OWNS FOR-PROFIT SUBSIDIARIES THAT PROVIDE SERVICES AND SUPPORT THE MISSION OF THE ORGANIZATION. AS A RESULT, SOME OFFICERS OF THE MAHHC ALSO MAY BE OFFICERS OF FOR-PROFIT ENTITIES WITHIN THE HEALTHCARE SYSTEM.
FORM 990, PART VI, SECTION A, LINE 6	DARTMOUTH-HITCHCOCK HEALTH, A NEW HAMPSHIRE VOLUNTARY CORPORATION, IS THE SOLE CORPORATE MEMBER OF MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER.
FORM 990, PART VI, SECTION A, LINE 7A	DARTMOUTH-HITCHCOCK HEALTH HAS THE POWER TO APPOINT 1/3 OF THE MEMBERS OF MAHHC'S BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER HAS THE RIGHT TO RATIFY MOUNT ASCUTNEY HOSPITAL & HEALTH CENTER'S NOMINATION OF 2/3 OF THE MEMBERS OF THE BOARD OF TRUSTEES; REMOVE TRUSTEES AFTER CONSULTATION WITH THE CHAIRPERSON OF THE BOARD; APPROVE THE DISSOLUTION OR LIQUIDATION OF MAHHC; APPOINT, EVALUATE, TERMINATE, AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO; AND OTHER GOVERNANCE DECISIONS.
FORM 990, PART VI, SECTION B, LINE 11B	BOARD OF TRUSTEES REVIEWED PRIOR TO FILING, PROVIDED MULTIPLE DAYS TO PROVIDE FEEDBACK AND/OR QUESTIONS AND HOSPITAL THEN FILED AFTER THERE WAS SATISFACTION.
FORM 990, PART VI, SECTION B, LINE 12C	THE FINANCE AND AUDIT COMMITTEE MONITOR AND REPORT TO THE BOARD OF DIRECTORS
FORM 990, PART VI, SECTION B, LINE 15	THE EXECUTIVE COMMITTEE OF THE BOARD MEETS ANNUALLY TO REVIEW COMPENSATION FOR THE CEO, USING INDEPENDENT SURVEYS OF AREA COMPENSATION FOR EXECUTIVES OF VARIOUS SIZED HOSPITALS. OTHER OFFICERS AND KEY EMPLOYEES SALARIES ARE DETERMINED, BY THE HR DEPARTMENT USING COMPARABLE MARKET DATA.
FORM 990, PART VI, SECTION C, LINE 19	ALL INTERNAL POLICIES, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST
FORM 990, PART XI, LINE 9:	CHANGE IN NET ASSETS TO RECOGNIZE FUNDED STATUS OF POST RETIREMENT PLANS 496,356. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST 185,694.
FORM 990, PART XII, LINE 3B:	THE SINGLE AUDIT WAS PERFORMED ON THE COMBINED FINANCIAL INFORMATION OF DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES INCLUDING MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER.
SCHEDULE H, PART V, LINE 4:	THE HOSPITAL CONDUCTED A CHNA SUBSEQUENT TO THE CURRENT TAX YEAR BEING REPORTED, IN TAX YEAR 2018.
SCHEDULE H, PART V, LINE 7A:	HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ COMMUNITYHEALTHANNUALREPORT_2018.PDF
SCHEDULE H, PART V, LINE 9:	THE HOSPITAL ADOPTED AN IMPLEMENTATION STRATEGY SUBSEQUENT TO THE CURRENT TAX YEAR BEING REPORTED, IN TAX YEAR 2018.
SCHEDULE H, PART V, LINE 10A:	HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/ DOCUMENTS/CHNA%20IMPLEMENTATION%20PLAN%202015-2.PDF
