TY 2019 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JOHN BRUMSTED MD...................................................................... TRUSTEE	6.0 ................. 44.0	X				0	1,766,660	227,413
(2) TODD KEATING...................................................................... INTERIM TREASURER,CFO 12/2019	10.0 ................. 40.0		X			0	796,192	29,767
(3) CHRISTIAN BEAN MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	61,534	570,131	68,596
(4) CHRISTOPHER MERIAM MD...................................................................... TRUSTEE, PRES-ELECT MED STAFF	50.0 ................. 0.0	X				55,330	557,831	52,020
(5) SARA GRAVES MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	49,890	498,602	66,035
(6) JOHN BEGLY MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	24,515	473,079	41,852
(7) MASHKURI JAVAD MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	42,108	406,299	81,274
(8) ANNA T NOONAN...................................................................... TRUSTEE, PRESIDENT/COO	35.0 ................. 15.0	X	X			441,286	0	49,596
(9) MARK DEPMAN MD...................................................................... TRUSTEE, UNTIL 12/2019	50.0 ................. 0.0	X				57,624	364,442	35,944
(10) DAVID OSPINA MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	56,641	329,837	64,022
(11) PATRICIA FISHER MD...................................................................... CHIEF MEDICAL OFFICER	50.0 ................. 0.0			X		349,316	0	30,186
(12) JEREMIAH ECKHAUS MD...................................................................... TRUSTEE, PRES-ELECT MED STAFF	50.0 ................. 0.0	X				13,910	285,675	44,245
(13) CATHY PALMER MD...................................................................... TRUSTEE, UNTIL 10/2019	3.0 ................. 42.0	X				0	287,584	47,467
(14) STEPHEN KENNEY...................................................................... TREASURER, CFO, UNTIL 12/2019	50.0 ................. 0.0		X			254,363	0	32,915
(15) ROBERT PATTERSON...................................................................... VP OF HR & CLINICAL OPERATIONS	50.0 ................. 0.0			X		237,154	0	41,460
(16) MATTHEW CHOATE...................................................................... VP PATIENT CARE SERVICES	50.0 ................. 0.0			X		229,367	0	35,281
(17) JAMES ALVAREZ...................................................................... VP SUPPORT SERVICES	50.0 ................. 0.0			X		219,454	0	17,652

(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)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MARC GAGNON........................................................................ VP PRACTICE OPERATIONS	50.0 .......................0.0			X	179,471	23,877
(19) ALLEN YEARICK........................................................................ ADMIN/VP AGING SVCS WDR	50.0 .......................0.0			X	178,322	19,117
(20) MICHAEL DELLIPRISCOLI........................................................................ TRUSTEE, IMMEDIATE PAST CHAIR	1.0 .......................2.0	X			0	0
(21) CAROL WELCH........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0
(22) THOMAS GOLONKA........................................................................ TRUSTEE, CHAIR-ELECT	1.0 .......................2.0	X	X		0	0
(23) JOYCE JUDY........................................................................ TRUSTEE, SECRETARY	1.0 .......................0.0	X	X		0	0
(24) MARY MOULTON........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0
(25) MARTA MURPHY MARBLE........................................................................ TRUSTEE, UNTIL 1/2020	1.0 .......................0.0	X			0	0
(26) TONI KAEDING........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0
(27) SANDY ROUSSE........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0
(28) CONNIE COLMAN........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0
(29) PAULETTE THABAULT........................................................................ TRUSTEE, CHAIR-ELECT	1.0 .......................0.0	X	X		0	0
(30) JOAN MARIE MISEK........................................................................ TRUSTEE, AS OF 12/2019	1.0 .......................0.0	X			0	0
(31) CORY RICHARDSON........................................................................ TRUESTEE	1.0 .......................0.0	X			0	0

(A) Name and business address	(B) Description of services	(C) Compensation
PC CONSTRUCTION COMPANY, 193 TILLEY DRIVE SOUTH BURLINGTON,VT05403	CONSTRUCTION CNTRCTR	3,108,622
CONNOR CONTRACTING INC, 1100 US ROUTE 2 BERLIN,VT05602	CONSTRUCTION CNTRCTR	1,832,187
MEDICAL SOLUTIONS, 1010 NORTH 102ND STREET OMAHA,NE68114	NURSE STAFFING	1,345,619
E4H- ENVIRONMENTS FOR HEALTH LLC, PO BOX 779062 CHICAGO,IL606779062	ARCHITECTURE	754,651
MARCAM ASSOCIATES LLC, PO BOX 60 ROCHESTER,NH03866	AR BILLING/COLLECT	703,899
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 26

- 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

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 CENTRAL VERMONT MEDICAL CENTER INC

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
RESTRICTED	,	$ RESTRICTED	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 CENTRAL VERMONT MEDICAL CENTER INC		Employer identification number 22-2547186

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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

Page 4


Name of organization CENTRAL VERMONT MEDICAL CENTER INC			Employer identification number 22-2547186
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Part I-A

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

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

22,515

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

22,515

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
LOBBYING ACTIVITY	SCHEDULE C, PART II-B, LINE 1I CENTRAL VERMONT MEDICAL CENTER IS A MEMBER OF, AND PAYS DUES TO, THE VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SERVICE PROVIDERS AS WELL AS THE AMERICAN HOSPITAL ASSOCIATION, AND THE VERMONT HEALTH CARE ASSOCIATION. A PORTION OF THE DUES IS USED FOR LOBBYING PURPOSES.

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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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 ....	8,456,305	8,191,232	7,997,540	7,988,798	7,726,226
b	Contributions ...
c	Net investment earnings, gains, and losses	202,581	265,073	193,692	358,742	306,265
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,272,378			350,000	43,693
f	Administrative expenses ....
g	End of year balance ......	7,386,508	8,456,305	8,191,232	7,997,540	7,988,798

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

Board designated or quasi-endowment SchDMd Bullet

57.000 %

Permanent endowment SchDMd Bullet

43.000 %

Term endowment SchDMd Bullet

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)

Yes

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

3a(ii)

Yes

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

Yes

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 .....	5,510,000		5,510,000
b	Buildings ....	111,383,246	69,922,678	41,460,568
c	Leasehold improvements	5,555,077	4,589,895	965,182
d	Equipment ....	48,165,580	38,895,366	9,270,214
e	Other .....	10,893,471		10,893,471
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				68,099,435

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 (A) NETWORK INVESTMENT POOL	59,107,196	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	59,107,196

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	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	33,512,146
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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

ENDOWMENT FUNDS

SCHEDULE D, PART V, LINE 4 CVMC HAS ENDOWMENT INVESTMENTS AND AN INVESTMENT SPENDING POLICY THAT GUIDES THE DISTRIBUTION OF THE FUNDS TO SUPPORT THE MISSION OF CENTRAL VERMONT MEDICAL CENTER.

ASC 740 DISCLOSURE

SCHEDULE D, PART X, LINE 2, FIN 48 (ASC 740) CENTRAL VERMONT MEDICAL CENTER, INC. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVM HEALTH NETWORK"). THE FOOTNOTE STATES: UVM HEALTH NETWORK ACCOUNTS FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC 740 INCOME TAXES, WHICH ADDRESSES HOW TO ACCOUNT FOR AND REPORT THE EFFECTS OF TAXES BASED ON INCOME. NO PROVISION FOR UNCERTAIN TAX POSITIONS IS RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.

Schedule D (Form 990) 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

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 %

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? . . . . . .

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) . . .	1,605,355		1,605,355	0.690 %
b	Medicaid (from Worksheet 3, column a) . . . . .	50,134,845	27,879,828	22,255,017	9.520 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	51,740,200	27,879,828	23,860,372	10.210 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	74,913		74,913	0.030 %
f	Health professions education (from Worksheet 5) . . .	331,686		331,686	0.140 %
g	Subsidized health services (from Worksheet 6) . . . .	47,739,318	35,747,329	11,991,990	5.130 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	74,913		74,913	0.030 %
j	Total. Other Benefits . .	48,220,830	35,747,329	12,473,502	5.330 %
k	Total. Add lines 7d and 7j .	99,961,030	63,627,157	36,333,874	15.540 %

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

Yes

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

5,852,538

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. ......

117,051

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).....

37,508,032

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

111,395,515

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

-73,887,483

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)
1	CENTRAL VERMONT MEDICAL CENTER 130 FISHER ROAD BERLIN,VT05602 WWW.CVMC.ORG 470001	X	X	X

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)

	CENTRAL VERMONT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

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 18

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

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 SECTION C

Other website (list url): HTTP://WWW.GMCBOARD.VERMONT.GOV

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 19

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

Yes

If "Yes" (list url): SEE SECTION C

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)

	CENTRAL VERMONT MEDICAL CENTER
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 200.%
and FPG family income limit for eligibility for discounted care of 400.%

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 SECTION C

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

SEE SECTION C

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

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

	CENTRAL VERMONT MEDICAL CENTER
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)

	CENTRAL VERMONT MEDICAL CENTER
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
PART V, SECTION B, LINE 3E	REPRESENTATIVES FROM CVMC, THRIVE, AND COMMUNITY ACTION NETWORK (CAN) REVIEWED THE CHNA FINDINGS IN CONJUNCTION WITH THE VERMONT DEPARTMENT OF HEALTH 2019-23 STATE HEALTH IMPROVEMENT PLAN (SHIP) TO DETERMINE THE MOST PRESSING NEEDS IMPACTING RESIDENTS ACROSS WASHINGTON COUNTY AND THE CVMC SERVICE AREA. THE FOLLOWING CRITERIA WERE APPLIED TO DETERMINE PRIORITIES ON WHICH TO FOCUS COMMUNITY WIDE HEALTH IMPROVEMENT EFFORTS. CHNA FINDINGS PRIORITIZATION CRITERIA: - SCOPE: HOW MANY PEOPLE ARE AFFECTED? - SEVERITY: HOW CRITICAL IS THE ISSUE? - ABILITY TO IMPACT: CAN WE ACHIEVE THE DESIRED OUTCOME? - COMMUNITY READINESS: IS THE COMMUNITY PREPARED TO TAKE ACTION? APPLYING THESE CRITERIA TO THE LIST OF TOP HEALTH NEEDS IDENTIFIED BY THE CHNA RESEARCH, THRIVE AND CAN MEMBERS RANK ORDERED THE COMMUNITY'S HEALTH NEEDS IN THE FOLLOWING ORDER. 1. SUBSTANCE USE DISORDERS 2. MENTAL HEALTH 3. SOCIAL INFLUENCERS OF HEALTH (HOUSING, FOOD SECURITY, TRANSPORTATION, ECONOMIC STABILITY) 4. CHRONIC DISEASE PREVENTION 5. HEALTHY LIFESTYLES AND RISK BEHAVIORS THE 2019 CHNA PRIORITIZED HEALTH NEEDS ALIGN WITH THE VT DOH SHIP PRIORITES, PROMOTING COLLABORATION BETWEEN PUBLIC HEALTH, HOSPITAL, AND COMMUNITY BASED ORGANIZATIONS. AS A RESULT OF THE CHNA PROCESS, SIGNIFICANT INVESTMENT HAS OCCURRED. ALTHOUGH IT TAKES TIME TO EVALUATE WHETHER OR NOT ACTIONS ARE MOVING THE NEEDLE ON ISSUES, THE ORGANIZATION FIRMLY BELIEVES THAT THE ACTIONS TAKEN AND FUNDING PROVIDED HAVE HAD A POSITIVE IMPACT ON THE COMMUNITY.
PART V, SECTION B, LINE 5	THE CHNA PURSUED INPUT FROM PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY, INCLUDING LEADERS WITH SPECIAL KNOWLEDGE OR EXPERTISE AS WELL AS COMMUNITY RESIDENTS. THE CHNA COMMUNITY STEERING GROUP DISTRIBUTED A COMMUNITY SURVEY THAT WAS COMPLETED BY 1,429 RESIDENTS. IN ADDITION, THE GROUP CIRCULATED A KEY INFORMANT SURVEY TO THRIVE COMMUNITY MEMBERS WITH SPECIAL KNOWLEDGE OF COMMUNITY HEALTH, AND CONDUCTED KEY INFORMANT INTERVIEWS WITH 33 STAKEHOLDERS TO OBTAIN A BETTER UNDERSTANDING OF NEEDS AMONG UNDERSERVED POPULATIONS.
PART V, SECTION B, LINE 6B	THE 2019 CHNA WAS CONDUCTED IN COLLABORATION WITH THRIVE, THE REGIONAL ACCOUNTABLE COMMUNITY FOR HEALTH MODEL. THIS MULTI-AGENCY COALITION, MADE UP OF HEALTH PROVIDERS, SOCIAL SERVICE AGENCIES, GOVERNMENT, CIVIC, AND RELIGIOUS ENTITIES, AND NUMEROUS OTHER COMMUNITY PARTNERS, IS DEDICATED TO IMPROVING HEALTH FOR THE RESIDENTS OF WASHINGTON AND NORTHERN ORANGE COUNTIES. THRIVE MEMBERS PLAYED AN INTEGRAL ROLE IN OVERSEEING DATA COLLECTION AND REVIEWING FINDING TO DETERMINE COMMUNITY HEALTH PRIORITIES BASED ON CHNA STUDY.
PART V, SECTION B, LINES 7A AND 10A	COMMUNITY HEALTH NEEDS ASSESSMENT https://www.cvmc.org/sites/default/files/documents/Community-Health-Needs- Assessment-2019.pdf IMPLEMENTATION STRATEGY https://www.cvmc.org/sites/default/files/documents/UVMHN_CVMC_CHNA-Impleme ntation-Strategy-2019.pdf FROM REGISTRATION, PATIENTS ARE ROUTINELY REFERRED TO OUR FINANCIAL ADVOCACY DEPARTMENT OR COMMUNITY HEALTH IMPROVEMENT DEPARTMENT. BOTH AREAS PROVIDE KNOWLEDGE AND ASSISTANCE IN THE APPLICATION PROCESS FOR CHARITY AND OTHER APPLICABLE FUNDING SOURCES. ADVOCATES ACTIVELY EDUCATE ALL INPATIENT, OBSERVATION AND OUTPATIENT INVASIVE SERVICE PATIENTS OF OUR PROGRAM, PRIOR TO OR CONCURRENT WITH THE PATIENTS' STAY, SUBSEQUENTLY AIDING IN THE APPLICATION PROCESS FOR STATE AID AND UVM MEDICAL CENTER'S FINANCIAL PROGRAM.
PART V, SECTION B, LINE 11	CENTRAL VERMONT MEDICAL CENTER'S 2019 CHNA IMPLEMENTATION STRATEGY WAS APPROVED BY THE BOARD OF DIRECTORS IN SEPTEMBER 2019. THE IMPLEMENTATION STRATEGY SET OUT THE FOLLOWING OBJECTIVES TO EXPAND ACCESS TO HIGH-QUALITY, COMPREHENSIVE MENTAL HEALTH RESOURCES TO IMPROVE THE HEALTH AND WELL-BEING OF PATIENTS, THEIR FAMILIES, AND COMMUNITY MEMBERS IN WASHINGTON COUNTY: 1. ACCESS TO PRIMARY AND SPECIALTY CARE. IMPROVE ACCESS TO CARE THROUGH IMPLEMENTATION OF TELEHEALTH SERVICES FOR PRIMARY AND SPECIALTY CARE. CVMC HAS BEEN SUCCESSFUL WITH ACCELERATED ADOPTION OF TELEHEALTH ACROSS ALL PRACTICE SITES. 2. HEART DISEASE. EXPAND CARDIOLOGY HEART FAILURE INPATIENT CONSULTATION SERVICE TO BE AVAILABLE FOR ALL PATIENTS WITH NEWLY DIAGNOSED HEART FAILURE AND ANYONE ADMITTED WITH RECURRENT SYMPTOMS OF HEART FAILURE. IMPROVE THE TRANSITION OF PATIENTS ADMITTED WITH HEART FAILURE TO THE OUTPATIENT SETTING BY CREATING MORE TIMELY CONNECTIONS TO HOME HEALTH, TELEHEALTH, AND CARDIOLOGY. 3. MENTAL HEALTH CARE. ACCESS TO MENTAL HEALTH SERVICES AND TREATMENT WAS IDENTIFIED AS THE #2 HEALTH CHALLENGE IN THE CHNA SURVEY. 26% OF WASHINGTON COUNTY ADULTS ARE DIAGNOSED WITH DEPRESSION AND 15% OF WASHINGTON COUNTY TEENAGERS REPORT THEY HAVE A SUICIDE PLAN. TO ASSESS GAPS IN SERVICE DELIVERY AND IDENTIFY OPPORTUNITIES FOR ALIGNMENT WITH COMMUNITY PARTNERS AROUND STRATEGIC RESOURCE ALLOCATION TO BEST ADDRESS PREVENTION, EARLY INTERVENTION AND ACCESS TO MENTAL HEALTH SERVICES FOR ALL POPULATIONS SHOULD BE INCORPORATED. THE REMAINING SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA (SUBSTANCE USE DISORDER, AFFORDABLE HOUSING, CHILDHOOD AND FAMILY HEALTH, DISEASE PREVENTION, AND CANCER) HAVE BEEN PRIORITY AREAS IN PREVIOUS CHNA IMPLEMENTATION PLANS AND REMAIN TOP PRIORITIES FOR THE ORGANIZATION. ONGOING WORK IN EACH AREA CONTINUES UNDER THOSE IMPLEMENTATION STRATEGIES WITH INCLUSION OF COMMUNITY STAKEHOLDER INPUT AND INVESTMENTS TO ADDRESS NEEDS AT VARIOUS LEVELS. HOWEVER, THESE IDENTIFIED NEEDS ARE NOT ADDRESSED SPECIFICALLY BY THE STRATEGIC PLAN.
PART V, SECTION B, LINE 15E	WHILE THE ASSISTANCE POLICY DOES NOT PROVIDE A LIST OF "EXTERNAL" CONTACT INFORMATION FOR NON CENTRAL VERMONT MEDICAL CENTER PARTIES OR AGENCIES WHO MAY ASSIST PATIENTS IN THE APPLICATION PROCESS, APPLICATION COMPLETION AID IS WELL PUBLISHED WITH MULTIPLE INTERNAL, ORGANIZATIONAL AND CENTRAL VERMONT MEDICAL CENTER COMMUNITY HEALTH ASSISTANCE TEAM MEMBERS AVAILABLE TO ASSIST OUR PATIENTS. IT IS ALSO IMPORTANT TO NOTE, PATIENTS ARE REVIEWED IN ADVANCE OF SERVICE FOR POTENTIAL HARDSHIP; THE UNINSURED AND UNDERINSURED PATIENTS WHO ARE IDENTIFIED ARE ACTIVELY COUNSELED WITH HELP FOR GOVERNMENT AND EXCHANGE PROGRAMS AS WELL AS ASSISTANCE IN THE CENTRAL VERMONT MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. PART V, SECTION B, LINES 16A, 16B & 16C https://www.cvmc.org/sites/default/files/documents/CVMC-Financial-Assistan ce-Policy-2020.pdf https://www.cvmc.org/sites/default/files/documents/CVMC-Financial-Assistan ce-Application-2021.pdf https://www.cvmc.org/sites/default/files/documents/CVMC-Financial-Assistan ce-Policy-Summary-2020.pdf https://www.cvmc.org/sites/default/files/documents/CVMC-Financial-Assistan ce-Policy-Summary-2020.pdf
PART V, SECTION B, LINE 16J	IN ADDITION TO HAVING THE APPLICATION FOR FINANCIAL ASSISTANCE AND THE SLIDING SCALE GRID OF HOW FINANCIAL ASSISTANCE IS AWARDED, CVMC HAS COMPREHENSIVE INFORMATION ON THE WEBSITE ABOUT THE POLICY, MATERIALS REQUIRED TO APPLY AND CONTACT INFORMATION FOR THE FINANCIAL COUNSELORS, SO INTERESTED INDIVIDUALS CAN APPLY. ADDITIONALLY, THERE IS REFERENCE MADE TO THE POLICY ON PATIENT'S BILLS AS WELL AS APPLICATIONS AND INFORMATION AVAILABLE IN REGISTRATION AREAS IN THE HOSPITAL AND CLINIC LOCATIONS. CVMC ALSO EMPLOYS A TEAM OF FINANCIAL COUNSELORS WHO WORK WITH PATIENTS THROUGHOUT THEIR VISIT TO ENSURE THAT WE COMMUNICATE WITH AS MANY ELIGIBLE INDIVIDUALS AS POSSIBLE. THESE FINANCIAL COUNSELORS ALSO WORK WITH PATIENTS TO EXPLORE THE OTHER OPPORTUNITIES AVAILABLE TO INDIVIDUALS IN NEED THROUGHOUT THE STATE OF VERMONT.
PART V, SECTION B, LINE 18F	CVMC DID NOT INITIATE ANY OF THE ACTIONS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 18. HOWEVER, IF THE HOSPITAL HAD UNDERTAKEN ANY OF THE LISTED ACTIONS, IT WOULD HAVE FIRST NOTIFIED PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY ON ADMISSION, PRIOR TO DISCHARGE, AND IN COMMUNICATIONS WITH THE PATIENTS REGARDING THEIR BILLS. ADDITIONALLY, CVMC WOULD HAVE DOCUMENTED ITS DETERMINATION OF WHETHER PATIENTS WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 20E ON MARCH 23, 2020, THE ORGANIZATION SUSPENDED COLLECTION ACTIVITIES IN RESPONSE TO THE COVID-19 PANDEMIC, IN RECOGNITION OF THE FACT THAT MANY PATIENTS, STAFF, AND MEMBERS OF THE WIDER COMMUNITY WOULD FACE FINANCIAL CHALLENGES IN ADDITION TO HEALTH CHALLENGES DURING THE PANDEMIC. COLLECTION ACTIVITIES RESUMED IN JULY 2020.