SCHEDULE H, PART V, LINE 11 CONTINUED:	8. INCOME POVERTY AND FAMILY STRESS THE RESOURCE CENTER'S ECONOMIC SERVICES SERVED 202 PEOPLE, AN INCREASE FROM 188 IN 2017; MENTAL HEALTH COUNSELING INCREASED FROM 336 TO 776; EMPLOYMENT COUNSELING INCREASED FROM ZERO TO 6. 9. ACCESS TO TRANSPORTATION IMPLEMENTED RIDES TO WELLNESS PILOT PROGRAM WITH VERMONT PUBLIC TRANSPORTATION ASSOCIATION. VOLUNTEERS PROVIDED MEDICAL TRANSPORTATION WHEN NEEDED. VOUCHERS AND GAS CARDS WERE PROVIDED THROUGH OUR FREE CLINIC. PUBLISHED AN ARTICLE WITH NATIONAL EXPOSURE THROUGH THE AMERICAN HOSPITAL ASSOCIATION, ENTITLED, "HUDDLE FOR CARE" ABOUT REDUCING BARRIERS TO TRANSPORTATION IN A RURAL ENVIRONMENT. APRIL 2018, WHICH HIGHLIGHTED OUR TRANSPORTATION ALGORITHMS AND EFFORTS PRESENTED A NATIONAL WEBEX THROUGH THE FEDERAL OFFICE OF RURAL HEALTH ENTITLED "TRANSPORTATION - A SOCIAL DETERMINANT OF HEALTH PROMOTING SOLUTIONS SINCE APRIL, THE RIDES TO WELLNESS PROGRAM HAS ASSISTED 30 PATIENTS AND HAS GIVEN A TOTAL OF 78 RIDES THROUGH VOLUNTEERS IN ACTION, PREPAID GAS CARDS AND TAXI VOUCHERS 10. ACCESS TO PRIMARY HEALTH CARE ACHIEVEMENT OF NCQA REDESIGNATION AS LEVEL III PATIENT- CENTERED MEDICAL HOME. RECRUITMENT OF PRIMARY CARE PROVIDERS. COMMUNITY HEALTH TEAM WORKING WITH COMMUNITY PARTNERS TO DECREASE COSTS AND INCREASE QUALITY FOR HIGH RISK AND VERY HIGH RISK, COMPLEX, CHRONIC CARE PATIENTS. CARE COORDINATION OUTREACH WITH SASH, SENIOR SOLUTIONS, VNH, BAYADA, AND HCRS. PROVIDED LEADERSHIP FOR REGIONAL IMPLEMENTATION OF ONECARE VERMONT AND BLUEPRINT FOR HEALTH PROGRAMS AND INITIATIVES 11. SMOKING/TOBACCO USE/VAPING TOWN PRESENTATIONS TO SELECTBOARDS ON POLICIES/ORDINANCES RELATED TO "ADULT-ONLY" PRODUCTS INCLUDING TOBACCO, FLAVORED TOBACCO PRODUCTS, CANNABIS PRODUCTS, AND ALCOHOL. MET WITH AREA TOWN SELECT BOARD MEMBERS TO DISCUSS "ADULT ONLY" RETAIL ESTABLISHMENT AND HOW RETAIL OUTLET DENSITY, LOCATION, AND PRODUCT ADVERTISING CAN IMPACT TOWN CULTURE. HOSTED "WORLD NO TOBACCO DAY" AT MT. ASCUTNEY HOSPITAL DISSEMINATED INFORMATION ON FLAVORED TOBACCO PRODUCTS, CESSATION OPPORTUNITIES, AND SECONDHAND SMOKE. SPONSORED A PSA CONTEST FOR AREA SCHOOL YOUTH TO CREATE PREVENTION MESSAGING AROUND TOBACCO, VAPING, AND ALCOHOL USE. CONTINUED WORK WITH WINDSOR'S AUTUMN MOON FESTIVAL PLANNING COMMITTEE ON MAKING THE FESTIVAL A SMOKE-FREE EVENT. WORKED TO CREATED FESTIVAL MARKETING MATERIALS ADVERTISING THIS STATUS.
SCHEDULE H, PART V, LINE 16A:	HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ MAH%20FINANCIAL%20ASSISTANCE%20POLICY_0.PDF
SCHEDULE H, PART V, LINE 16B:	HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/FINANCIAL%20ASSIST ANCE.PDF
SCHEDULE H, PART V, LINE 16C:	HTTP://WWW.MTASCUTNEYHOSPITAL.ORG/SITES/DEFAULT/FILES/CONTENT/DOCUMENTS/ MAH17_FINANCIALASSISTANCEPOLICYBROCHURE_WEB.PDF