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?1
Name and address		Type of Facility (describe)
1	CVMC - WOODRIDGE NURSING HOME 142 Woodridge Drive BERLIN,VT05602	SKILLED NURSING FACILITY
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
SCHEDULE H, PART VI, LINE 1	THE ORGANIZATION'S REQUIRED SCHEDULE H SPECIFIC LINE ITEM DESCRIPTIONS ARE AS FOLLOWS:
PART I, LINES 3A-C:	TO QUALIFY FOR FINANCIAL ASSISTANCE, AN ELIGIBLE PATIENT MUST PASS BOTH AN INCOME AND ASSETS TEST. INCOME IS SET AT A MAXIMUM OF 400% OF FEDERAL POVERTY LEVEL GUIDELINES ("FPLG") AND THE ASSETS TEST IS SET AT $50,000 LIQUID ASSETS, AS FURTHER DEFINED AND DESCRIBED IN THE POLICY. ASSISTANCE IS GRANTED BASED UPON THE PATIENT'S INCOME FPLG.
PART I, LINE 7:	CENTRAL VERMONT MEDICAL CENTER UTILIZED THE AXIOM COST ACCOUNTING SYSTEM TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE ON LINE 7. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS, INCLUDING, BUT NOT LIMITED TO, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS ALSO UTILIZED FOR SOME OF THE FIGURES REPORTED IN THE TABLE ON LINE 7. THE CENTRAL VERMONT MEDICAL CENTER'S ANNUAL MEDICAID PROVIDER TAX IS ASSESSED ON VERMONT ACUTE CARE HOSPITALS BY THE STATE OF VERMONT. THE TAX ASSESSMENT IS CALCULATED AS 6% OF A HOSPITAL'S BASE YEAR NET PATIENT CARE REVENUE.
PART I, LINE 7, COLUMN (F):	THE PROVISION FOR BAD DEBT INCLUDED ON FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE AMOUNT REPORTED ON LINE 7(F) IS $0. ALL PATIENT RELATED BAD DEBT IS SHOWN AS A DEDUCTION FROM PATIENT REVENUE.
PART III, LINE 2:	CENTRAL VERMONT MEDICAL CENTER'S FINANCIAL STATEMENTS INCLUDE A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. RECEIVABLES ARE REPORTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE PROVISION FOR PATIENT RELATED BAD DEBTS IS REPORTED AS A DEDUCTION FROM GROSS REVENUE. THIS EXPENSE IS DETERMINED AS A PERCENTAGE OF GROSS PATIENT SERVICE REVENUE BASED ON ACTUAL WRITE-OFF HISTORY, REVIEWED ON A QUARTERLY BASIS AND ADJUSTED ON A SEMI-ANNUAL BASIS.
PART III, LINE 3:	DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE NETTED AGAINST THE TOTAL GROSS CHARGES WHEN DETERMINING BAD DEBT EXPENSE. THE $117,051 REFLECTS THE ADJUSTED BAD DEBT EXPENSE FOR ALL PATIENTS WHO SUBMITTED AN INITIAL APPLICATION, BUT UPON FOLLOW-UP, DID NOT RESPOND TO REQUESTS FOR ADDITIONAL INFORMATION OR SUPPORTING DOCUMENTATION.
PART III, LINE 4:	PLEASE REFERENCE FOOTNOTE NUMBER 3 ON PAGE 17-18 IN THE FISCAL YEAR 2020 AUDITED CONSOLIDATED FINANCIAL STATEMENTS.
PART III, LINE 8:	THE AMOUNT REPORTED IN PART III, LINE 6, MEDICARE ALLOWABLE COSTS OF CARE, IS DERIVED FROM CENTRAL VERMONT MEDICAL CENTER'S FYE 9/30/20 MEDICARE COST REPORT, WORKSHEET D-1, COMPUTATION OF INPATIENT OPERATING COSTS, WORKSHEET E PART B, CALCULATION OF OUTPATIENT SETTLEMENT, AND WORKSHEET I-4, COMPUTATION OF AVERAGE COST PER TREATMENT FOR OUTPATIENT RENAL DIALYSIS. WHILE CVMC HAS HISTORICALLY FOLLOWED THE CATHOLIC HOSPITAL ASSOCIATION'S GUIDANCE AND HAS NOT CONSIDERED ANY MEDICARE SHORTFALL (REPORTED IN PART III, LINE 7) AS A COMMUNITY BENEFIT, IT IS LIKELY THAT SOME PORTION OF MEDICARE PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE UNDER OUR POLICIES IN THE ABSENCE OF MEDICARE COVERAGE, SUCH THAT SHORTFALLS ASSOCIATED WITH THOSE PATIENTS WOULD OTHERWISE HAVE BEEN INCLUDED IN OUR COMMUNITY BENEFITS.
PART III, LINE 9B:	THE CENTRAL VERMONT MEDICAL CENTER CREDIT AND COLLECTIONS POLICY IS DETACHED IN TERMS OF WHETHER PATIENTS QUALIFY FOR ASSISTANCE. INVOICES OF PATIENTS WHO DO QUALIFY OR ARE KNOWN TO QUALIFY WILL NOT AGE TO COLLECTIONS. BALANCES THAT REMAIN UNPAID AFTER THE APPROPRIATE DISCOUNT HAS BEEN ADJUSTED WILL AGE TO COLLECTIONS. AN EXTENSION OF UP TO 120 DAYS CAN BE GRANTED IN THE COLLECTION AGENCY WINDOW WHEN PATIENTS APPLY AND ARE APPROVED FOR ASSISTANCE WITHIN THE APPLICATION WINDOW. THE COLLECTION PROCESS IN PLACE AT CENTRAL VERMONT MEDICAL CENTER INCLUDES GENERATION OF MONTHLY STATEMENTS, FOLLOWED BY A PRE-COLLECTION LETTER OVER THE COURSE OF 120 DAYS. IN THE CASE OF UNDELIVERABLE MAIL, EFFORTS WILL BE MADE TO REACH THE PATIENT BY TELEPHONE. IF A NEW BILLING ADDRESS IS OBTAINED, THE 120 DAY WINDOW WILL BEGIN AGAIN. IF NO CONTACT CAN BE MADE AND PAYMENT IS NOT RECEIVED WITHIN THE REVISED 120 DAY WINDOW, THE ACCOUNT WILL BE REFERRED TO A COLLECTION AGENCY. IF CONTACT IS MADE, THE PATIENT WILL BE OFFERED A BUDGET PLAN. ALL STATEMENTS, LETTERS AND CONTACT WILL INCLUDE THE FACT THAT FINANCIAL ASSISTANCE IS AVAILABLE. AS AN ACCOMMODATION TO PATIENTS AND FAMILIES, COLLECTION ACTIVITY WAS SUSPENDED IN MARCH 2020 IN RECOGNITION OF THE FINANCIAL CHALLENGES ASSOCIATED WITH THE COVID-19 PANDEMIC. COLLECTION ACTIVITY RESUMED IN JULY 2020.
NEEDS ASSESSMENT	PART VI, LINE 2 THE COMPREHENSIVE 2019 CHNA INCLUDED AN IN-DEPTH REVIEW OF PRIMARY AND SECONDARY DATA. HEALTH TRENDS, SOCI-ECONOMIC STATISTICS, AND STAKEHOLDER PERCEPTIONS, AMONG OTHER INFORMATION WE ANALYZED TO INFORM COMMUNITY HEALTH PLANNING. PRIMARY STUDY METHODS WERE USED TO SOLICIT INPUT FROM HEALTH CARE CONSUMERS AND KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. SECONDARY STUDY METHODS WERE USED TO IDENTIFY AND ANALYZE STATISTICAL DEMOGRAPHIC AND HEALTH TRENDS. COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE 2019 CHNA WITH WIDE PARTICIPATION FROM NEARLY 1,500 COMMUNITY STAKEHOLDERS WHO PARTICIPATED IN SURVEYS, FOCUS GROUPS, PLANNING MEETINGS, AND OTHER DIALOGUE. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEB ADDRESS: https://www.cvmc.org/sites/default/files/documents/Community-Health-Needs- Assessment-2019.pdf