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

WINDSOR HOSPITAL CORPORATION

Employer identification number

03-0183721

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?
(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	Yes	No
(1)HISTORIC HOMES OF RUNNEMEDE 289 COUNTY ROAD WINDSOR,VT05089 23-7396147	PROVIDING SVCS FOR THE AGING	VT	501(C)(3)	LINE 11	WINDSOR HOSPITAL CORPORATION	Yes
(2)MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION INC 289 COUNTY ROAD WINDSOR,VT05089 03-0300481	HEALTH EDUCATION & PROMOTION	VT	501(C)(3)	LINE 3	WINDSOR HOSPITAL CORPORATION	Yes
(3)DARTMOUTH-HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON,NH03756 22-2715483	SUPPORTING ORG	NH	501(C)(3)	LINE 12B, II	N/A		No
(4)MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON,NH03756 02-0222140	HOSPITAL	NH	501(C)(3)	LINE 3	DARTMOUTH-HITCHCOCK HEALTH		No
(5)DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON,NH03756 22-2519596	PHYS SVCS	NH	501(C)(3)	LINE 11	DARTMOUTH-HITCHCOCK HEALTH		No
(6)HITCHCOCK FOUNDATION ONE MEDICAL CENTER DRIVE LEBANON,NH03756 02-0222139	HLTHCRE RSRCH	NH	501(C)(3)	LINE 7	DARTMOUTH-HITCHCOCK CLINIC		No
(7)HAMDEN RISK RETENTION GROUP INC 30 MAIN STREET SUITE 330 BURLINGTON,VT05401 20-8530788	SELF INS	VT	501(C)(3)	LINE 12B, II	DARTMOUTH-HITCHCOCK CLINIC		No
(8)THE NEW LONDON HOSPITAL ASSOC INC 273 COUNTY ROAD NEW LONDON,NH03257 02-0222171	HOSPITAL	NH	501(C)(3)	LINE 3	DARTMOUTH-HITCHCOCK HEALTH		No
(9)VISITING NURSE ASSOCIATION AND HOSPICE OF VT AND NH INC 205 BILLINGS FARM RD NO 5 WILDER,VT05088 03-6006494	HOSPICE	VT	501(C)(3)	LINE 11	DARTMOUTH-HITCHCOCK HEALTH		No
(10)CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE,NH03431 02-0354549	HOSPITAL	NH	501(C)(3)	LINE 3	DARTMOUTH-HITCHCOCK HEALTH		No
(11)ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DR LEBANON,NH03766 02-0222791	HOSPITAL	NH	501(C)(3)	LINE 3	DARTMOUTH-HITCHCOCK HEALTH		No
(12)SURGERY CENTER OF GREATER NASHUA 10 PROSPECT ST NO 101 NASHUA,NH03060 46-1084049	SURGERY CENTER	NH	501(C)(3)	LINE 3	N/A		No
(13)CHESHIRE HEALTH FOUNDATION 580 COURT STREET KEENE,NH03431 02-0202220	SUPPORTING ORG	NH	501(C)(3)	LINE 12B, II	CHESHIRE MEDICAL CENTER		No
(14)CHESIRE HEALTH SERVICES 580 COURT STREET KEENE,NH03431 47-3379283	HEALTHCARE	NH	501(C)(3)	LINE 3	CHESHIRE MEDICAL CENTER		No
(15)DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON,NH03756 26-4812335	PARENT ORG	NH	501(C)(3)	LINE 7	N/A		No
(16)ALICE PECK DAY LIFECARE CENTER 30 ALICE PECK DAY DRIVE LEBANON,NH03766 02-0479094	SENIOR LIVING	NH	501(C)(3)	LINE 10	ALICE PECK DAY MEMORIAL HOSPITAL		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) DH MASTER INVESTMENT PARTNERSHIP ONE MED CTR DR LEBANON,NH03756 02-0505863	POOLED INVESTMENT	NH	MARY HITCHCOCK MEMORIAL HOSPITAL	EXCLUDED	1,085,918	16,858,213		No	-6,151		No	2.460 %
(2) NEW ENGLAND PHARMACY COLLAB ONE MED CTR DR LEBANON,NH03756 26-3819035	GROUP PURCHASING	NH	N/A		-71			No			No	4.740 %

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) IMAGINECARE INC ONE MEDICAL CENTER DRIVE LEBANON,NH03756 81-3105071	SOFTWARE TECHNOLOGY	DE	N/A	C				No
(2) HITCHCOCK HEALTH CONNECT INC ONE MEDICAL CENTER DRIVE LEBANON,NH03756 80-0908979	TELEHEALTH	DE	N/A	C				No
(3) POMPANOOSUC INVESTMENT CORPORATION ONE MEDICAL CENTER DRIVE LEBANON,NH03756 02-0352330	REAL ESTATE HLDG	NH	N/A	C				No
(4) HAMDEN ASSURANCE COMPANY LIMITED 44 CHURCH ST HAMILTON HM 12 BD 98-0121409	LIABILITY INSURANCE	BD	N/A	C				No
(5) KEARSARGE COMMUNITY SERVICES INC 273 COUNTY RD NEW LONDON,NH03257 02-0460136	REAL ESTATE HLDG	NH	N/A	C				No
(6) NEW LONDON PHYSICIAN GROUP INC 273 COUNTY RD NEW LONDON,NH03257 02-0494420	PHYSICIAN GROUP	NH	N/A	C				No
(7) NEW LONDON MEDICAL CENTER EAST INC 273 COUNTY RD NEW LONDON,NH03257 02-0480857	REAL ESTATE HLDG	NH	N/A	C				No
(8) KEENE HEALTH SERVICES 580 COURT STREET KEENE,NH03431 02-0374997	REAL ESTATE HLDG	NH	N/A	C				No
(9) KEENE HEALTH REALTY 580 COURT STREET KEENE,NH03431 02-0374998	REAL ESTATE HLDG	NH	N/A	C				No
(10) KEENE HEALTH ENTERPRISES 580 COURT STREET KEENE,NH03431 02-0374999	REAL ESTATE HLDG	NH	N/A	C				No
(11) 88 PROSPECT ST CONDO OWNERS ASSOC 88 PROSPECT STREET WHITE RIVER JUNCTION,VT06002 02-0480857	REAL ESTATE HLDG	VT	N/A	C				No
(12) CHARITABLE REMAINDER UNITRUSTS (10) 289 COUNTY RD WINDSOR,VT05089	CHARITABLE TRUST	VT	N/A	T				No

Schedule R (Form 990) 2019

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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) MARY HITCHCOCK MEMORIAL HOSPITALDARTMOUTH-HITCHCOCK HEALTH	E	11,002,812	ACTUAL
(2) HISTORIC HOMES OF RUNNEMEDE	Q	186,822	ACTUAL
(3) NEW ENGLAND ALLIANCE FOR HEALTH LLC (MHMH)	P	438,826	ACTUAL
(4) DARTMOUTH-HITCHCOCK CLINIC	E	566,875	ACTUAL
(5) DARTMOUTH-HITCHCOCK CLINIC	O	3,164,525	ACTUAL
(6) MARY HITCHCOCK MEMORIAL HOSPITAL	P	348,101	ACTUAL
(7) MARY HITCHCOCK MEMORIAL HOSPITALDARTMOUTH-HITCHCOCK HEALTH	R	197,978	ACTUAL
(8) MARY HITCHCOCK MEMORIAL HOSPITAL	E	47,110	ACTUAL

Schedule R (Form 990) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	906,396	1,057,821
9	Program service revenue (Part VIII, line 2g) .........	51,135,484	53,629,858
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	624,393	883,372
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	159,577	77,823
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	52,825,850	55,648,874
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	30,149,034	32,199,150
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 288,074
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	20,347,045	21,315,219
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	50,496,079	53,514,369
19	Revenue less expenses. Subtract line 18 from line 12.......	2,329,771	2,134,505
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	50,695,886	54,844,981
21	Total liabilities (Part X, line 26).............	25,152,463	26,292,087
22	Net assets or fund balances. Subtract line 21 from line 20.....	25,543,423	28,552,894

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 43,130,184 including grants of $ ) (Revenue $ 53,661,706 )
	MT. ASCUTNEY HOSPITAL AND HEALTH CENTER (MAHHC) OPERATES A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHICH PROVIDES PRIMARY AND SECONDARY HEALTH CARE. MAHHC'S PRIMARY SERVICE AREA INCLUDES WINDSOR, CLAREMONT, WOODSTOCK, HARTLAND, SPRINGFIELD, AND BROWNSVILLE. THE HOSPITAL PROVIDES ESSENTIAL HEALTHCARE SERVICES INCLUDING EMERGENCY DEPARTMENT, MED/SURG INPATIENT, AND ANCILLARY DIAGNOSTIC TESTS, IMAGING/RADIOLOGY PROCEDURES, AND WELLNESS/PREVENTION SERVICES. MAHHC STAFFS A TOTAL OF 25 ACUTE MED/SURG BEDS AND 10 ACUTE REHABILITATION BEDS. DURING THE YEAR, THERE WERE 1,075 DISCHARGES, 1,597 SURGERIES, 60,786 LAB TESTS, AND 11,746 IMAGING PROCEDURES. MAHHC IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING THE PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE AND PEDIATRICS IN WINDSOR AND WOODSTOCK. MAHHC PROVIDES FREE CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. FOREGONE CHARGES FURNISHED UNDER MAHHC'S FREE CARE POLICY AMOUNTED TO $949,742 IN FY18.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses43,130,184

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,983,468	1,583,309	810,437

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	740,954

f	All other contributions, gifts, grants, and similar amounts not included above		1f	316,867

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,057,821

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE LIVES OF THOSE WE SERVE. OUR ACTIVITIES INCLUDE PROVIDING HEALTHCARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	540
6	Total number of volunteers (estimate if necessary) .............	6	185
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-6,151
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-6,151