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CENTRAL VERMONT MEDICAL CENTER UTILIZES A VARIETY OF METHODS TO INFORM, EDUCATE AND ASSIST PATIENTS IN IDENTIFYING PAYMENT SOURCES, INCLUDING STATE / FEDERAL PROGRAMS AS WELL AS OUR PATIENT ASSISTANCE PROGRAM. INFORM & EDUCATE: PATIENT EDUCATION IS PROVIDED ACROSS THE CONTINUUM OF CARE. PATIENT BENEFIT ADVISORS, FINANCIAL ADVOCATES, REGISTRARS, CASE MANAGERS, SOCIAL WORKERS AND CUSTOMER SERVICE REPRESENTATIVES ACTIVELY INFORM AND EDUCATE PATIENTS ON THE PROGRAM, GUIDELINES, REQUIREMENTS FROM: - PRE-ARRIVAL SCREENING/REGISTRATION TO POINT OF SALE EDUCATION AT REGISTRATION - AT THE BEDSIDE OF AN INPATIENT OR OBSERVATION PATIENT- AFTER DISCHARGE WITH CONTINUED FOLLOW-UP BY FINANCIAL ADVOCATES AND - DURING THE SELF-PAY BILLING FOLLOW-UP PROCESS. PATIENTS ARE INFORMED OF THE PROGRAM, APPLICATIONS AND ASSISTANCE WITH COMPLETION ARE PROVIDED WITH FINANCIAL ADVOCATES ALSO PROVIDING EDUCATION AND ASSISTANCE FOR MEDICAID AND HEALTH INFORMATION EXCHANGE PROGRAMS, ALONG WITH ASSISTANCE IN APPLYING FOR THE UVM MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. PATIENTS ARE ROUTINELY REFERRED TO ADVOCATES AND ADVISORS IN ADVANCE OF SERVICE WITH ADVOCATES ACTIVELY ASSISTING PATIENTS WHO ARE ADMITTED TO THE ORGANIZATION URGENTLY OR EMERGENTLY. POLICIES, SUMMARIES AND APPLICATIONS ARE AVAILABLE AT ALL REGISTRATION LOCATIONS, THEY ARE REFERENCED IN ALL INTERVIEW PROCESSES AND FURTHER AVAILABLE IN THE WAITING AREAS. OUR ORGANIZATIONAL WEBSITES PROVIDE EDUCATION, APPLICATIONS, POLICIES, SUMMARIES, FAQ DOCUMENTS ALONG WITH CONTACT INFORMATION AS A PASSIVE MEANS OF COMMUNICATION IN ADDITION TO THE ACTIVE EDUCATION REFERENCED PREVIOUSLY. OUR BILLING STATEMENTS REFLECT FINANCIAL ASSISTANCE HELP AND OUR COMMUNITY BENEFIT TEAM EDUCATE WITHIN THE COMMUNITY ON OUR PROGRAMS. APPLICATIONS AND INFORMATION ARE ADDITIONALLY AVAILABLE IN THE LOCAL COMMUNITY HEALTH CENTERS. ASSIST: - ALL INPATIENT AND OUTPATIENT PROCEDURES ARE FINANCIALLY SCREENED TO IDENTIFY THE UNDERINSURED OR UNINSURED PATIENT POPULATION. PRIOR TO SERVICE, CONCURRENT WITH SERVICE AND POST SERVICE, OUR PATIENT FINANCIAL COUNSELORS WILL CALL AND/OR MEET WITH PATIENTS AND FAMILIES TO EDUCATE THEM ON THE AVAILABLE PROGRAMS AND WHERE APPLICABLE, ASSIST IN THE APPLICATION PROCESS. THIS INCLUDES STATE AND FEDERAL AID APPLICATIONS AND THE CENTRAL VERMONT MEDICAL CENTER CHARITY APPLICATION PROCESS. OUR FINANCIAL COUNSELORS/ADVOCATES HAVE BEEN CERTIFIED AS ASSISTERS IN THE PROCESS FOR HEALTH EXCHANGE INSURANCE, MEDICAID AND THE FINANCIAL ASSISTANCE PROGRAMS. COUNSELORS WILL ADDITIONALLY MEET WITH PATIENTS AT THE BEDSIDE TO HELP COMPLETE THE APPLICATIONS, PROVIDE DETAILS ON SUPPORTING DOCUMENTATION NEEDS AND FACILITATE AND EXPEDITE THE REVIEW PROCESS UNTIL A NOTICE OF DECISION HAS BEEN RECEIVED.
COMMUNITY INFORMATION	PART VI, LINE 4 CENTRAL VERMONT MEDICAL CENTER SERVES AS THE COMMUNITY HOSPITAL AND BASED ON THE ESTIMATED 2020 CENSUS SERVES A POPULATION OF WASHINGTON COUNTY OF APPROXIMATELY 59,559 RESIDENTS. THE POPULATION INCREASED 0.1% FROM THE 2010 CENSUS, AND IS PROJECTED TO INCREASE BY 0.7% BY 2023. THE PROJECTED POPULATION GROWTH IS CONSISTENT WITH VERMONT OVERALL, AND LOWER THAN THE NATIONAL PROJECTION OF 4%.
PROMOTION OF COMMUNITY HEALTH	PART VI, LINE 5 AS A PARTNER IN THE UNIVERSITY OF VERMONT HEALTH NETWORK, CENTRAL VERMONT MEDICAL CENTER IS PART OF A REGION-WIDE EFFORT TO TRANSFORM HEALTH CARE THAT IS TRANSLATING TO BETTER CARE HERE IN OUR LOCAL CENTRAL VERMONT COMMUNITIES. IN ADDITION TO OUR NETWORK PARTNERSHIP, WE BELIEVE THAT MAINTAINING THE HIGHEST QUALITY CARE FOR OUR PATIENTS ALSO DEPENDS ON OUR SUPPORT AND COLLABORATION WITH THE MANY LOCAL ORGANIZATIONS THROUGHOUT CENTRAL VERMONT THAT ARE ALSO PROVIDING VITAL SERVICES TO OUR COMMUNITY. SOME OF OUR COMMUNITY PARTNERS INCLUDE: A. CENTRAL VERMONT HOME HEALTH AND HOSPICE B. GREEN MOUNTAIN TRANSIT AUTHORITY (GMTA) C. GREEN MOUNTAIN UNITY WAY D. PEOPLE'S HEALTH AND WELLNESS CLINIC (PHWC) E. PHARMACIES F. VERMONT STATE DEPARTMENT OF HEALTH G. WASHINGTON COUNTY MENTAL HEALTH THE MAJORITY OF CVMC'S GOVERNING BODY (BOARD OF TRUSTEES) IS COMPRISED OF INDIVIDUALS WHO RESIDE IN CVMC'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS, NOR CONTRACTORS OF THE ORGANIZATION. CVMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. CENTRAL VERMONT MEDICAL CENTER (CVMC) IS ALSO THE ADMINISTRATIVE ENTITY FOR THE VERMONT BLUEPRINT FOR HEALTH, PATIENT CENTERED MEDICAL HOMES FOR THE BARRE HEALTH SERVICE AREA (HSA). THE GOAL OF THE VERMONT BLUEPRINT FOR HEALTH, PASSED BY THE VERMONT LEGISLATURE IN 2010, IS TO SUPPORT VERMONT'S EFFORTS TO DEVELOP A COMPREHENSIVE, PROACTIVE SYSTEM OF CARE THAT IMPROVES THE QUALITY OF LIFE FOR PEOPLE WITH, OR AT RISK FOR CHRONIC CONDITIONS. AT THE END OF 2019, OVER 50 PRIMARY CARE PROVIDERS WERE ALL PART OF A RECOGNIZED NATIONAL COMMITTEE FOR QUALITY ASSURANCE, PATIENT CENTERED MEDICAL HOME IN THE BARRE HSA CARING FOR OVER 30,000 PATIENTS. THE CVMC COMMUNITY HEALTH TEAM (CHT) IS A PATIENT CENTERED MULTIDISCIPLINARY TEAM THAT STRIVES TO IMPROVE THE PRIMARY HEALTH AND WELLNESS FOR ALL PATIENTS IN CENTRAL VERMONT. CHT IS COMMITTED TO REMOVING HEALTH BARRIERS BY OFFERING SERVICE FREE OF CHARGE, WHICH CONSISTS OF A NURSE, OR DIETITIAN, OR WELLNESS COACH, OR CLINICAL SOCIAL WORKERS IN THE COMFORT OF YOUR PRIMARY CARE OFFICE. CHT SERVICES CAN HELP YOU OR THOSE YOU LOVE IMPROVE THEIR CHANCES FOR REACHING GOALS WHILE PROVIDING ONE-ON-ONE SUPPORT. THE CHT TEAM WORKS WITHIN THE CVMC PRIMARY CARE PRACTICES AROUND CENTRAL VERMONT, AS WELL AS WOMEN'S HEALTH. CVMC APPLIES SURPLUS FUNDS TO REVITALIZE FACILITIES, PURCHASE EQUIPMENT, STAFF EDUCATION AND TO ENHANCE PROGRAMS TO PROVIDE BETTER PATIENT AND FAMILY CENTERED CARE (PFCC).
AFFILIATED HEALTH CARE SYSTEM	PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: AS OF OCTOBER 1, 2011, CENTRAL VERMONT MEDICAL CENTER, INC. (CVMC) AND THE UNIVERSITY OF VERMONT MEDICAL CENTER (UVMMC) BECAME MEMBERS OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVMHN), AN INTEGRATED SYSTEM OF CARE SERVING THE COMMUNITIES OF VERMONT AND NORTHERN NEW YORK. THE UNIVERSITY OF VERMONT HEALTH NETWORK IS CARRYING OUT CENTRALIZED ACTIVITIES FOR THE BENEFIT OF PATIENTS OF PARTNER ORGANIZATIONS, INCLUDING IMPROVING ACCESS TO LOCAL CARE, COST SAVINGS THROUGH GREATER JOINT PURCHASING POWER, ENHANCING INFORMATION TECHNOLOGY, INCREASING ACADEMIC OPPORTUNITIES FOR PHYSICIANS, ENGAGING IN REGIONAL STRATEGIC PLANNING, AND PARTICIPATING IN JOINT QUALITY AND CLINICAL INITIATIVES. SINCE THE HEALTH NETWORK'S INCEPTION, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, ELIZABETH COMMUNITY HOSPITAL, ALICE HYDE MEDICAL CENTER, PORTER MEDICAL CENTER, AND UVM HEALTH NETWORK HOME HEALTH & HOSPICE HAVE ALSO JOINED.
STATE FILING OF COMMUNITY BENEFIT REPORT	PART VI, LINE 7 THE CENTRAL VERMONT MEDICAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF VERMONT.