(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
(A) Name and title
(18) DONNA VANFLEET........................................................................ CHAIR (EFFECTIVE THRU 12/2017)	1.00 .......................	X	X		0	0	0
(19) DAVID SANVILLE........................................................................ CFO	32.00 .......................		X		181,809	0	20,699
(20) MARY JOYCE........................................................................ PHYSICIAN	40.00 .......................			X	249,664	0	20,699
(21) CHRISTOPHER CONNOR........................................................................ PHYSICIAN	40.00 .......................			X	315,647	0	10,000
(22) HEIDI CRUZ........................................................................ PHYSICIAN	40.00 .......................			X	238,721	0	20,689
(23) DENNIS HEIBEIN........................................................................ PHYSICIAN	40.00 .......................			X	244,242	0	10,000
(24) PETER RAUERT........................................................................ PHYSICIAN	40.00 .......................			X	407,201	0	18,140

		Business Code
2a	PATIENT SERVICES	621110	97,368,607	97,368,607
b	PROGRAM & MISC OTHER	621110	2,821,217	2,821,217
c	ONE CARE VERMONT	621110	732,703	732,703
d	DSH/VAHHS REVENUE	621110	683,877	683,877
e	PROVISION FOR DOUBTFUL ACCOUNTS	621110	-1,541,879	-1,541,879
f	All other program service revenue.		-46,434,667	-46,434,667
g	Total. Add lines 2a–2f .....		53,629,858

3 Investment income (including dividends, interest, and othersimilar amounts) ......			252,096		-6,151	258,247
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		26,322	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		26,322	6c
d	Net rental income or (loss).......			26,322			26,322
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	21,700	623,898	7a
b	Less: cost or other basis and sales expenses	14,322	0	7b
c	Gain or (loss)	7,378	623,898	7c
d	Net gain or (loss).........			631,276			631,276
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	40,801
b	Less: direct expenses ...		8b	21,148
c	Net income or (loss) from fundraising events..			19,653			19,653
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	EQUITY IN INCOME OF SUBSIDIARIES		621110	31,848	31,848
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			31,848
12	Total revenue. See instructions.....			55,648,874	53,661,706	-6,151	935,498

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	542,826	35,172	507,654
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	24,579,332	20,861,262	3,570,842	147,228
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	909,748	771,488	132,877	5,383
9	Other employee benefits .......	4,453,548	3,739,282	689,930	24,336
10	Payroll taxes ...........	1,713,696	1,426,481	277,276	9,939
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	23,641		23,641
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	86,288		86,288
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,183,293	2,235,830	1,915,209	32,254
12	Advertising and promotion ....	123,053	11,811	82,064	29,178
13	Office expenses .......	63,724	51,450	11,478	796
14	Information technology ......	441,317	139,412	293,093	8,812
15	Royalties ..
16	Occupancy ...........	679,706	656,571	23,103	32
17	Travel ............	67,161	43,119	23,244	798
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	226,535		226,535
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,076,659	2,076,659
23	Insurance ...	600,378	408,795	189,909	1,674
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	PURCHASED SERVICES	5,505,993	5,166,528	339,465
b	SUPPLIES	3,446,707	3,220,412	205,865	20,430
c	DUES/FEES/TAXES	2,263,091	1,875,622	385,024	2,445
d	UTILITIES	671,316	33,495	637,821
e	All other expenses	856,357	376,795	474,793	4,769
25	Total functional expenses. Add lines 1 through 24e	53,514,369	43,130,184	10,096,111	288,074
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			6,094,896	1	7,170,204
2	Savings and temporary cash investments .........			172,467	2	174,261
3	Pledges and grants receivable, net ......			603,278	3	692,307
4	Accounts receivable, net .............			5,888,667	4	6,004,348
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			478,194	8	459,566
9	Prepaid expenses and deferred charges ......			581,355	9	472,047
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	44,631,560
b	Less: accumulated depreciation	10b	26,546,318	17,135,210	10c	18,085,242
11	Investments—publicly traded securities .			15,281,709	11	17,206,629
12	Investments—other securities. See Part IV, line 11 .....			1,856,051	12	1,888,026
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			2,604,059	15	2,692,351
16	Total assets. Add lines 1 through 15 (must equal line 33)...			50,695,886	16	54,844,981

17	Accounts payable and accrued expenses .....	4,820,536	17	6,599,443
18	Grants payable ...		18
19	Deferred revenue .........		19	953,292
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	753,948	23	567,610
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	19,577,979	25	18,171,742
26	Total liabilities. Add lines 17 through 25..	25,152,463	26	26,292,087

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	25,543,423	32	28,552,894
33	Total liabilities and net assets/fund balances ........	50,695,886	33	54,844,981