Schedule H (Form 990) 2019

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number
22-2547186

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) PEOPLES HEALTH AND WELLNESS CENTER 553 NORTH MAIN ST SUITE 5 BARRE,VT05641	03-0343290	501(c)(3)	26,000	HEALTH CARE FOR THE UNINSURED
(2) AREA HLTH EDU CNTRS PRM UNIV VT COL OF MED UHC CMP ARNLD 51 SPRRCT BRLNGTN,VT05401	03-0179440	501(c)(3)	28,400	EDU LOAN RPMT TO HLTHCR PRFSNLS
(3) CAPSTONE COMMUNITY ACTION 20 GABLE PLACE BARRE,VT05641	03-0216254	501(c)(3)	15,000	FUEL YOUR NEIGHBORS CAMPAIGN
(4) VERMONT YOUTH CONSERVATION CORPS 1949 EAST MAIN ST RICHMOND,VT05477	03-0328834	501(c)(3)	17,277	SUPPORT MISSION OF PROVIDING FOOD FOR FOOD-INSECURE FAMILIES IN CENTRAL VT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS	SCHEDULE I, PART I, LINE 2 CENTRAL VERMONT MEDICAL CENTER OCCASIONALLY GRANTS FUNDS TO ORGANIZATIONS THAT SUPPORT CVMC'S EXEMPT PURPOSE OF SERVING THE HEALTHCARE NEEDS OF CENTRAL VERMONT RESIDENTS. GRANT FUNDS ARE APPROVED AND OVERSEEN BY THE BOARD.

Schedule I (Form 990) 2019

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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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

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

Yes

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)
1JOHN BRUMSTED MD TRUSTEE	(i) (ii)	0 ------------- 991,339	0 ------------- 0	0 ------------- 775,321	0 ------------- 198,824	0 ------------- 28,589	0 ------------- 1,994,073	0 ------------- 383,556
2JEREMIAH ECKHAUS MD TRUSTEE, PRES-ELECT MED STAFF	(i) (ii)	5,399 ------------- 236,964	0 ------------- 0	8,511 ------------- 48,711	835 ------------- 15,966	0 ------------- 27,444	14,745 ------------- 329,085	0 ------------- 0
3MARK DEPMAN MD TRUSTEE, UNTIL 12/2019	(i) (ii)	5,190 ------------- 296,412	22,591 ------------- 0	29,843 ------------- 68,030	0 ------------- 13,725	0 ------------- 22,219	57,624 ------------- 400,386	0 ------------- 0
4ANNA T NOONAN TRUSTEE, PRESIDENT/COO	(i) (ii)	327,854 ------------- 0	77,877 ------------- 0	35,555 ------------- 0	16,876 ------------- 0	32,720 ------------- 0	490,882 ------------- 0	0 ------------- 0
5CATHY PALMER MD TRUSTEE, UNTIL 10/2019	(i) (ii)	0 ------------- 263,664	0 ------------- 0	0 ------------- 23,920	0 ------------- 19,600	0 ------------- 27,867	0 ------------- 335,051	0 ------------- 0
6ALLEN YEARICK ADMIN/VP AGING SVCS WDR	(i) (ii)	158,659 ------------- 0	17,628 ------------- 0	2,035 ------------- 0	2,106 ------------- 0	17,011 ------------- 0	197,439 ------------- 0	0 ------------- 0
7MATTHEW CHOATE VP PATIENT CARE SERVICES	(i) (ii)	205,419 ------------- 0	22,740 ------------- 0	1,208 ------------- 0	12,701 ------------- 0	22,580 ------------- 0	264,648 ------------- 0	0 ------------- 0
8CHRISTOPHER MERIAM MD TRUSTEE, PRES-ELECT MED STAFF	(i) (ii)	11,345 ------------- 474,591	0 ------------- 0	43,985 ------------- 83,240	2,910 ------------- 16,800	0 ------------- 32,310	58,240 ------------- 606,941	0 ------------- 0
9ROBERT PATTERSON VP OF HR & CLINICAL OPERATIONS	(i) (ii)	193,875 ------------- 0	23,376 ------------- 0	19,903 ------------- 0	13,056 ------------- 0	28,404 ------------- 0	278,614 ------------- 0	0 ------------- 0
10JAMES ALVAREZ VP SUPPORT SERVICES	(i) (ii)	197,561 ------------- 0	21,465 ------------- 0	428 ------------- 0	7,029 ------------- 0	10,623 ------------- 0	237,106 ------------- 0	0 ------------- 0
11PATRICIA FISHER MD CHIEF MEDICAL OFFICER	(i) (ii)	308,835 ------------- 0	34,003 ------------- 0	6,478 ------------- 0	1,613 ------------- 0	28,573 ------------- 0	379,502 ------------- 0	0 ------------- 0
12TODD KEATING INTERIM TREASURER,CFO 12/2019	(i) (ii)	0 ------------- 602,531	0 ------------- 99,498	0 ------------- 94,163	0 ------------- 25,200	0 ------------- 4,567	0 ------------- 825,959	0 ------------- 0
13STEPHEN KENNEY TREASURER, CFO, UNTIL 12/2019	(i) (ii)	253,819 ------------- 0	0 ------------- 0	544 ------------- 0	0 ------------- 0	32,915 ------------- 0	287,278 ------------- 0	0 ------------- 0
14MARC GAGNON VP PRACTICE OPERATIONS	(i) (ii)	147,098 ------------- 0	32,294 ------------- 0	79 ------------- 0	0 ------------- 0	23,877 ------------- 0	203,348 ------------- 0	0 ------------- 0
15CHRISTIAN BEAN MD PHYSICIAN	(i) (ii)	11,989 ------------- 501,612	0 ------------- 0	49,545 ------------- 68,519	12,357 ------------- 26,572	0 ------------- 29,667	73,891 ------------- 626,370	0 ------------- 0
16JOHN BEGLY MD PHYSICIAN	(i) (ii)	9,558 ------------- 405,671	0 ------------- 15,000	14,957 ------------- 52,408	0 ------------- 12,487	0 ------------- 29,365	24,515 ------------- 514,931	0 ------------- 0
17DAVID OSPINA MD PHYSICIAN	(i) (ii)	7,283 ------------- 309,905	0 ------------- 0	49,358 ------------- 19,932	2,861 ------------- 32,890	0 ------------- 28,271	59,502 ------------- 390,998	0 ------------- 0
18MASHKURI JAVAD MD PHYSICIAN	(i) (ii)	7,496 ------------- 351,087	0 ------------- 0	34,612 ------------- 55,212	0 ------------- 52,242	0 ------------- 29,032	42,108 ------------- 487,573	0 ------------- 0
19SARA GRAVES MD PHYSICIAN	(i) (ii)	10,037 ------------- 444,898	0 ------------- 0	39,853 ------------- 53,704	12,243 ------------- 24,578	0 ------------- 29,214	62,133 ------------- 552,394	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

SCHEDULE J, PART I, LINE 3

IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, CVMC RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THE GUIDANCE: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4A DURING CALENDAR YEAR 2019, STEPHEN KENNEY RECEIVED $5,192 IN SEVERANCE PAYMENTS AFTER HIS DEPARTURE IN DECEMBER 2019. EXECUTIVE BENEFITS SCHEDULE J, PART I, LINE 4B CERTAIN LISTED INDIVIDUALS PARTICIPATED IN THE UVM MEDICAL CENTER EXECUTIVE BENEFIT PLAN UNDER WHICH PARTICIPANTS ARE CREDITED A BENEFIT ALLOWANCE EQUAL TO A SPECIFIED PERCENTAGE OF BASE PAY. UNDER THE PLAN, PARTICIPANTS MAY ELECT TO HAVE THE AMOUNT OF THE BENEFIT ALLOWANCE DEFERRED TO A CAPITAL ACCUMULATION ACCOUNT SUBJECT TO SECTION 457(F). NO AMOUNTS WERE DEFERRED TO OR PAID FROM A CAPITAL ACCUMULATION ACCOUNT IN CALENDAR 2019. DURING CALENDAR YEAR 2015, THE UNIVERSITY OF VERMONT MEDICAL CENTER, INC. ENTERED INTO A SUPPLEMENTAL RETIREMENT BENEFIT PLAN (SRP) WITH EXECUTIVE CHIEF OFFICER BRUMSTED. UNDER THE TERMS OF THE SRP, UVM MEDICAL CENTER MAKES ANNUAL CREDITS EQUAL TO 15% OF THE CEO'S BASE SALARY FOR EACH YEAR THROUGH THE PLAN YEAR ENDING SEPTEMBER 30, 2019. PURSUANT TO THE TERMS OF DR. BRUMSTED'S CONTRACT RENEWAL IN JANUARY 2019, THE SRP WAS EXTENDED THROUGH THE PLAN YEAR ENDING SEPTEMBER, 30, 2021, WITH THE ANNUAL CREDITS REMAINING FIXED AT 15% OF BASE SALARY. THE AMOUNT DEFERRED FOR CALENDAR YEAR 2019 IS INCLUDED ON SCHEDULE J, PART II, COLUMN C. A DISTRIBUTION OF $393,821 IN CALENDAR YEAR 2019 IS REPORTED IN COLUMN B(III). AMOUNTS DEFERRED REMAIN SUBJECT TO FORFEITURE IF CERTAIN CONDITIONS ARE NOT MET.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SUBSTANTIAL DONOR	SUBSTANTIAL CONTRIBUTOR	1,832,187	SERVICES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Return Reference	Explanation
DESCRIPTION OF THE ORGANIZATION'S MISSION	FORM 990, PART III, LINE 1 CENTRAL VERMONT MEDICAL CENTER IS THE PRIMARY HEALTH CARE PROVIDER FOR 66,000 PEOPLE WHO LIVE, AND WORK, AND PLAY IN THE 26 COMMUNITIES OF CENTRAL VERMONT. CENTRAL VERMONT MEDICAL CENTER HOSPITAL PROVIDES 24-HOUR EMERGENCY CARE, WITH A FULL SPECTRUM OF INPATIENT (LICENSED FOR 122 BEDS) AND OUTPATIENT SERVICES, CLOSE TO HOME. CENTRAL VERMONT MEDICAL CENTER NAMED ONE OF THE NATIONS TOP 20 RURAL COMMUNITY HOSPITALS BY THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA). TOP 20 RURAL COMMUNITY HOSPITALS ARE THOSE ACHIEVING SUCCESS IN OVERALL PERFORMANCE BASED ON A COMPOSITE RATING FROM EIGHT INDICATORS OF STRENGH - INPATIENT MARKET SHARE, OUTPATIENT MARKET SHARE, QUALITY, OUTCOMES, PATIENT PERSPECTIVES, COSTS, CHARGES AND FINANCIAL STABILITY. IN ADDITION, CENTRAL VERMONT MEDICAL CENTER HOSPITAL HAS RECEIVED FIVE STAR CMS HOSPITAL CARE RATINGS FOR TWO YEARS IN A ROW 2020/2021. THE CENTRAL VERMONT MEDICAL CENTER PROFESSIONAL STAFF INCLUDES OVER 200 PHYSICIANS AND 70 ADVANCED PRACTICE PROVIDERS REPRESENTING 25 MEDICAL SPECIALTIES. CENTRAL VERMONT MEDICAL CENTER'S WOODRIDGE REHABILITATION AND NURSING IS A LONG-TERM AND SHORT-TERM FACILITY ON OUR MAIN CAMPUS PROVIDING 153 SKILLED NURSING BEDS. CVMC WOODRIDGE REHABILITATION AND NURSING EARNED BEST NURSING HOMES STATUS BY ACHIEVING A RATING OF "HIGH PERFORMING," THE HIGHEST POSSIBLE RATING, FOR SHORT-TERM REHABILITATION. U.S. NEWS GIVES THE DESIGNATION OF BEST NURSING HOME ONLY TO THOSE HOMES THAT SATISFY U.S. NEWSS ASSESSMENT OF THE APPROPRIATE USE OF KEY SERVICES AND CONSISTENT PERFORMANCE IN QUALITY MEASURES. COMBINED AS CENTRAL VERMONT MEDICAL CENTER (HOSPITAL, 28 MEDICAL PRACTICES, AND WOODRIDGE REHABILITATION AND NURSING) ARE A CRITICAL SOURCE OF HIGH QUALITY CARE, CLOSE TO HOME. WITH OVER 1700 EMPLOYEES (FROM WASHINGTON, ORANGE, LAMOILLE, CHITTENDEN COUNTIES AND MORE), CENTRAL VERMONT MEDICAL CENTER IS THE LARGEST PRIVATE EMPLOYER IN CENTRAL VERMONT. FORM 990, PART VI, LINE 2 THERE IS A BUSINESS RELATIONSHIP BETWEEN DR. JOHN BRUMSTED AN OFFICER OF THE UNIVERSITY OF VERMONT MEDICAL CENTER (UVMMC), DR. CATHY PALMER AN EMPLOYEE OF UVMMC AND TODD KEATING, INTERIM TREASURER, CFO OF CENTRAL VERMONT MEDICAL CENTER INC. (CVMC). DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part VI, Line 6 THE UNIVERSITY OF VERMONT HEALTH NETWORK IS THE SOLE MEMBER AND PARENT CORPORATION OF CENTRAL VERMONT MEDICAL CENTER, INC. (CVMC). THE UNIVERSITY OF VERMONT HEALTH NETWORK IS A VERMONT NON-PROFIT CORPORATION WHICH HAS BEEN RECOGNIZED BY THE IRS AS A 501(C)(3) ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION.NOT A PRIVATE FOUNDATION.
ELECTION OF GOVERNING BODY & GOVERNANCE DECISIONS	FORM 990, PART VI, LINE 7A & 7B THE UNIVERSITY OF VERMONT HEALTH NETWORK HOLDS THE POWER TO ELECT CVMC'S BOARD OF TRUSTEES AND TO APPROVE SIGNIFICANT CORPORATE ACTIONS, INCLUDING ANNUAL OPERATING AND CAPITAL BUDGETS, STRATEGIC PLANS, THE APPOINTMENT OF THE PRESIDENT/COO, THE INCURRENCE OF LONG-TERM INDEBTEDNESS, AND AMENDMENTS TO CVMC'S BYLAWS AND ARTICLES OF ORGANIZATION.
DESCRIPTION OF PROCESS USED BY MGMNT &/OR GOVERNING BODY TO REVIEW 990	FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE ACCOUNTING MANAGER AND REVIEWED IN DETAIL BY CVMC'S OUTSIDE TAX ADVISORS BEFORE BEING REVIEWED BY THE OFFICERS OF THE CORPORATION AND BY THE OTHER MEMBERS OF THE SENIOR MANAGEMENT TEAM. THE ACCOUNTING MANAGER PROVIDES REGULATORY UPDATES REGARDING THE FORM 990 TO THE EXECUTIVE COMMITTEE AND MAKES AVAILABLE TO THE EXECUTIVE COMMITTEE THE FORM 990 ALONG WITH HIGHLIGHTS OF ALL SIGNIFICANT PARTS OF THE FORM 990. THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO THE FORM BEING FILED WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST	FORM 990, PART VI, LINE 12C THE COMPLIANCE OFFICER FOR UVMHN MAINTAINS THE CONFLICT OF INTEREST STATEMENTS AND REGULARLY MONITORS THEM AS WELL AS ANY OTHER ACTIVITIES THAT MAY CONSTITUTE A CONFLICT OF INTEREST. THE ORGANIZATION'S PRACTICE IS TO SEND OUT ANNUAL DISCLOSURE QUESTIONNAIRES TO BOARD OF TRUSTEE MEMBERS, SENIOR OFFICERS, AND DIRECTORS OF THE ORGANIZATION OR OTHER INDIVIDUALS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION WHO HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST, AS DEFINED BELOW, AS AN "INTERESTED PERSON." THIS DEFINITION SHALL ALSO INCLUDE MEMBERS OF THE ORGANIZATION'S LEADERSHIP GROUP, MEDICAL DIRECTORS AND ANY EMPLOYEES INVOLVED WITH RECOMMENDING OR PURCHASING PRODUCTS/SERVICES. THE RESPONSES ARE TAKEN TO THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE GOVERNANCE COMMITTEE SHALL MAINTAIN A LIST OF INDIVIDUALS WHO MAY BE CONSIDERED DISQUALIFIED PERSONS UNDER IRS REGULATIONS. THE GOVERNANCE COMMITTEE SHALL REPORT THE RESULTS OF ITS REVIEW ANNUALLY TO THE BOARD OF TRUSTEES. IF THERE IS ANY POSSIBILITY OF FINANCIAL GAIN BY A TRUSTEE AND OR EMPLOYEE FROM ANY DECISION THAT IS TO BE DELIBERATED ON, THEN THAT TRUSTEE/EMPLOYEE MAY MAKE A PRESENTATION, BUT IS THEN REMOVED FROM THOSE DISCUSSIONS TO ENSURE THAT THE TRUSTEE/EMPLOYEE WILL NOT TAKE PART IN ANY DELIBERATIONS THAT HE OR SHE MIGHT PERSONALLY GAIN FROM. THE TRUSTEE/EMPLOYEE OPERATING UNDER A CONFLICT IS PROHIBITED FROM VOTING ON ANY MATTER TO WHICH THE CONFLICT RELATES.
WHISTLEBLOWER & DOCUMENT RETENTION - DESTRUCTION POLICIES	FORM 990, PART VI, LINES 13 & 14 CVMC HAS BOTH A WHISTLEBLOWER AND A DOCUMENT RETENTION - DESTRUCTION POLICY. THESE POLICIES ARE EFFECTIVE WITHOUT FORMAL BOARD APPROVAL.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN	FORM 990, PART VI, LINES 15A & 15B THE PROCESS FOR DETERMINING COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/COO IS HANDLED BY THE UVM HEALTH NETWORK'S COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE MEETS ANNUALLY AND UTILIZES SURVEY DATA TO MAKE TOTAL COMPENSATION RECOMMENDATIONS. TO ASSIST THE COMPENSATION COMMITTEE WITH THIS WORK, THE UVM HEALTH NETWORK ENGAGES AN INDEPENDENT CONSULTING FIRM, INTEGRATED HEALTHCARE STRATEGIES (IHS)/GALLAGER, WITH NATIONAL EXPERTISE IN HEALTH CARE COMPENSATION. IHS/GALLAGHER BENCHMARKS THE COMPENSATION PAID BY CVMC TO ITS PRESIDENT/COO AGAINST THE COMPENSATION PAID BY OTHER COMPARABLE ORGANIZATIONS AND PROVIDES AN OPINION TO THE COMPENSATION COMMITTEE OF THE UVM HEALTH NETWORK AS TO WHETHER THE COMPENSATION IS IN EXCESS OF REASONABLE COMPENSATION. THE RECOMMENDATIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE CVMC BOARD. AN ANALYSIS IS PERFORMED ANNUALLY TO EVALUATE CVMC SENIOR LEADERSHIP COMPENSATION. THIS IS CONDUCTED BY THE UVM HEALTH NETWORK'S TOTAL REWARDS COMPENSATION TEAM. RECOMMENDATIONS ARE REVIEWED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE OF THE CVMC BOARD OF TRUSTEES. MARKET STUDY DATA COMES FROM, BUT IS NOT LIMITED TO, HFMA, VAHHS, NEAH, AHA, INDUSTRY SPECIFIC COMPENSATION SURVEYS OTHER HEALTHCARE SOURCES. THE COMPENSATION OF OTHER KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED THROUGH MARKET STUDY ANALYSIS PERFORMED BY THE HUMAN RESOURCES DEPARTMENT AND REVIEWED BY THE BOARD OF TRUSTEES IF NECESSARY. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, CVMC RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THE NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THE GUIDANCE: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS OF THE ORGANIZATION FOR FY2020 CAN ALSO BE FOUND ON THE WEBSITE, WWW.CVMC.ORG. FORM 990, PART VII TWO PHYSICIANS SERVING AS BOARD MEMBERS, DR. MERIAM AND DR. ECKHAUS, RECEIVE COMPENSATION FROM A RELATED ORGANIZATION (UVMMG) FOR THEIR SERVICES AS PHYSICIANS. THIS COMPENSATION IS NOT RELATED TO THEIR PARTICIPATION AS MEMBERS OF THE BOARD OF TRUSTEES.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: CHANGE IN MINIMUM PENSION LIABILITY $3,836,871 TRANSFER OF NET ASSETS 1,566,752 OTHER CHANGES TO TEMP RESTRICTED ASSETS (13,823) CHANGE IN PERPETUAL TRUST (50,822) ------------------------------------------------------------------------- TOTAL: $5,338,978
CIRCULAR A-133 AUDIT	FORM 990, PART XII, LINE 3B: DURING FY20, CVMC DID NOT REACH THE LEVEL REQUIRED TO WARRANT AN AUDIT UNDER OMB CIRCULAR A-133. HOWEVER, BECAUSE OF CVMC'S AFFILIATION WITH THE UNIVERSITY OF VERMONT HEALTH NETWORK, CVMC WAS INCLUDED IN THE A-133 THAT WAS PERFORMED FOR THE UNIVERSITY OF VERMONT MEDICAL CENTER.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 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

CENTRAL VERMONT MEDICAL CENTER INC

Employer identification number

22-2547186

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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)UNIVERSITY OF VERMONT MEDICAL CENTERINC 111 COLCHESTER AVE BURLINGTON,VT05401 03-0219309	HOSPITAL	VT	501(c)(3)	3	UVMHN	Yes
(2)UNIV OF VERMONT HEALTH NETWORK INC 111 COLCHESTER AVE BURLINGTON,VT05401 45-2880726	HOLDING CO	VT	501(C)(3)	12A-I	NA		No
(3)UNIV OF VERMONT MEDICAL GROUP - NEW YORK 183 PARK STREET MALONE,NY12953 20-3905216	PHYS SVCS	NY	501(C)(3)	3	UVMMG	Yes
(4)UNIVERSITY OF VERMONT MEDICAL GROUP 111 COLCHESTER AVE BURLINGTON,VT05401 03-0225105	PHYS SVCS	VT	501(C)(3)	12A-I	UVMHN	Yes
(5)UNIV OF VERMONT MEDICAL CTR FDN INC 111 COLCHESTER AVE BURLINGTON,VT05401 26-3159849	FUNDRAISING	VT	501(C)(3)	12A-I	UVMMC	Yes
(6)CENTRAL VERMONT HOSPITAL AUXILIARY 130 FISHER RD BERLIN,VT05602 03-0264240	SERVICE	VT	501(C)(3)	12D-III-O	NA		No
(7)COMMUNITY PROVIDERS INC 75 BEEKMAN ST PLATTSBURGH,NY12901 22-2544844	HLTH SVC COOR	NY	501(C)(3)	12A-I	UVMHN	Yes
(8)CHAMPLAIN VALLEY PHYSICIANS HOSPITAL 75 BEEKMAN STREET PLATTSBURGH,NY12901 14-1338471	HOSPITAL	NY	501(C)(3)	3	CPI	Yes
(9)ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET ELIZABETHTOWN,NY12932 14-1364513	HOSPITAL	NY	501(C)(3)	3	CPI	Yes
(10)EMERGENCY MEDICAL TRANSPORT OF CVPH INC 75 BEEKMAN ST PLATTSBURGH,NY12901 06-1718419	AMBULANCE SVC	NY	501(C)(3)	12B-II	CPI	Yes
(11)CVPH MEDICAL CENTER FOUNDATION 75 BEEKMAN ST PLATTSBURGH,NY12901 14-1727048	HLTH SVC SUPP	NY	501(c)(3)	12B-II	CVPH	Yes
(12)UNIVERSITY MEDICAL EDUCATION ASSOCIATES 89 BEAUMONT AVE BURLINGTON,VT05405 23-7107832	EDUCATIONAL	VT	501(C)(3)	11	UVMMG	Yes
(13)UNIVERSITY HEALTH CENTER 111 CoOLCHESTER AVE BURLINGTON,VT05401 03-0229931	HOSPITAL	VT	501(C)(3)	12C-III-FI	UVMMG	Yes
(14)ALICE HYDE MEDICAL CENTER 133 PARK STREET MALONE,NY12953 15-0346515	HOSPITAL	NY	501(C)(3)	3	CPI	Yes
(15)PORTER MEDICAL CENTER INC 115 PORTER DRIVE MIDDLEBURY,VT05753 03-0310862	SUPPTG ORG	VT	501(C)(3)	12-BII	UVMHN	Yes
(16)HELEN PORTER NURSING HOME 37 PORTER DRIVE MIDDLEBURY,VT05753 03-0306549	NURSING HOME	VT	501(C)(3)	3	PMC	Yes
(17)AUXILIARY OF PORTER MEDICAL CENTER 37 PORTER DRIVE MIDDLEBURY,VT05753 23-7363227	SUPPORTG ORG	VT	501(C)(3)	12-B,II	PMC	Yes
(18)PORTER HOSPITAL INC 37 PORTER DRIVE MIDDLEBURY,VT05753 03-0181058	HOSPITAL	VT	501(C)(3)	3	PMC	Yes
(19)VMC INDEMNITY COMPANY INC 95 ST PAUL ST BURLINGTON,VT05401 83-1102018	INSURANCE	VT	501(C)(3)	12A-I	UVMHN	Yes

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	(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 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) ONECARE VERMONT ACCOUNTABLE CA 111 COLCHESTER AVENUE BURLINGTON,VT05401 45-5399218	ACCOUNTABLE C	VT	NA
(2) ADIRONDACKS ACO LLC 75 BEEKMAN STREET PLATTSBURGH,NY12901 46-2840926	ACCOUNTABLE C	NY	NA

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) CHARITABLE IRREVOCABLE TRUST (7)	SUPPORT	VT	UVMMCCVMC	TRUST
(2) UNIV OF VT MED CTR HEALTH VENT INC 111 COLCHESTER AVE BURLINGTON,VT05401 04-3380045	HOLDING COMPANY	VT	UVMMC	C CORP
(3) CHARITABLE REMAINDER TRUST (5)	SUPPORT	VT	UVMMCCVMC	TRUST
(4) PERPETUAL TRUST (4)	SUPPORT	VT	UVMMC	TRUST
(5) CHAMPLAIN VALLEY HEALTH NETWORK 75 BEEKMAN STREET PLATTSBURGH,NY12901 16-1586102	ADMIN SERVICE	NY	NA	C CORP
(6) MEDQUEST INC PO BOX 1656 PLATTSBURGH,NY12901 14-1663061	MED OFFICE LE	NY	NA	C CORP
(7) YANKEE MEDICAL INC 276 NORTH AVENUE BURLINGTON,VT05401 03-0225363	HOME MED EQUIP	VT	UVMHN VENTURES	C CORP
(8) UVMHN CREDENTIALING & ENROLLMENT 111 COLCHESTER AVE BURLINGTON,VT05401 03-0333056	ADMIN SVC	VT	UVMHN VENTURES	C CORP

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) ............................

Yes

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

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

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) ............................

Yes

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

Yes

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

Yes

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) .................

Yes

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) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) UNIVERSITY OF VERMONT MEDICAL CENTER	J	1,932,359	FMV
(2) PERPETUAL TRUSTS	S	111,825	FMV
(3) UNIVERSITY OF VERMONT MEDICAL CENTER	O	24,558,015	FMV
(4) UNIVERSITY OF VERMONT MEDICAL CENTER	P	34,405,384	FMV
(5) UNIVERSITY OF VERMONT MEDICAL CENTER	R	637,347	FMV

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, Part IV, Line 1	University of Vermont Medical Center, Inc. (UVM Medical Center) has a beneficial interest in four of these trusts. CVMC has a beneficial interest in three of these trusts.
Schedule R, Part V, Transaction K	UVM Medical Center leases and shares facilities, equipment, and other assets with CVMC. The value of these transactions is indeterminable.

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CVMC WORKS COLLABORATIVELY TO MEET THE NEEDS AND IMPROVE THE HEALTH OF THE RESIDENTS OF CENTRAL VERMONT.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,998
6	Total number of volunteers (estimate if necessary) .............	6	119
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	552,463	24,651,108
9	Program service revenue (Part VIII, line 2g) .........	228,844,006	210,066,200
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,478,888	2,701,825
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	330,998	328,335
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	232,206,355	237,747,468
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	134,444	93,277
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)	139,223,505	146,091,601
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 134,410
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	94,883,749	87,611,215
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	234,241,698	233,796,093
19	Revenue less expenses. Subtract line 18 from line 12.......	-2,035,343	3,951,375
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	163,844,396	192,238,723
21	Total liabilities (Part X, line 26).............	81,845,107	99,131,399
22	Net assets or fund balances. Subtract line 21 from line 20.....	81,999,289	93,107,324

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 147,442,346 including grants of $ 93,277 ) (Revenue $ 144,109,089 )
	HOSPITAL SERVICES: INPATIENT, OUTPATIENT, AND 24/7 EMERGENCY DEPARTMENT SERVICES: CVMC HAS 122 LICENSED BEDS TO PROVIDE FOR A FULL SPECTRUM OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. 18,111 INPATIENT DAYS, MORE THAN 245,000 OUTPATIENT PROCEDURES, AND 22,064 EMERGENCY ROOM VISITS WERE RECORDED DURING FISCAL YEAR 2020. OUTPATIENT ANCILLARY SERVICE UNITS MAKE UP THE MAJORITY OF SERVICE VOLUME, INCLUDING 31,265 RADIOLOGY PROCEDURES, 438,007 LAB TESTS, 14,177 CARDIOLOGY TESTS, AND 128,658 UNITS OF PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. EMERGENCY DEPARTMENT: THE ER IS OPEN 24 HOURS A DAY 365 DAYS A YEAR. THE NUMBER OF PATIENTS SEEN IN THE ER IN FISCAL YEAR 20 WAS 22,064. THE CANCER TREATMENT CENTER PROVIDED 4,804 ONCOLOGY AND RADIATION TREATMENTS. THE HOSPITAL ALSO HAS BEEN ACTIVE IN ITS OUTREACH TO CENTRAL VERMONT'S UNINSURED AND UNDER INSURED RESIDENTS.

4b	(Code: ) (Expenses $ 58,851,196 including grants of $ 0 ) (Revenue $ 48,355,839 )
	MEDICAL GROUP PRACTICES: AT THE END OF THE FISCAL YEAR WE HAD 28 PRIMARY CARE, INFIRMARY, AND SPECIALTY PRACTICES. THIS INCLUDED 10 PRIMARY AND FAMILY CARE CLINICS, 1 PEDIATRIC CLINICS, AS WELL AS SPECIALTY CLINICS FOR UROLOGY, CARDIOLOGY, PODIATRY, RHEUMATOLOGY, ENT, ENDOCRINOLOGY, ORTHOPAEDICS, PSYCHOLOGY, AND OBSTETRICS/ GYNECOLOGY. THERE WERE A TOTAL OF 296,471 PRACTICE VISITS DURING FISCAL YEAR 2020.

4c	(Code: ) (Expenses $ 17,951,638 including grants of $ 0 ) (Revenue $ 17,601,272 )
	WOODRIDGE REHAB & NURSING IS A MEDICARE-CERTIFIED 153-BED SKILLED NURSING FACILITY LOCATED ON THE CAMPUS OF CENTRAL VERMONT MEDICAL CENTER. APPROXIMATELY TWO-THIRDS OF THE FACILITIES BEDS ARE DEDICATED TO LONG TERM CARE, INCLUDING PALLIATIVE CARE/END OF LIFE CARE AND THE OTHER ONE-THIRD PROVIDE SHORT TERM REHABILITATION THERAPY AND POST-ACUTE CARE FOR A GREAT VARIETY OF MEDICAL CARE CATEGORIES, INCLUDING PAIN MANAGEMENT AND WOUND CARE. THE FACILITY PROVIDES "PERSON-CENTERED", ROUND THE CLOCK NURSING CARE AND SOCIAL SERVICES SUPPORT COMPLEMENTING DAILY, ROBUST ACTIVITIES PROGRAMS, FINE DINING AND HAS A FULL COMPLIMENT OF SUPPORT SERVICES INCLUDING HOUSEKEEPING/LAUNDRY, MAINTENANCE AND TRANSPORTATION. MANY OTHER AMENITIES ARE AVAILABLE TO FACILITY RESIDENTS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses224,245,180

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,450,285	6,336,332	1,008,719

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	37,030
e	Government grants (contributions)		1e	24,462,234

f	All other contributions, gifts, grants, and similar amounts not included above		1f	151,844

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

h Total. Add lines 1a-1f.......		24,651,108

		Business Code
2a	NET PATIENT SERVICE REVENUE	900099	148,363,413	148,363,413
b	REV FROM MANAGED CARE AND CAPITATED	900099	45,456,991	45,456,991
c	340B CONTRACT PHARMACY REVENUE	900099	10,116,962	10,116,962
d	BLUEPRINT PMPM	900099	883,431	883,431
e	CAFETERIA REVENUE	900099	902,143	902,143
f	All other program service revenue.		4,343,260	4,343,260
g	Total. Add lines 2a–2f .....		210,066,200

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,701,825			2,701,825
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		401,654	6a
b	Less: rental expenses		73,319	6b
c	Rental income or (loss)	0	328,335	6c
d	Net rental income or (loss).......			328,335			328,335
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			237,747,468	210,066,200		3,030,160

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	93,277	93,277
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	2,023,212		2,023,212
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	115,783,629	113,451,939	2,223,303	108,387
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,491,548	4,325,512	161,904	4,132
9	Other employee benefits .......	15,992,827	15,401,629	576,484	14,714
10	Payroll taxes ...........	7,800,385	7,512,032	281,176	7,177
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	132,566		132,566
c	Accounting ...........	79,583		79,583
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	29,117		29,117
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	13,311,429	10,945,880	2,365,549
12	Advertising and promotion ....	862,100	460,950	401,150
13	Office expenses .......	2,599,607	2,493,533	106,074
14	Information technology ......	7,182,760	7,151,716	31,044
15	Royalties ..	0
16	Occupancy ...........	6,025,075	5,976,626	48,449
17	Travel ............	94,943	78,439	16,504
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	547,066	533,542	13,524
20	Interest ...........	610,691	610,691
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	8,082,083	8,082,083
23	Insurance ...	576,046	383,340	192,706
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	STATE TAX ASSESMENT	11,356,599	11,356,599
b	MAINTENANCE & REPAIRS	2,196,636	2,163,857	32,779
c	MEDICAL & SURGICAL SUPPLIES	29,409,335	29,409,335
d	FOOD EXPENSE	1,588,087	1,588,087	0
e	All other expenses	2,927,492	2,226,113	701,379
25	Total functional expenses. Add lines 1 through 24e	233,796,093	224,245,180	9,416,503	134,410
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 ........			0	1	0
2	Savings and temporary cash investments .........			6,088,055	2	27,956,469
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			22,346,848	4	22,364,139
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 .......
				0	5	0
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) ...
				0	6	0
7	Notes and loans receivable, net ...........			2,424,419	7	4,860,401
8	Inventories for sale or use ............			4,481,927	8	5,082,486
9	Prepaid expenses and deferred charges ......			1,449,525	9	1,679,221
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	181,507,374
b	Less: accumulated depreciation	10b	113,407,939	67,370,690	10c	68,099,435
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			56,607,088	12	59,107,196
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			3,075,844	15	3,089,376
16	Total assets. Add lines 1 through 15 (must equal line 33)...			163,844,396	16	192,238,723

17	Accounts payable and accrued expenses .....	33,117,752	17	41,027,360
18	Grants payable ...	0	18	0
19	Deferred revenue .........	26,158	19	15,246
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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 .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	15,855,759	23	24,576,647
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	32,845,438	25	33,512,146
26	Total liabilities. Add lines 17 through 25..	81,845,107	26	99,131,399

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	73,718,001	27	84,890,681
28	Net assets with donor restrictions ...........	8,281,288	28	8,216,643
	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 ...........	81,999,289	32	93,107,324
33	Total liabilities and net assets/fund balances ........	163,844,396	33	192,238,723